Intraoperative intact parathyroid hormone level monitoring as a guide to parathyroid reimplantation after thyroidectomy.
OBJECTIVE
The goal of this study was to determine whether intraoperative intact parathyroid hormone (IOiPTH) levels can predict the functional status of remaining parathyroids at the end of total thyroidectomy and thereby be a guide for parathyroid autotransplantation when glands are deemed not functional.


METHODS
Prospective study involving 23 patients undergoing either total thyroidectomy or completion thyroidectomy


METHODS
During surgery, an attempt was made to identify all four parathyroid glands. Normal size vascular glands were preserved, whereas avascular glands were microdissected and reimplanted. Serial IOiPTH was measured preoperatively after each parathyroid was identified, manipulated, or removed and serum iPTH measurements were done postoperatively up to 56 days.


RESULTS
The sensitivity of low IOiPTH in identifying a devascularized gland was 88.9%, and specificity was 92.9%. A normal IOiPTH level indicates at least two functioning glands. IOiPTH levels between 1.5 and 10 pg/mL indicate only one functional gland. Undetectable IOiPTH levels indicate no residual functioning gland.


CONCLUSIONS
For patients undergoing total or completion thyroidectomy, IOiPTH should be routinely measured at the end of the procedure, and a level less than 10 pg/mL requires reassessment of remaining parathyroid glands. Vascularized glands should be preserved regardless of IOiPTH levels. Devascularized glands or glands of questionable vascularity should be considered for autotransplantation.
Friedman
Michael
M
Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60602, USA.
Vidyasagar
Ramakrishnan
R
Bliznikas
Darius
D
Joseph
Ninos J
NJ
D006801:Humans; D007432:Intraoperative Period; D010280:Parathyroid Glands / Q000098:blood supply / Q000293:injuries / Q000637:transplantation*; D010281:Parathyroid Hormone / Q000097:blood*; D012680:Sensitivity and Specificity; D013965:Thyroidectomy; D014182:Transplantation, Autologous
D010281:Parathyroid Hormone