title: Intraoperative parathyroid hormone assay-cutting the Gordian knot.
abstract: BACKGROUND
  Hyperparathyroidism is treated by surgical excision of the hyperfunctioning parathyroid gland. In case of adenoma the single abnormal gland is removed, while in hyperplasias, a subtotal excision, that is, three-and-a-half of the four glands are removed. This therapeutic decision is made intraoperatively through frozen section evaluation and is sometimes problematic, due to a histological overlap between hyperplasia and the adenoma. The intraoperative parathyroid hormone (IOPTH) assay, propogated in recent years, offers an elegant solution, with a high success rate, due to its ability to identify the removal of all hyperfunctioning parathyroid tissue.
  
  
  OBJECTIVE
  To study the feasibility of using IOPTH in our setting.
  
  
  METHODS
  Seven patients undergoing surgery for primary hyperparathyroidism had their IOPTH levels evaluated, along with the routine frozen and paraffin sections.
  
  
  RESULTS
  All seven patients showed more than a 50% intraoperative fall in serum PTH after excision of the abnormal gland. This was indicative of an adenoma and was confirmed by histopathological examination and normalization of serum calcium postoperatively.
  
  
  CONCLUSIONS
  The intraoperative parathyroid hormone is a sensitive and specific guide to a complete removal of the abnormal parathyroid tissue. It can be incorporated without difficulty as an intraoperative guide and is superior to frozen section diagnosis in parathyroid surgery.
authors.affiliation: Department of Histopathology, Lilavati Hospital and Research Center, Bandra, Mumbai, India.
authors.forename: Chandralekha
authors.initials: C
authors.lastname: Tampi
authors.affiliation: Department of Pathology, Lilavati Hospital and Research Center, Bandra, Mumbai, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Chavan
authors.affiliation: Department of Oncosurgery, Lilavati Hospital and Research Center, Bandra, Mumbai, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Parikh
keywords: Frozen section; intraoperative parathyroid hormone assay; parathyroid adenoma; parathyroid hyperplasia
references.citation: Am J Clin Pathol. 1968 Jun;49(6):761-75
references.pmid: 5654505
references.citation: J Clin Endocrinol Metab. 2012 Jun;97(6):1834-41
references.pmid: 22508712
references.citation: Clin Lab. 2002;48(3-4):131-41
references.pmid: 11934215
references.citation: Arq Bras Endocrinol Metabol. 2006 Oct;50(5):869-75
references.pmid: 17160210
references.citation: Clin Endocrinol (Oxf). 2007 Jun;66(6):878-85
references.pmid: 17437518
references.citation: Arch Pathol Lab Med. 2003 Nov;127(11):1424-42
references.pmid: 14567726
references.citation: Am J Med. 1997 Aug;103(2):134-45
references.pmid: 9274897
references.citation: World J Surg. 2005 Jun;29(6):785-8
references.pmid: 15883666
references.citation: Am J Clin Pathol. 1994 Sep;102(3):365-73
references.pmid: 8085562
references.citation: N Engl J Med. 2004 Apr 22;350(17):1746-51
references.pmid: 15103001