COULD THE RATE OF DECREASE IN INTRAOPERATIVE PARATHYROID HORMONE LEVEL BE A DETERMINANT OF SURGICAL TECHNIQUE IN TERTIARY HYPERPARATHYROIDISM?

CONTEXT: Intraoperative parathyroid hormone (IO PTH) monitoring has determinative role in surgery for tertiary hyperparathyroidism (tHPT).

OBJECTIVE

We tried to find out whether the extent of surgery to be performed can be dedicated via IO PTH monitoring in tHPT.

DESIGN

Renal transplantation (RTX) recipients who had been operated and followed up because of tHPT between 9/2014 and 5/2021 at our institution were retrospectively analysed.

SUBJECTS AND

METHODS

We analysed the pre-operative and postoperative data of 41 patients with tHPT.

RESULTS

Considering IO PTH monitoring; 70% and more decrease of the hormone level leaded us favourable results (89% surgical success) regardless of the PTX method (p<0.05). We obtained the same surgical success rate (75%) in patients in whom monitoring was done and was not done. We observed high success ratios (100%) in the latter group via subtotal PTX and total PTX plus autotransplantation (AT) (p<0.05).

CONCLUSIONS

In surgery for tHPT, IO PTH monitoring should be maintained. When we observe 70% or more decline in the hormone level, we can decide to finish the operation regardless of the surgical technique. If hormone level decrease is below 70%, we have to continue exploration.