John I Lew1, George L Irvin. 1. DeWitt Daughtry Family Department of Surgery, Division of Endocrine Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA. JLew@med.miami.edu
Abstract
BACKGROUND: There remains concern that focused parathyroidectomy guided by intra-operative parathormone monitoring (IPM) will miss multiglandular disease (MGD) leading to a higher recurrence rate. This study reports the 10-year outcome of patients with sporadic primary hyperparathyroidism treated by focused parathyroidectomy guided by IPM. METHODS: From 1993 to 1998, 173 consecutive patients with sporadic primary hyperparathyroidism underwent focused parathyroidectomy guided by IPM. When IPM showed >50% decrease 10 minutes after abnormal gland excision, the operation was completed. Recurrent hyperparathyroidism was defined as elevated serum calcium and parathormone (PTH) levels >6 months after successful parathyroidectomy. RESULTS: There were 164 patients with a mean follow-up of 83 months. In this group, 96% patients had single gland disease (SGD) and 4% had MGD. Five (3%) patients developed recurrent hyperparathyroidism at 2, 4, 9, 10, and 12 years. In 43 eucalcemic patients followed for >10 years, PTH levels remained normal in 54%, were constantly above normal range in 2%, or varied between normal and above normal range in 44%. CONCLUSION: In patients 10 years after treatment, IPM-guided parathyroidectomy does not fail to identify MGD, allows for limited dissection in SGD, and shows that various sized parathyroid glands left in situ do not cause higher recurrence rates.
BACKGROUND: There remains concern that focused parathyroidectomy guided by intra-operative parathormone monitoring (IPM) will miss multiglandular disease (MGD) leading to a higher recurrence rate. This study reports the 10-year outcome of patients with sporadic primary hyperparathyroidism treated by focused parathyroidectomy guided by IPM. METHODS: From 1993 to 1998, 173 consecutive patients with sporadic primary hyperparathyroidism underwent focused parathyroidectomy guided by IPM. When IPM showed >50% decrease 10 minutes after abnormal gland excision, the operation was completed. Recurrent hyperparathyroidism was defined as elevated serum calcium and parathormone (PTH) levels >6 months after successful parathyroidectomy. RESULTS: There were 164 patients with a mean follow-up of 83 months. In this group, 96% patients had single gland disease (SGD) and 4% had MGD. Five (3%) patients developed recurrent hyperparathyroidism at 2, 4, 9, 10, and 12 years. In 43 eucalcemic patients followed for >10 years, PTH levels remained normal in 54%, were constantly above normal range in 2%, or varied between normal and above normal range in 44%. CONCLUSION: In patients 10 years after treatment, IPM-guided parathyroidectomy does not fail to identify MGD, allows for limited dissection in SGD, and shows that various sized parathyroid glands left in situ do not cause higher recurrence rates.
Authors: Sahzene Yavuz; William F Simonds; Lee S Weinstein; Michael T Collins; Electron Kebebew; Naris Nilubol; Giao Q Phan; Steven K Libutti; Alan T Remaley; Manuel Van Deventer; Stephen J Marx Journal: J Clin Endocrinol Metab Date: 2012-04-16 Impact factor: 5.958
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