Abstract
BackgroundThe objective of this study was to validate our approach of treating primary hyperparathyroidism using sestamibi scan directed parathyroidectomy, without routine use of intraoperative parathyroid hormone measurements (ioPTH).MethodsWe prospectively established a protocol limiting the use of ioPTH to patients with negative or equivocal sestamibi scans, and those who had risk factors for multi-gland disease. We then performed a retrospective review to determine our disease control rate.Results128 patients underwent sestamibi-guided parathyroidectomy without (111/128 = 87%) or with (17/128 = 13%) ioPTH. The overall disease control (eucalcemia) rate was 95%. 3/111 (3%) of patients who had surgery without ioPTH measurements required re-exploration.ConclusionsSelective use of ioPTH is an effective strategy. ioPTH is best reserved for patients who have non-localizing preoperative imaging, are at risk for multi-gland disease, or require revision surgery.
Highlights
The objective of this study was to validate our approach of treating primary hyperparathyroidism using sestamibi scan directed parathyroidectomy, without routine use of intraoperative parathyroid hormone measurements
What was once a tedious four-gland exploration has become a relatively short procedure directed at the solitary abnormal gland in most instances. This paradigm shift has been facilitated by improved preoperative localization, usually with a Tc 99 m sestamibi scan with or without ultrasound, and the advent of intraoperative testing with intraoperative parathyroid hormone levels or a gamma probe
The objective of this study is to review our rates of intraoperative parathyroid hormone measurements (ioPTH) utilization and disease control using this protocol
Summary
The objective of this study was to validate our approach of treating primary hyperparathyroidism using sestamibi scan directed parathyroidectomy, without routine use of intraoperative parathyroid hormone measurements (ioPTH). What was once a tedious four-gland exploration has become a relatively short procedure directed at the solitary abnormal gland in most instances. This paradigm shift has been facilitated by improved preoperative localization, usually with a Tc 99 m sestamibi scan with or without ultrasound, and the advent of intraoperative testing with intraoperative parathyroid hormone levels or a gamma probe. Proponents of routine ioPTH utilization site the advantage of immediate confirmation of successful treatment at the time of surgery, and the ability to detect multi- gland disease. Multi-gland disease is purported to occur in as many as 15% of cases, which would seem to support the use of routine testing
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