Novel criteria for parathyroid hormone levels in parathyroid hormone-guided parathyroid surgery.

Abstract

CONTEXT:

Novel criteria for decrease of perioperative parathyroid hormone measurement may improve the accuracy of perioperative quick parathyroid hormone (qPTH)-guided parathyroidectomy.

OBJECTIVE:

To assess overall cure rate based on conventional criteria (50% decline of qPTH). Perioperative qPTH levels were evaluated to determine novel criteria for successful parathyroid surgery.

DESIGN:

Analysis of perioperative qPTH measurement findings of all consecutive patients undergoing parathyroidectomy for hyperparathyroidism (72 with primary hyperparathyroidism and 28 with secondary or tertiary hyperparathyroidism or multiple endocrine neoplasia I/IIa disease).

RESULTS:

Measurement of qPTH (based solely on the criterion of greater than 50% decline of parathyroid hormone) in 72 patients with primary hyperparathyroidism (77 procedures) showed true-positive results in 69, false-positive results in 4, and true-negative results in 4 procedures. In our series, false-positive and true-negative results were associated with high postexcision levels. However, when qPTH declines of greater than 70% and 80% were used in cases of postexcision qPTH levels of 100 to 200 ng/L and greater than 200 ng/L, respectively, no false-positive results were observed.

CONCLUSIONS:

Through adherence to these novel criteria, reexploration of the neck could have been prevented in 29% of patients with primary hyperparathyroidism due to multiple gland disease. These novel criteria demand future evaluation to establish their value.

• Authors: Robert de Vos tot Nederveen Cappel, Nicole Bouvy, Wouter de Herder, Yolanda de Rijke, Hans van Toor, Jaap Bonjer
• Journal: Archives of pathology & laboratory medicine (Arch Pathol Lab Med) Vol. 131 Issue 12 Pg. 1800-4 (Dec 2007) ISSN: 1543-2165 [Electronic] United States
• PMID: 18081439 (Publication Type: Journal Article)

Chemical References

• Parathyroid Hormone

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• False Negative Reactions
• False Positive Reactions
• Female
• Humans
• Immunoassay (methods)
• Intraoperative Care (methods)
• Male
• Middle Aged
• Parathyroid Diseases (blood, surgery)
• Parathyroid Hormone (blood)
• Parathyroidectomy
• Reference Values
• Sensitivity and Specificity