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Minimal Benefit to Subsequent Intraoperative Parathyroid Hormone Testing After All Four Glands Have Been Identified

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Modern tools, such as intraoperative parathyroid hormone (IoPTH) assay, reduce operative time and extent of parathyroidectomy. However, the utility of a subsequent final set of IoPTH after all four glands are visualized remains questionable. This study was designed to determine the added value of IoPTH assay following parathyroidectomy with four-gland visualization in patients with primary hyperparathyroidism (PHPT).

Methods

A retrospective review of patients who underwent parathyroidectomy for PHPT between July 2001 and February 2012 by two experienced endocrine surgeons was performed. Included were patients with operative reports indicating that all four parathyroid glands were identified. Following four-gland visualization a subsequent final set of IoPTH was measured to confirm cure. Cure was defined as at least 50 % fall by 5, 10, or 15 min postexcision compared with preincision levels.

Results

Of 1,838 patients that underwent parathyroidectomy, four glands were visualized in 238 cases (13 %). Of those patients meeting inclusion criteria with four glands visualized, the final set of IoPTH fell to cure criteria in 235 patients (98 %). An inadequate drop was documented in three (2 %) patients all of which were found to have multigland disease. Only in one patient (0.4 %) was a fifth parathyroid gland identified and resected. In all three cases, the subsequent final IoPTH did not affect the ultimate outcome or cure rate.

Conclusions

When experienced surgeons visualize all four parathyroid glands, drawing a subsequent final set of IoPTH rarely changes the operative course and therefore serves a limited role.

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References

  1. Adler JT, Sippel RS, Chen H. New trends in parathyroid surgery. Curr Probl Surg. 2010;47:958–1017.

    Article  PubMed  Google Scholar 

  2. Mazeh H, Sippel RS, Chen H. The role of gender in primary hyperparathyroidism: same disease, different presentation. Ann Surg Oncol. 2012;19:2958–62.

    Google Scholar 

  3. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002;235:665–70; discussion 70–2.

    Article  PubMed  Google Scholar 

  4. Lew JI, Solorzano CC. Surgical management of primary hyperparathyroidism: state of the art. Surg Clin N Am. 2009;89:1205–25.

    Article  PubMed  Google Scholar 

  5. Allendorf J, DiGorgi M, Spanknebel K, Inabnet W, Chabot J, Logerfo P. 1112 consecutive bilateral neck explorations for primary hyperparathyroidism. World J Surg. 2007;31:2075–80.

    Article  PubMed  Google Scholar 

  6. Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg. 2005;140:472–8; discussion 8–9.

    Article  PubMed  Google Scholar 

  7. Palazzo FF, Delbridge LW. Minimal-access/minimally invasive parathyroidectomy for primary hyperparathyroidism. Surg Clin N Am. 2004;84:717–34.

    Article  PubMed  Google Scholar 

  8. Chen H, Sokoll LJ, Udelsman R. Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. Surgery. 1999;126:1016–21; discussion 21–2.

    Article  PubMed  CAS  Google Scholar 

  9. Gracie D, Hussain SS. Use of minimally invasive parathyroidectomy techniques in sporadic primary hyperparathyroidism: systematic review. J Laryngol Otol. 2012;126:221–7.

    Article  PubMed  CAS  Google Scholar 

  10. Lee JA, Inabnet III WB. The surgeon’s armamentarium to the surgical treatment of primary hyperparathyroidism. J Surg Oncol. 2005;89:130–5.

    Article  PubMed  Google Scholar 

  11. Irvin III GL, Dembrow VD, Prudhomme DL. Operative monitoring of parathyroid gland hyperfunction. Am J Surg. 1991;162:299–302.

    Article  PubMed  Google Scholar 

  12. Irvin III GL, American Association of Endocrine Surgeons. Presidential address: chasin’ hormones. Surgery. 1999;126:993–7.

    Article  PubMed  Google Scholar 

  13. Norman J, Lopez J, Politz D. Abandoning unilateral parathyroidectomy: why we reversed our position after 15,000 parathyroid operations. J Am Coll Surg. 2012;214:260–9.

