Validation of selective use of intraoperative PTH monitoring in parathyroidectomy.
BACKGROUND
The objective of this study was to validate our approach of treating primary hyperparathyroidism using sestamibi scan directed parathyroidectomy, without routine use of intraoperative parathyroid hormone measurements (ioPTH).


METHODS
We prospectively established a protocol limiting the use of ioPTH to patients with negative or equivocal sestamibi scans, and those who had risk factors for multi-gland disease. We then performed a retrospective review to determine our disease control rate.


RESULTS
128 patients underwent sestamibi-guided parathyroidectomy without (111/128 = 87%) or with (17/128 = 13%) ioPTH. The overall disease control (eucalcemia) rate was 95%. 3/111 (3%) of patients who had surgery without ioPTH measurements required re-exploration.


CONCLUSIONS
Selective use of ioPTH is an effective strategy. ioPTH is best reserved for patients who have non-localizing preoperative imaging, are at risk for multi-gland disease, or require revision surgery.
Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. alexandra.thielmann@me.com.
Alexandra
A
Thielmann
Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Paul
P
Kerr
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D055815:Young Adult
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
Parathyroid hormone; Parathyroidectomy; Primary hyperparathyroidism; Technetium Tc 99 m sestamibi