title: Is Intraoperative Parathyroid Hormone Monitoring Warranted in Cases of 4D-CT/Ultrasound Localized Single Adenomas?
abstract: OBJECTIVE
  To analyze the utility of intraoperative parathyroid hormone (IOPTH) monitoring for patients with primary hyperparathyroidism who had evidence of single-gland disease on preoperative imaging with modified 4-dimensional computed tomography that was done in conjunction with ultrasonography (Mod 4D-CT/US).
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care university medical center.
  
  
  METHODS
  Patients were drawn from consecutive directed parathyroidectomies performed between December 2001 and June 2013 by the senior authors. All patients had primary hyperparathyroidism and underwent a Mod 4D-CT/US study that showed findings on both studies that were consistent with a single adenoma. The modified Miami criteria were used for IOPTH monitoring (parathyroid hormone decrease by >50% and into the normal range).
  
  
  RESULTS
  Of 356 patients who underwent parathyroid surgery, 206 had a single gland localized on the Mod 4D-CT and the US studies. IOPTH monitoring was used in 172 cases, of which 169 had adequate clinical follow-up to assess the surgical outcome. Twenty-one patients (12.4%) had IOPTH values that did not meet modified Miami criteria after removal of one gland, of which 7 were found to have multigland disease (4.1%). Three patients (1.8%) had persistent primary hyperparathyroidism despite an IOPTH that met modified Miami criteria.
  
  
  CONCLUSIONS
  Although IOPTH monitoring correctly identifies a small percentage of patients with multigland disease, some patients will be subjected to unnecessary neck explorations that can result in difficult intraoperative decisions, such as whether to remove normal or equivocal-sized glands when they are encountered.
authors.affiliation: Weill Cornell Medical College, New York, New York, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Heineman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork Presbyterian, New York, New York, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Kutler
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork Presbyterian, New York, New York, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Cohen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork Presbyterian, New York, New York, USA wkuhel@med.cornell.edu.
authors.forename: William I
authors.initials: WI
authors.lastname: Kuhel
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016105:Parathyroidectomy; D011184:Postoperative Period; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D010281:Parathyroid Hormone
keywords: 4D CT; intraoperative parathryoid hormone monitoring; parathyroid surgery; primary hyperparathyroidism