The need for intraoperative parathyroid hormone monitoring during radioguided parathyroidectomy by video-assisted thoracoscopy (VATS).
OBJECTIVE
We report on a patient with primary hyperparathyroidism (1HPT) who had a preoperative Tc-99m sestamibi scan localizing a single parathyroid adenoma in the mediastinum.


METHODS
On removal of this hyperfunctioning adenoma by radioguided video-assisted thoracoscopic surgery (VATS), intraoperative PTH levels failed to decline in the appropriate manner consistent with curative resection. This prompted the surgical team to investigate further for a second adenoma, which revealed a 2 x 1-cm mass near the inferior border of the thyroid gland on the right lateral aspect of the trachea.


RESULTS
In the absence of intraoperative PTH monitoring, the operation would have been terminated after the removal of the mediastinal adenoma, leading to an incomplete surgical resection and persistent 1HPT.


CONCLUSIONS
In our patient, curative resection was obtained and a second operation was avoided because of the use of intraoperative PTH monitoring. This case also emphasizes that although VATS was planned, in treating patients with 1HPT, one must also be prepared to perform a neck exploration.
Wild
Jeffrey L
JL
Department of Surgery, University of Wisconsin, Madison, WI 53792, USA.
Weigel
Tracey
T
Chen
Herbert
H
D000368:Aged; D005188:False Negative Reactions; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008479:Mediastinal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D019275:Radiopharmaceuticals; D025321:Surgery, Computer-Assisted / Q000379:methods; D017256:Technetium Tc 99m Sestamibi; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi