scholarly journals Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

2015 ◽  
Vol 97 (8) ◽  
pp. 603-607 ◽  
Author(s):  
OA Mownah ◽  
G Pafitanis ◽  
WM Drake ◽  
JN Crinnion
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Frozen Section ◽  
Lateral Approach ◽  
Preoperative Imaging ◽  
Surgical Cure ◽  
Focused Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Iopth Measurement

Introduction Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement. Methods Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment. Results Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia. Conclusions This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.

Minimally Invasive Parathyroid Surgery, The Norman 20% Rule: Is It Valid?

2011 ◽  
Vol 77 (4) ◽  
pp. 484-487 ◽  
Author(s):  
Amy R. Quillo ◽  
Jeffery M. Bumpous ◽  
Richard E. Goldstein ◽  
Muffin M. Fleming ◽  
Ccrp ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Parathyroid Gland ◽  
Ex Vivo ◽  
Frozen Section ◽  
Postoperative Management ◽  
Average Percentage ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone

The 20 per cent rule proposed by Norman established a guideline using radioactivity in the minimally invasive radioguided parathyroidectomy (MIRP) technique to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20 per cent of excision site/background radioactivity, the 20 per cent rule was satisfied. Patients meeting these criteria underwent unilateral MIRP without intraoperative parathyroid hormone assay or intraoperative frozen section. The study aim was to independently evaluate the 20 per cent rule in MIRP patients with primary hyperparathyroidism. Using the University of Louisville Parathyroid Database from January 1, 1999 to December 31, 2007, 216 MIRP patients with complete radioguided and postoperative management data were identified. The average percentage of ex vivo parathyroid gland radioactivity compared with excision site/background radioactivity was 107 per cent with a range from 14 to 388 per cent. For 99 per cent (196/198) radioactivity recorded from the excised gland was at least 20 per cent of radioactivity recorded from the excision site. Normocalcemia was documented in 98.5 per cent (195/198) at 12 month follow-up. Our data supports the 20 per cent rule in that in 99 per cent of MIRP patients the resected gland radioactivity was at least 20 per cent of excision site radioactivity allowing localization and confirmation of an overactive gland without intraoperative parathyroid hormone monitoring or tissue analysis.

scholarly journals The CaPTHUS Scoring Model revisited: Applicability from a UK Cohort with Primary Hyperparathyroidism

2017 ◽  
Vol 9 (1) ◽  
pp. 7-12
Author(s):  
David M Scott-Coombes ◽  
Tobias W James ◽  
Michael J Stechman
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
High Recurrence Rate ◽  
Scoring Model ◽  
Upper Limit ◽  
Single Positive ◽  
Sestamibi Scanning ◽  
Focused Parathyroidectomy ◽  
The Uk ◽  
Intraoperative Parathyroid Hormone

ABSTRACT Introduction Focused parathyroidectomy for primary hyperparathyroidism (pHPT) in patients with a single positive localizing scan may have an unacceptably high recurrence rate unless intraoperative parathyroid hormone (ioPTH) is used. The CaPTHUS score was previously developed to predict singlegland disease in such instances. We evaluated the accuracy of this model in a cohort of patients with pHPT in the UK. Materials and methods CaPTHUS scores were calculated from prospectively collected data on consecutive patients undergoing surgery for pHPT [(1 point each for: Preoperative calcium ≥3 mmol/L; PTH ≥2 times upper limit; ultrasound (1 point) and sestamibi (1 point) positive for single enlarged gland; concordant positive scans]. Diagnosis of single or multigland disease was confirmed on pathology. Results From June 2007 to October 2011, 324 patients (251 female, median age 66, 10.89) underwent surgery for pHPT guided with ioPTH. Single-gland pathology was observed in 291 (89.8%) patients and multi-gland disease seen in 33 (10.2%). In single-gland disease patients, significantly higher preoperative calcium (p = 0.030) and PTH levels (p = 0.033) were seen with sensitivities of 65.6% for ultrasound and 66.0% for sestamibi scanning. A CaPTHUS score ≥3 was seen in 51.2% of all patients with a positive predictive value (PPV) for single-gland disease of 99.4%. Conclusion A CaPTHUS score ≥3 was accurate at predicting single-gland disease in >50% of patients with pHPT, providing a similar PPV and reducing the need for ioPTH implementation in this population. However, recent conflicting literature suggests the CaPTHUS score may not be universally applicable, local audit is recommended before implementation. How to cite this article James TW, Stechman MJ, Scott- Coombes DM. The CaPTHUS Scoring Model revisited: Applicability from a UK Cohort with Primary Hyperparathyroidism. World J Endoc Surg 2017;9(1):7-12.

Focused parathyroidectomy with intraoperative parathyroid hormone monitoring in patients with lithium-associated primary hyperparathyroidism

Surgery ◽  
2013 ◽  
Vol 153 (5) ◽  
pp. 718-722 ◽  
Author(s):  
Thomas J. Wade ◽  
Tina W.F. Yen ◽  
Amanda L. Amin ◽  
Douglas B. Evans ◽  
Stuart D. Wilson ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Hormone Monitoring ◽  
Focused Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone

scholarly journals Surgery for Primary Hyperparathyroidism in Patients with Preoperatively Negative Sestamibi Scan and Discordant Imaging Studies: The Usefulness of Intraoperative Parathyroid Hormone Monitoring

2013 ◽  
Vol 6 ◽  
pp. CMED.S13114 ◽  
Author(s):  
Pietro Giorgio Caló ◽  
Giuseppe Pisano ◽  
Giulia Loi ◽  
Fabio Medas ◽  
Alberto Tatti ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Preoperative Imaging ◽  
Imaging Studies ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Pth ◽  
Group A ◽  
Group B ◽  
Intraoperative Parathyroid Hormone ◽  
The Impact

The aim of this study was to evaluate the impact of intraoperative parathyroid hormone (PTH) monitoring on surgical strategy, intraoperative findings, and outcome in patients with negative sestamibi scintigraphy and with discordant imaging studies. We divided our 175 patients into 3 groups: group A was methoxyisobutylisonitrile (MIBI)-positive and ultrasonography positive and was concordant (114 patients), group B was MIBI-positive and ultrasonography-negative (50 patients), and group C was MIBI–-and ultrasonography-negative (11 patients). The overall operative success was 99.12% in group A, 98% in group B, and 90.91% in group C, with an incidence of multiglandular disease of 3.5% in group A, 12% in group B, and 9.09% in group C. Intraoperative PTH monitoring changed the operative management in 2.63% of patients in group A and 14% in group B. The use of intraoperative PTH achieves to obtain excellent results in the treatment of primary hyperparathyroidism in high-volume centers, even in the most difficult cases, during MIBI-negative and discordant preoperative imaging studies.

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