Clinical science
The additional value of intraoperative parathyroid hormone assessment is marginal in patients with nonfamilial primary hyperparathyroidism: a prospective cohort study

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Abstract

Background

The success of minimally invasive parathyroidectomy is attributed to evolving preoperative imaging techniques and intraoperative parathyroid hormone (IOPTH) measurement. The additional value of IOPTH measurement in patients undergoing surgery for primary hyperparathyroidism (pHPT) was evaluated.

Methods

Between 1999 and 2010 there were 119 patients who underwent surgery for pHPT at our institutions. In all patients, preoperative imaging was performed and IOPTH samples were collected prospectively but the results were not disclosed during surgery.

Results

Postoperative calcium level normalized in 114 patients (96%). The 5 surgical failures represented the maximum yield of IOPTH sampling. Three of these patients would have been identified intraoperatively by an inadequate IOPTH decrease, whereas IOPTH decreased inaccurately in the other 2 patients. In addition, in 1 of these 3 patients no abnormal gland was found during minimally invasive parathyroidectomy and subsequent conventional neck exploration. Therefore, only 2 reoperations would have been prevented (1.7%).

Conclusions

IOPTH would have changed the outcome in 2 patients, increasing the biochemical cure rate from 96% to 98%. We believe that although it can be helpful in certain cases, it may not be necessary routinely in patients treated for pHPT.

Section snippets

Patients and Methods

The study was performed between March 1999 and August 2010. Prospective data collection of patients undergoing surgery for primary hyperparathyroidism started in March 1999 at the University Medical Center Utrecht (hospital A) and in 2006 at the affiliated Diakonessen Hospital Utrecht (hospital B). Patients with a positive family history or a known multiple endocrine neoplasia syndrome (MEN) were not included in the study: during the study period 26 patients with known MEN syndromes were

Results

During the study period, 119 consecutive patients underwent surgery for nonhereditary pHPT. There were 30 men and 89 women, with a median age of 63 years (range, 20–88 y). Patient characteristics are listed in Table 1.

Preoperative imaging studies visualized a solitary adenoma in 105 patients and suggested multiglandular disease (MGD) in 5 patients, although no abnormality was observed in 9 patients (Fig. 1). A total of 101 of the 105 patients with visualized solitary adenomas were selected for

Comments

In this prospective unselected cohort undergoing surgery for nonfamilial pHPT without using IOPTH sampling, the success rate of the first surgery was 96%. IOPTH would have altered intraoperative decision making in only 2 patients and could have increased the success rate from 95.7% to 97.4%.

The present study assessed the value of the IOPTH measurements prospectively by collecting intraoperative samples but not disclosing IOPTH values during surgery. In addition, the present cohort did not

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    The authors have no potential conflicts of interest.

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