Does the final intraoperative PTH level really have to fall into the normal range to signify cure?

Abstract

BACKGROUND:

Intraoperative parathyroid hormone (IOPTH) helps shorten the duration of surgery and increase the likelihood of surgical cure. Although general consensus agrees that the IOPTH should fall by 50%, there is much debate as to whether the IOPTH needs to fall into the normal range.

METHODS:

We retrospectively reviewed a prospective database of patients undergoing surgery for treatment of primary hyperparathyroidism. We included all patients with an IOPTH that fell by >50% by 10 or 15 min, but that did not fall into the normal range (parathyroid hormone remained ≥ 60 pg/ml). We excluded patients who had undergone prior neck surgery or had known multiple endocrine neoplasia 1 or 2.

RESULTS:

A total of 1,231 patients underwent a parathyroidectomy, 155 of whom met the study's inclusion/exclusion criteria (12.6%). A total of 117 patients had an IOPTH fall by 50% by 10 min, and 38 patients' IOPTH fell by 50% by 15 min. Overall surgical cure rate was 98.7%. One patient from the 10-minute group and one patient from the 15-minute group had persistent disease on follow-up. One patient in the 15-minute group had recurrent disease. With a mean ± SEM 18.1 ± 2.1 months' follow-up, the recurrence rate in this cohort was 0.6%. The average calcium at last follow-up was 9.4 ± 0.0 mg/dl.

CONCLUSIONS:

Allowing the IOPTH to fall by 50% by 15 min, regardless of whether the IOPTH falls into the normal range, results in a high success rate when performed by experienced surgeons. This helps reduce intraoperative time used waiting for additional parathyroid hormone levels and the risks associated with unnecessary bilateral neck exploration.

• Authors: Alexandra E Reiher, Sarah Schaefer, Herbert Chen, Rebecca S Sippel
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 19 Issue 6 Pg. 1862-7 (Jun 2012) ISSN: 1534-4681 [Electronic] United States
• PMID: 22203183 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Parathyroid Hormone

Topics

• Biomarkers (blood)
• Female
• Follow-Up Studies
• Humans
• Hyperparathyroidism, Primary (blood, diagnosis, surgery)
• Immunoassay
• Male
• Middle Aged
• Monitoring, Intraoperative
• Neoplasm Staging
• Parathyroid Hormone (blood)
• Parathyroid Neoplasms (blood, diagnosis, surgery)
• Parathyroidectomy
• Prognosis
• Prospective Studies
• Reference Values
• Retrospective Studies