title: Parathyroidectomy monitored by intra-operative PTH: the relevance of the 20 min end-point.
abstract: OBJECTIVE
  RI-PTH measurements are a prerequisite for minimally invasive parathyroidectomy, providing guidance regarding the removal of hyper-functioning tissue. Different criteria of PTH decrease, concentration and clearance were analyzed in order to predict surgical treatment.
  
  
  METHODS
  Blood samples at pre-incision, manipulation, 5, 10 and 20 min after resection, were collected from 145 patients presenting unambiguous, pre-surgical "single adenoma" diagnosis.
  
  
  RESULTS
  The meeting of Irvin criterion would have permitted the identification of 28% uncured cases leading to 4% unnecessary neck exploration. On the contrary, we would have identified all of the uncured patients, to the detriment of 7% unnecessarily prolonged procedure by taking into account PTH drop, concentration and clearance shape at 20 min.
  
  
  CONCLUSIONS
  The 20' end-point plays a key role in the correct determination of surgical outcome, strongly improving the possibility of adequate patient treatment. However, since the high success rate of traditional parathyroidectomy, yet not provided by RI-PTH, the utmost improvement to hyper-parathyroidism surgical treatment by RI-PTH could be achieved in pre-operative equivocal glands localization or multiglandular disease selected population to quickly guide and confirm the complete removal of all hyper-secreting tissue.
authors.affiliation: Institute of Biochemistry and Clinical Biochemistry, Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
authors.forename: Cinzia
authors.initials: C
authors.lastname: Carrozza
authors.forename: Celestino
authors.initials: C
authors.lastname: Pio Lombardi
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.forename: Emanuela
authors.initials: E
authors.lastname: Traini
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
authors.forename: Cecilia
authors.initials: C
authors.lastname: Zuppi
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone