BACKGROUND: Routine use of intraoperative parathyroid hormone (IOPTH) has been challenged in both unilateral/limited (LE) and bilateral exploration (BE). To investigate this, we assessed the usefulness of IOPTH in surgical management of primary hyperparathyroidism and parathyroid carcinoma (PC). METHODS: Between 1998 and 2006, 1133 patients were explored for hyperparathyroidism: 185 LE, 743 BE with IOPTH, 95 BE without IOPTH, 110 reoperations, and 4 PCs. IOPTH patterns were correlated with parathyroid pathology (single adenoma [SA] or multigland disease [MGD]) and operative success. RESULTS: In LE, IOPTH returned to normal in 78% of patients; all patients had SA, and 99% were cured at a mean +/- SEM of 1.2 +/- .24 years; 22% of LE patients (n = 41) whose IOPTH did not return to normal were converted to BE, and all had MGD. BE with and without IOPTH was equally successful 97% and 98% (P = NS) of the time, respectively. In BE in which IOPTH did not return to normal, 9% of patients remained hypercalcemic; tumor distribution mirrored other BE patients (75% SA, 25% MGD). In reoperations, a normal final IOPTH correlated with cure in 99%; otherwise, 59% had persistent disease. Differential bilateral internal jugular vein IOPTH sampling lateralized disease in 77% of reoperations. CONCLUSIONS: IOPTH is an important adjunct for successful LE by identifying the presence of MGD and avoiding operative failure. IOPTH adds little to BE; however, final IOPTH values may predict persistent disease in BE, reoperations, and PCs.
BACKGROUND: Routine use of intraoperative parathyroid hormone (IOPTH) has been challenged in both unilateral/limited (LE) and bilateral exploration (BE). To investigate this, we assessed the usefulness of IOPTH in surgical management of primary hyperparathyroidism and parathyroid carcinoma (PC). METHODS: Between 1998 and 2006, 1133 patients were explored for hyperparathyroidism: 185 LE, 743 BE with IOPTH, 95 BE without IOPTH, 110 reoperations, and 4 PCs. IOPTH patterns were correlated with parathyroid pathology (single adenoma [SA] or multigland disease [MGD]) and operative success. RESULTS: In LE, IOPTH returned to normal in 78% of patients; all patients had SA, and 99% were cured at a mean +/- SEM of 1.2 +/- .24 years; 22% of LE patients (n = 41) whose IOPTH did not return to normal were converted to BE, and all had MGD. BE with and without IOPTH was equally successful 97% and 98% (P = NS) of the time, respectively. In BE in which IOPTH did not return to normal, 9% of patients remained hypercalcemic; tumor distribution mirrored other BE patients (75% SA, 25% MGD). In reoperations, a normal final IOPTH correlated with cure in 99%; otherwise, 59% had persistent disease. Differential bilateral internal jugular vein IOPTH sampling lateralized disease in 77% of reoperations. CONCLUSIONS:IOPTH is an important adjunct for successful LE by identifying the presence of MGD and avoiding operative failure. IOPTH adds little to BE; however, final IOPTH values may predict persistent disease in BE, reoperations, and PCs.
Authors: M-H Gannagé-Yared; B Abboud; M Amm-Azar; A Saab; S Khalife; G Halaby; C Atallah; R Medlej; S Jambart Journal: J Endocrinol Invest Date: 2009-02 Impact factor: 4.256
Authors: Lilah F Morris; Kyle Zanocco; Philip H G Ituarte; Kevin Ro; Quan-Yang Duh; Cord Sturgeon; Michael W Yeh Journal: Ann Surg Oncol Date: 2009-11-03 Impact factor: 5.344
Authors: David F Schneider; Kristin A Ojomo; Haggi Mazeh; Sarah C Oltmann; Rebecca S Sippel; Herbert Chen Journal: J Surg Res Date: 2013-05-03 Impact factor: 2.192