Minimally invasive parathyroidectomy for primary hyperthyroidism guided by intra-operative parathyroid hormone monitoring

Abstract

s / International Journal of Surgery 10 (2012) S1–S52 S32 ABSTRACTS course of IA mean free T4 was 30 pmol/L and 11.4 pmol/L respectively (range: 9.4 to 22.7 pmol/L). There were no adverse effects to IA. Therewere no complications following surgery. Conclusions: Iopanoic acid is safe and effective in rapidly controlling thyrotoxicosis prior to total thyroidectomy. 0623: SESTA-MIBI SCANS, CAN THEY PREDICT INTRATHYROID PARATHYROID ADENOMA? Rachel French, R.K. Maitra, Vijay Kurup. North Tees University Hospital, Stockton-on-Tees, UK Aim: To evaluate the role of sesta-mibi scans in predicting intrathyroidal parathyroid adenoma in primary hyperparathyroidism. Method: Retrospective analysis of parathyroidectomies performed in a distric general hospital during the last 6 years(2005-11). Sesta-mibi scans were performed pre-operatively in all patients with primary hyperparathyroidism. Where no adenoma was identified during exploration of neck, a hemithyroidectomy was performed on the side suggested by sestamibi scan. Results: 78 patients had exploration of neck, 82% female, 18% male, with a mean age 62 years. Sestamibi was positive in 60 patients and 54 had parathyroid adenoma identified on exploration. 6 patients after a failed neck exploration underwent hemithyroidectomy . Histology revealed intrathyroidal parathyroid adenoma in 5 patients(83%) . Out of 18 patients with negative scans 14 had an adenoma removed. Sestamibi scans had a sensitivity of 81% and positive predictive value of 98.3%. Conclusion: Sestamibi scan helped to identify 5patients with intrathyroidal parathyroid adenoma when neck exploration was negative. When no adenoma is visible on exploration a hemithyroidectomy at the side suggested by the scan is justified. 0681: MINIMALLY INVASIVE PARATHYROIDECTOMY FOR PRIMARY HYPERTHYROIDISM GUIDED BY INTRA-OPERATIVE PARATHYROID HORMONE MONITORING Alison Lyon , O.O. Komolafe , Christopher Wilson . University of Sydney, Sydney, Australia; Western Infirmary, Glasgow, UK Aim: Intra-operative parathyroid hormone (PTH) levels can demonstrate successful removal of a parathyroid adenoma during minimally invasive parathyroidectomy. However, this technique remains controversial due to variations in blood sampling and excision criteria. In this study, we explored the success rate of our technique. Methods: A consecutive series of 92 patients with histologically confirmed primary hyperparathyroidism was analysed retrospectively. All were treated with a minimally invasive technique. Serum PTH levels were checked prior to gland removal and twenty minutes after gland removal to confirm a decrease of greater than 50%, which was considered to indicate a curative procedure. Results: The median pre-operative PTH level was 14.35ng/L (interquartile range (IQR) 10.7-20.3). The two week post operative median level was 5.4ng/L (IQR 3.4-7) and median adjusted calcium level was 2.39mmol/L (IQR 2.28-2.5). The average intraoperative PTH decrease was 75.6%. Of the 92 patients, 8 (8.7%) required multiple gland removal due to adenoma location differing to that indicated by preoperative imaging (3 were retrosternal). The biochemical cure rate within this cohort was 98%. 2 patients had no intraoperative PTH drop and persisting hypercalcaemia. They underwent further imaging and curative surgery. Conclusion: Intra-operative PTH monitoring is a useful adjunct to minimally invasive parathyroidectomy. 0721: PATIENT OUTCOME FOLLOWING LAPAROSCOPIC BILATERAL ADRENALECTOMY Carol Watson, Craig Parnaby, Patrick ODwyer. Gartnavel General Hospital,