Optimal use of intraoperative PTH levels in parathyroidectomy

Melanie W. Seybt, Kelly A. Loftus, Anthony L. Mulloy, David J. Terris

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives/Hypothesis: Localization and the intraoperative parathyroid hormone assay (IOPTH) have facilitated minimally invasive parathyroidectomy. The precise algorithm governing use of IOPTH has been debated. Numerous authors advocate acquisition of a so-called pre-excision (P-E) baseline level (obtained after dissection of the adenoma, but prior to excision) in addition to a preincision baseline, to guard against spurious elevation in the baseline that might confuse interpretation of postexcision levels. We sought to clarify the optimal timing of PTH level determination. Study Design: Consecutive single-surgeon case series with planned data collection from patients undergoing parathyroid surgery at a university hospital. Methods: Demographic data and intraoperative laboratory and surgical findings from patients undergoing parathyroidectomy were prospectively gathered and analyzed. Attention was paid to the value of P-E and 5-minute postexcision levels and their impact on intraoperative decision-making. Results: One hundred twelve patients underwent parathyroidectomy. Thirty were for secondary or tertiary hyperparathyroidism and were excluded. Seventy-nine (96.3%) of the 82 patients with primary hyperparathyroidism were rendered eucalcemic. In no case did the P-E value change what was otherwise destined to be a successful result. In 65.3% of cases, operative time was conserved as the procedure was correctly stopped after the 5-minute level, without the need to wait until the 10-minute postexcision level was reported. Conclusions: Pre-excision baseline IOPTH levels, although logical in their original proposal, appear to play little role in determining the completeness of an exploration. A 5-minute postexcision level adds value in nearly two thirds of cases by allowing earlier termination of the operation.

Original languageEnglish (US)
Pages (from-to)1331-1333
Number of pages3
JournalLaryngoscope
Volume119
Issue number7
DOIs
StatePublished - Jul 1 2009

Fingerprint

Parathyroidectomy
Parathyroid Hormone
Primary Hyperparathyroidism
Hyperparathyroidism
Operative Time
Adenoma
Dissection
Decision Making
Demography

Keywords

  • Minimally invasive parathyroid surgery
  • PTH 3
  • Parathyroid
  • Parathyroidectomy

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Optimal use of intraoperative PTH levels in parathyroidectomy. / Seybt, Melanie W.; Loftus, Kelly A.; Mulloy, Anthony L.; Terris, David J.

In: Laryngoscope, Vol. 119, No. 7, 01.07.2009, p. 1331-1333.

Research output: Contribution to journalArticle

Seybt, Melanie W. ; Loftus, Kelly A. ; Mulloy, Anthony L. ; Terris, David J. / Optimal use of intraoperative PTH levels in parathyroidectomy. In: Laryngoscope. 2009 ; Vol. 119, No. 7. pp. 1331-1333.
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abstract = "Objectives/Hypothesis: Localization and the intraoperative parathyroid hormone assay (IOPTH) have facilitated minimally invasive parathyroidectomy. The precise algorithm governing use of IOPTH has been debated. Numerous authors advocate acquisition of a so-called pre-excision (P-E) baseline level (obtained after dissection of the adenoma, but prior to excision) in addition to a preincision baseline, to guard against spurious elevation in the baseline that might confuse interpretation of postexcision levels. We sought to clarify the optimal timing of PTH level determination. Study Design: Consecutive single-surgeon case series with planned data collection from patients undergoing parathyroid surgery at a university hospital. Methods: Demographic data and intraoperative laboratory and surgical findings from patients undergoing parathyroidectomy were prospectively gathered and analyzed. Attention was paid to the value of P-E and 5-minute postexcision levels and their impact on intraoperative decision-making. Results: One hundred twelve patients underwent parathyroidectomy. Thirty were for secondary or tertiary hyperparathyroidism and were excluded. Seventy-nine (96.3{\%}) of the 82 patients with primary hyperparathyroidism were rendered eucalcemic. In no case did the P-E value change what was otherwise destined to be a successful result. In 65.3{\%} of cases, operative time was conserved as the procedure was correctly stopped after the 5-minute level, without the need to wait until the 10-minute postexcision level was reported. Conclusions: Pre-excision baseline IOPTH levels, although logical in their original proposal, appear to play little role in determining the completeness of an exploration. A 5-minute postexcision level adds value in nearly two thirds of cases by allowing earlier termination of the operation.",
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