title: Intraoperative PTH monitoring in parathyroid hyperplasia requires stricter criteria for success.
abstract: BACKGROUND
  Intraoperative parathyroid hormone (IOPTH) monitoring in parathyroidectomy for multigland disease is less clear than for single-gland disease. This study assesses the role of IOPTH for hyperplasia.
  
  
  METHODS
  A prospective database revealed 45 patients with hyperplasia undergoing parathyroidectomy utilizing IOPTH from February 1999 to August 2003.
  
  
  RESULTS
  Twenty-six females and 19 males had a mean age of 55 years. Twenty-two patients underwent total parathyroidectomy. Twenty-three patients underwent subtotal parathyroidectomy. Twenty-seven patients (60%) had a drop of IOPTH greater than 50% at 10 minutes after removal of all presumably abnormal parathyroid tissue. Nine additional patients (20%) had an IOPTH drop greater than 50%, but continued exploration revealed more abnormal tissue. Nine patients failed to decrease greater than 50%, and exploration was continued. A final IOPTH less than 35 pg/mL or a greater than 90% decrease from baseline was predictive of a successful operation in 40 patients. The 5 patients who did not meet this criteria remained hyperparathyroid.
  
  
  CONCLUSIONS
  IOPTH identifies sporadic hyperplasia and guides completeness of resection for patients with known hyperplasia. However, more rigid criteria are required than for adenomas. Failure to achieve appropriate decreases in IOPTH should prompt further neck exploration or a search for a mediastinal gland.
authors.affiliation: Department of General Surgery, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Kaare J
authors.initials: KJ
authors.lastname: Weber
authors.forename: Subhasis
authors.initials: S
authors.lastname: Misra
authors.forename: Jane K
authors.initials: JK
authors.lastname: Lee
authors.forename: Scott W
authors.initials: SW
authors.lastname: Wilhelm
authors.forename: Robert
authors.initials: R
authors.lastname: DeCresce
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prinz
mesh_terms: D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000601:surgery; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010280:Parathyroid Glands / Q000473:pathology* / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D018579:Patient Selection
chemical_list: D010281:Parathyroid Hormone