Intraoperative parathyroid hormone examination in parathyroidectomy for primary hyperparathyroidism

Abstract

Objective To explore the effect of intraoperative parathyroid hormone (IOPTH) examination on parathyroidectomy for primary hyperparathyroidism. Methods The clinical data of 41 PHPT patients who received IOPTH monitoring (IOPTH group) from Jan. 2009 to Dec. 2014 were retrospectively analyzed. The clinical manifestation, examination and changes of parathyroid hormone and calcium before and after operation were collected. Results There were 12 males and 29 females. 36 cases had parathyroid adenoma, and 5 cases were parathyroid carcinoma. 23 cases were positive in 24 cases of 99Tcm-MIBI parathyroid adenoma radionuclide examination, and 2 cases were positive in 3 cases of parathyroid carcinoma radionuclide 99Tcm-MIBI inspection (P=0.213) . 10 mins after tumor resection, PTH in all cases decreased by 50% or more than that before tumor resection except for one case of parathyroid carcinoma. 23 cases appeared hypocalcemia in 36 cases of parathyroid adenoma after surgery and 2 cases appeared hypocalcemia in 5 cases of parathyroid cancer patients (P=0.361) . No postoperative hoarseness, cough, bleeding occoured. Patients were followed up from 6 to 72 months. Hypocalcemia symptoms recovered 2 weeks to 3 months after surgery. No permanent hypoparathyroidism occured. One case of parathyroid carcinoma died of hypercalcemia 5 months after surgery. The remaining 40 cases survived without recurrence or death. Conclusions Intraoperative PTH monitoring can help doctors analyze whether all the hyperthyroidism glands have been removed, which can help to avoid miss diagnosis of multiple gland disease and unnecessary bilateral neck exploration. This method is highly accurate so it is recommended for routine use in PHPT surgery. Key words: Primary hyperparathyroidism; Parathyroid adenoma; Parathyroid carcinoma; Surgical treatment; Parathyroid hormone