title: Limited role for intraoperative intact PTH measurement in parathyroid surgery.
abstract: Primary hyperparathyroidism may be cured surgically by complete excision of abnormal parathyroid tissue. Reoperation for persistent hypercalcaemia due to residual abnormal parathyroid tissue may be associated with a high complication rate. It is possible to assay intact parathormone (iPTH) intraoperatively and as iPTH has a relatively short half-life, its measurement intraoperatively may be used to predict successful parathyroidectomy. We have studied intraoperative iPTH levels in a consecutive series of 33 patients undergoing surgery for primary hyperparathyroidism. We found that iPTH levels fell significantly (P < 0.05) from a median pre-excision level of 122 pg/ml to a median level of 36 pg/ml 20 min after excision. However, in 3/31 successful parathyroidectomies, the intraoperative iPTH levels either remained unchanged or had risen. Reliance on intraoperative iPTH levels in these patients may have resulted in unnecessary re-exploration. We conclude that intraoperative iPTH measurement has limited usefulness as a predictor of successful parathyroidectomy for primary hyperparathyroidism.
authors.affiliation: York District Hospital.
authors.forename: P
authors.initials: P
authors.lastname: Tan
authors.forename: S H
authors.initials: SH
authors.lastname: Leveson
authors.forename: H
authors.initials: H
authors.lastname: Wilkinson
mesh_terms: D015415:Biomarkers / Q000097:blood; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000601:surgery*; D007432:Intraoperative Period; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods; D012086:Reoperation
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone