Value of intraoperative parathyroid hormone monitoring.
BACKGROUND
Routine use of intraoperative parathyroid hormone (IOPTH) has been challenged in both unilateral/limited (LE) and bilateral exploration (BE). To investigate this, we assessed the usefulness of IOPTH in surgical management of primary hyperparathyroidism and parathyroid carcinoma (PC).


METHODS
Between 1998 and 2006, 1133 patients were explored for hyperparathyroidism: 185 LE, 743 BE with IOPTH, 95 BE without IOPTH, 110 reoperations, and 4 PCs. IOPTH patterns were correlated with parathyroid pathology (single adenoma [SA] or multigland disease [MGD]) and operative success.


RESULTS
In LE, IOPTH returned to normal in 78% of patients; all patients had SA, and 99% were cured at a mean +/- SEM of 1.2 +/- .24 years; 22% of LE patients (n = 41) whose IOPTH did not return to normal were converted to BE, and all had MGD. BE with and without IOPTH was equally successful 97% and 98% (P = NS) of the time, respectively. In BE in which IOPTH did not return to normal, 9% of patients remained hypercalcemic; tumor distribution mirrored other BE patients (75% SA, 25% MGD). In reoperations, a normal final IOPTH correlated with cure in 99%; otherwise, 59% had persistent disease. Differential bilateral internal jugular vein IOPTH sampling lateralized disease in 77% of reoperations.


CONCLUSIONS
IOPTH is an important adjunct for successful LE by identifying the presence of MGD and avoiding operative failure. IOPTH adds little to BE; however, final IOPTH values may predict persistent disease in BE, reoperations, and PCs.
Sharma
Jyotirmay
J
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. jsharm3@emory.edu
Milas
Mira
M
Berber
Eren
E
Mazzaglia
Peter
P
Siperstein
Alan
A
Weber
Collin J
CJ
D000236:Adenoma / Q000097:blood* / Q000601:surgery*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
D010281:Parathyroid Hormone