Rapid intraoperative parathyroid hormone assay in the surgical management of hyperparathyroidism.

CONTEXT: Historically, successful surgical management of primary hyperparathyroidism has required bilateral exploration of the neck. By confirming complete removal of hypersecreting tissue, an intraoperative parathyroid hormone (IO-PTH) assay allows use of a more limited procedure.

OBJECTIVE

Our objective was to evaluate the utility of IO-PTH assay used in 32 parathyroid explorations versus conventional bilateral exploration used before the advent of IO-PTH assays.

METHODS

Minimally invasive parathyroidectomy (MIP) was used. Plasma samples were obtained at several intervals and were analyzed for IO-PTH by use of a rapid immunochemiluminescent assay (ICMA). Outcomes were assessed by univariate inferential testing, yielding one-tailed t-test results.

RESULTS

The study group had a mean plasma IO-PTH level decrease of 87% at ten minutes after excision. All 32 patients who underwent MIP using IO-PTH monitoring had successful surgery. At last postoperative follow-up examination, all 32 patients were normocalcemic. There were statistically significant decreases in duration of surgery, length of hospital stay, and surgery cost.

CONCLUSIONS

IO-PTH levels predicted the postoperative outcome for all patients studied, can provide valuable information to surgeons, and can decrease the duration of surgery and hospital stay.