The Necessity and Reliability of Intraoperative Parathyroid Hormone (PTH) Testing in Patients with Mild Hyperparathyroidism and PTH Levels in the Normal Range: Reply

2011 ◽  
Vol 36 (2) ◽  
pp. 484-485
Author(s):  
Amal Alhefdhi ◽  
Herbert Chen
Keyword(s):  
Parathyroid Hormone ◽  
Normal Range ◽  
Intraoperative Parathyroid Hormone

Factors Influencing Time to Decrease in Intraoperative Parathyroid Hormone (ioPTH) Levels in Patients Undergoing Focused Parathyroidectomy (FP)

2018 ◽  
Vol 84 (6) ◽  
pp. 772-775 ◽  
Author(s):  
Neal Bhutiani ◽  
Beunca Graffree ◽  
Robert C.G. Martin ◽  
Amy R. Quillo
Keyword(s):  
Parathyroid Hormone ◽  
Normal Range ◽  
Factors Affecting ◽  
Time Period ◽  
Lower Baseline ◽  
Focused Parathyroidectomy ◽  
Potential Factors ◽  
One Year ◽  
Intraoperative Parathyroid Hormone ◽  
Cure Rates

The aim of this study was to evaluate potential factors affecting the time period in which a 50 per cent parathyroid hormone (PTH) drop is observed. Eight-seven patients undergoing focused parathyroidectomy between 2011 and 2015, whose PTH values dropped to within normal range, were grouped according to whether they required > or ≤15 minutes after gland excision to achieve a 50 per cent PTH. Groups were compared according to preoperative PTH, calcium, age, glomer-ular filtration rate, and adenoma weight. Lower preoperative and preincision PTH levels were associated with requiring >15 minutes to achieve a >50 per cent drop in ioPTH. Time to >50 per cent ioPTH drop did not affect cure rates at one year, though a >15 minutes requirement was associated with higher serum calcium levels (P = 0.015). Lower baseline PTH and preincision PTH levels are significantly associated with a >15 minutes postexcision time to achieve a >50 per cent drop in ioPTH. Future analyses are warranted to determine whether a longer postexcision time threshold before proceeding with four-gland exploration is warranted in patients with primary hyperparathyroidism and mildly elevated preoperative PTH.

scholarly journals Clinical impact of two different intraoperative parathyroid hormone assays in primary and renal hyperparathyroidism

2009 ◽  
Vol 160 (2) ◽  
pp. 275-281 ◽  
Author(s):  
Sonja-Kerstin Meyer ◽  
Markus Zorn ◽  
Karin Frank-Raue ◽  
Markus W Büchler ◽  
Peter Nawroth ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Clinical Impact ◽  
Renal Hyperparathyroidism ◽  
Normal Range ◽  
Persistent Disease ◽  
Intraoperative Pth ◽  
Intraoperative Parathyroid Hormone

BackgroundIntraoperative parathyroid hormone (PTH) monitoring predicts successful surgery for primary hyperparathyroidism (pHPT). In renal HPT, intraoperative PTH assays can define whether parathyroid resection is adequate.MethodsIntraoperative PTH was measured with two different immunometric assays (Immulite Turbo DPC and ADVIA Centaur assay) in 91 patients undergoing parathyroidectomy for primary (n=57) and renal (n=34) hyperparathyroidism. PTH was monitored preoperatively, 10, 20, and 30 min after parathyroidectomy and 24 h postoperatively.ResultsTen minutes after parathyroidectomy, intraoperative PTH dropped into the normal range (<7.6 pmol/l) in 84% of patients with pHPT and tertiary HPT as measured with the ADVIA Centaur assay (PTH-A), compared with 100% of the samples measured with the Immulite Turbo DPC assay (PTH-I; P=0.0082). Twenty minutes after parathyroidectomy for secondary HPT, intraoperative PTH decreased to the normal range in 100% measured with PTH-I compared with 50% measured with PTH-A (P=0.009). Then, 24 h postoperatively, PTH-I and PTH-A levels were within the normal range in all of the successfully treated patients. Both assays correctly identified six patients with persistent disease and another patient with a double adenoma in pHPT.ConclusionsIn patients undergoing parathyroidectomy for primary or renal HPT, PTH levels decreasing to the normal range indicated successful surgery in all of the patients as measured with the PTH-I assay. Comparing the two assays, PTH-I was able to quantify the intraoperative PTH decay more quickly than PTH-A.

Does Rapid Intraoperative Parathyroid Hormone Analysis Predict Cure in Patients Undergoing Surgery for Primary Hyperparathyroidism?

2006 ◽  
Vol 95 (1) ◽  
pp. 28-32 ◽  
Author(s):  
F. S. Nilsen ◽  
E. Haug ◽  
M. Heidemann ◽  
S. J. Karlsen
Keyword(s):  
Parathyroid Hormone ◽  
False Negative ◽  
Parathyroid Tissue ◽  
Neck Surgery ◽  
Anatomical Location ◽  
Negative Results ◽  
Sestamibi Scintigraphy ◽  
False Negative Results ◽  
Intraoperative Pth ◽  
Intraoperative Parathyroid Hormone

Background and Aims: Preoperative 99mTc-sestamibi scintigraphy is used by many surgeons to identify the anatomical location of pathological parathyroid glands in patients undergoing surgical treatment for hyperparathyroidism. However, false negative results do occur. It has been suggested that intraoperative parathyroid hormone (PTH) analysis may enhance the possibility of performing successful focused, unilateral neck surgery in these patients. This study aimed to evaluate whether an adequate fall in intraoperative parathyroid hormone values predicts the removal of all hyperfunctioning parathyroid tissue and postoperative normocalcemia. Material and Methods: One hundred consecutive patients undergoing surgery for hyperparathyroidism had preoperative 99mTc-sestamibi scintigraphy and intraoperative parathyroid hormone (PTH) analysis. A fall in intraoperative PTH value by more than 50% of baseline value ended the procedure. This prospective study presents the clinical and biochemical results. Results: The overall sensitivity of the 99mTc-sestamib scintigraphy was 88% and for single adenomas 95%. The scintigraphy failed to detect the correct pathology in all cases with multiglandular disease (7 patients). A fall in intraoperative PTH value by more than 50% of baseline value was achieved in all patients. The combination of intraoperative PTH analysis and 99mTc-sestamibi scintigraphy enabled us to limit the operation to a focused, unilateral operation in 87 of the 100 patients. All patients were normocalcemic postoperatively. Conclusions: A fall in intraoperative PTH value more than 50 % of baseline value seems to predict postoperative normocalcemia and the removal of all hyperfunctioning parathyroid tissue. Bilateral neck exploration is avoided in the majority of patients.

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