Novel criteria for parathyroid hormone levels in parathyroid hormone-guided parathyroid surgery.
BACKGROUND
Novel criteria for decrease of perioperative parathyroid hormone measurement may improve the accuracy of perioperative quick parathyroid hormone (qPTH)-guided parathyroidectomy.


OBJECTIVE
To assess overall cure rate based on conventional criteria (50% decline of qPTH). Perioperative qPTH levels were evaluated to determine novel criteria for successful parathyroid surgery.


METHODS
Analysis of perioperative qPTH measurement findings of all consecutive patients undergoing parathyroidectomy for hyperparathyroidism (72 with primary hyperparathyroidism and 28 with secondary or tertiary hyperparathyroidism or multiple endocrine neoplasia I/IIa disease).


RESULTS
Measurement of qPTH (based solely on the criterion of greater than 50% decline of parathyroid hormone) in 72 patients with primary hyperparathyroidism (77 procedures) showed true-positive results in 69, false-positive results in 4, and true-negative results in 4 procedures. In our series, false-positive and true-negative results were associated with high postexcision levels. However, when qPTH declines of greater than 70% and 80% were used in cases of postexcision qPTH levels of 100 to 200 ng/L and greater than 200 ng/L, respectively, no false-positive results were observed.


CONCLUSIONS
Through adherence to these novel criteria, reexploration of the neck could have been prevented in 29% of patients with primary hyperparathyroidism due to multiple gland disease. These novel criteria demand future evaluation to establish their value.
de Vos tot Nederveen Cappel
Robert
R
Department of Surgery, Erasmus MC Rotterdam, Rotterdam, The Netherlands. robertdevostnc@planet.nl
Bouvy
Nicole
N
de Herder
Wouter
W
de Rijke
Yolanda
Y
van Toor
Hans
H
Bonjer
Jaap
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000097:blood* / Q000601:surgery*; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D012016:Reference Values; D012680:Sensitivity and Specificity
D010281:Parathyroid Hormone