    Article  PubMed  Google Scholar 

  14. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012;152:1008–15.

    Article  PubMed  Google Scholar 

  15. Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005;138:583–7; discussion 7–90.

    Article  PubMed  Google Scholar 

  16. Moor JW, Roberts S, Atkin SL, England RJ. Intraoperative parathyroid hormone monitoring to determine long-term success of total parathyroidectomy for secondary hyperparathyroidism. Head Neck. 2011;33:293–6.

    PubMed  Google Scholar 

  17. Pitt SC, Panneerselvan R, Chen H, Sippel RS. Secondary and tertiary hyperparathyroidism: the utility of ioPTH monitoring. World J Surg. 2010;34:1343–9.

    Article  PubMed  Google Scholar 

  18. Gasparri G, Camandona M, Bertoldo U, et al. The usefulness of preoperative dual-phase 99mTc MIBI-scintigraphy and IO-PTH assay in the treatment of secondary and tertiary hyperparathyroidism. Ann Surg. 2009;250:868–71.

    Article  PubMed  Google Scholar 

  19. Conzo G, Perna A, Avenia N, et al. Evaluation of the ‘putative’ role of intraoperative intact parathyroid hormone assay during parathyroidectomy for secondary hyperparathyroidism. A retrospective study on 35 consecutive patients: intraoperative iPTH assay during parathyroidectomy. Endocrine. 2012;42:606–11.

    Article  PubMed  CAS  Google Scholar 

  20. Smith N, Magnuson JS, Vidrine DM, Kulbersh B, Peters GE. Minimally invasive parathyroidectomy: use of intraoperative parathyroid hormone assays after 2 preoperative localization studies. Arch Otolaryngol Head Neck Surg. 2009;135:1108–11.

    Article  PubMed  Google Scholar 

  21. Schneider R, Waldmann J, Ramaswamy A, Fernandez ED, Bartsch DK, Schlosser K. Frequency of ectopic and supernumerary intrathymic parathyroid glands in patients with renal hyperparathyroidism: analysis of 461 patients undergoing initial parathyroidectomy with bilateral cervical thymectomy. World J Surg. 2011;35:1260–5.

    Article  PubMed  Google Scholar 

  22. Welch K, McHenry CR. The role of transcervical thymectomy in patients with hyperparathyroidism. Am J Surg. 2012;203:292–5; discussion 5–6.

    Article  PubMed  Google Scholar 

  23. d’Alessandro AF, Montenegro FL, Brandao LG, Lourenco Jr DM, Toledo Sde A, Cordeiro AC. Supernumerary parathyroid glands in hyperparathyroidism associated with multiple endocrine neoplasia type 1. Rev Assoc Med Bras. 2012;58:323–7.

    PubMed  Google Scholar 

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Disclosures

The authors have no disclosures or financial conflicts of interest.

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Authors and Affiliations

  1. Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA

    Kamal Ahmed MD, Amal Alhefdhi MD, David F. Schneider MD, MS, Kristin A. Ojomo MD, Rebecca S. Sippel MD, FACS, Herbert Chen MD, FACS & Haggi Mazeh MD

  2. Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Haggi Mazeh MD

Authors
  1. Kamal Ahmed MD
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  2. Amal Alhefdhi MD
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  3. David F. Schneider MD, MS
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  4. Kristin A. Ojomo MD
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  5. Rebecca S. Sippel MD, FACS
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  6. Herbert Chen MD, FACS
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  7. Haggi Mazeh MD
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Correspondence to Haggi Mazeh MD.

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Ahmed, K., Alhefdhi, A., Schneider, D.F. et al. Minimal Benefit to Subsequent Intraoperative Parathyroid Hormone Testing After All Four Glands Have Been Identified. Ann Surg Oncol 20, 4200–4204 (2013). https://doi.org/10.1245/s10434-013-3188-y

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  • DOI: https://doi.org/10.1245/s10434-013-3188-y

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