BACKGROUND: In minimally invasive surgery for primary hyperparathyroidism (HPT), intraoperative parathyroid hormone (IOPTH) monitoring assists in obtaining demonstrably better outcomes, but optimal criteria are controversial. METHODS: The outcomes of 1,108 initial parathyroid operations for sporadic HPT using IOPTH monitoring from 1997 to 2011 were stratified by final post-resection IOPTH level. All patients had adequate follow-up to verify cure. RESULTS: With mean follow-up of 1.8 years (range 0.5-14.3 years), parathyroidectomy using IOPTH monitoring failed in 1.2 % of cases, with an additional 0.5 % incidence of long-term recurrence at a mean of 3.2 years (range 0.8-6.8 years) postoperatively. Operative success was equally likely with a final IOPTH drop to 41-65 pg/mL vs ≤40 pg/mL (p = 1). In the 76 patients with an elevated baseline IOPTH level that did not drop to ≤65 pg/mL, surgical failure was 43 times more likely than with a drop into normal range (13 vs. 0.3 %; p < 0.001). When the final IOPTH level dropped by >50 % but not into the normal range, surgical failure was 19 times more likely (3.8 vs. 0.2 %; p = 0.015). Long-term recurrence was more likely in patients with a final IOPTH level of 41-65 pg/mL than with a level ≤40 pg/mL (1.2 vs. 0; p = 0.016). CONCLUSIONS: Adjunctive intraoperative PTH monitoring facilitates a high cure rate for initial surgery of sporadic primary hyperparathyroidism. A final IOPTH level that is within the normal range and drops by >50 % from baseline is a strong predictor of operative success. Patients with a final IOPTH level between 41-65 pg/mL should be followed beyond 6 months for long-term recurrence.
BACKGROUND: In minimally invasive surgery for primary hyperparathyroidism (HPT), intraoperative parathyroid hormone (IOPTH) monitoring assists in obtaining demonstrably better outcomes, but optimal criteria are controversial. METHODS: The outcomes of 1,108 initial parathyroid operations for sporadic HPT using IOPTH monitoring from 1997 to 2011 were stratified by final post-resection IOPTH level. All patients had adequate follow-up to verify cure. RESULTS: With mean follow-up of 1.8 years (range 0.5-14.3 years), parathyroidectomy using IOPTH monitoring failed in 1.2 % of cases, with an additional 0.5 % incidence of long-term recurrence at a mean of 3.2 years (range 0.8-6.8 years) postoperatively. Operative success was equally likely with a final IOPTH drop to 41-65 pg/mL vs ≤40 pg/mL (p = 1). In the 76 patients with an elevated baseline IOPTH level that did not drop to ≤65 pg/mL, surgical failure was 43 times more likely than with a drop into normal range (13 vs. 0.3 %; p < 0.001). When the final IOPTH level dropped by >50 % but not into the normal range, surgical failure was 19 times more likely (3.8 vs. 0.2 %; p = 0.015). Long-term recurrence was more likely in patients with a final IOPTH level of 41-65 pg/mL than with a level ≤40 pg/mL (1.2 vs. 0; p = 0.016). CONCLUSIONS: Adjunctive intraoperative PTH monitoring facilitates a high cure rate for initial surgery of sporadic primary hyperparathyroidism. A final IOPTH level that is within the normal range and drops by >50 % from baseline is a strong predictor of operative success. Patients with a final IOPTH level between 41-65 pg/mL should be followed beyond 6 months for long-term recurrence.
Authors: P Miccoli; A Pinchera; G Cecchini; M Conte; C Bendinelli; E Vignali; A Picone; C Marcocci Journal: J Endocrinol Invest Date: 1997 Jul-Aug Impact factor: 4.256
Authors: Jonathon E Kivela; Juraj Sprung; Melanie L Richards; Brad S Karon; Roger E Hofer; Lavonne M Liedl; Liedl M Liedl; Darrell R Schroeder; Toby N Weingarten Journal: Can J Anaesth Date: 2011-04-01 Impact factor: 5.063
Authors: G B Talpos; H G Bone; M Kleerekoper; E R Phillips; M Alam; M Honasoge; G W Divine; D S Rao Journal: Surgery Date: 2000-12 Impact factor: 3.982
Authors: Andrew J Leiker; Tina W F Yen; Dan C Eastwood; Kara M Doffek; Aniko Szabo; Douglas B Evans; Tracy S Wang Journal: JAMA Surg Date: 2013-07 Impact factor: 14.766
Authors: Julie McGill; Cord Sturgeon; Sharone P Kaplan; Bill Chiu; Edwin L Kaplan; Peter Angelos Journal: J Am Coll Surg Date: 2008-05-19 Impact factor: 6.113
Authors: Mohammad H Rajaei; Alex M Bentz; David F Schneider; Rebecca S Sippel; Herbert Chen; Sarah C Oltmann Journal: Ann Surg Oncol Date: 2014-09-06 Impact factor: 5.344
Authors: Kristin E Goodsell; Jae P Ermer; Salman Zaheer; Rachel R Kelz; Douglas L Fraker; Heather Wachtel Journal: Am J Surg Date: 2021-01-19 Impact factor: 3.125
Authors: Marcin Barczyński; Aleksandra Papier; Jakub Kenig; Ireneusz Nawrot Journal: Wideochir Inne Tech Maloinwazyjne Date: 2014-09-05 Impact factor: 1.195
Authors: Shimena R Li; Kelly L McCoy; Helena E Levitt; Meghan L Kelley; Sally E Carty; Linwah Yip Journal: Surgery Date: 2021-07-27 Impact factor: 3.982