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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1992 Jan;74(1):19–22.

Intraoperative parathyroid hormone estimation: a valuable adjunct to parathyroid surgery.

G S Robertson 1, S J Iqbal 1, A Bolia 1, P R Bell 1, P S Veitch 1
PMCID: PMC2497501  PMID: 1736788

Abstract

Serial measurements of serum intact parathyroid hormone (PTH) and adjusted total calcium levels were performed on 10 patients during unilateral neck exploration for a solitary parathyroid adenoma localised preoperatively by ultrasound scan. Frozen section was performed peroperatively to establish the presence of parathyroid tissue. Levels of PTH were shown to be within the normal range within 15 min of adenoma removal (a mean of 13.4% of their preoperative values), allowing clear early distinction from unsuccessful surgery where no change occurred. Frozen section wrongly identified thyroid tissue as parathyroid in one case leading to a failure of the initial neck exploration. Our findings show that intraoperative PTH measurements can accurately predict whether all hyperfunctioning parathyroid tissue has been removed. This is not always possible using frozen section techniques. The wider use of intraoperative PTH measurement, particularly in difficult cases, may avoid the need for prolonged explorations to identify all four glands and, perhaps, biopsy of normal glands, replacing the current standard use of frozen section as a more reliable indicator of the success of parathyroid surgery.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Blind E., Schmidt-Gayk H., Armbruster F. P., Stadler A. Measurement of intact human parathyrin by an extracting two-site immunoradiometric assay. Clin Chem. 1987 Aug;33(8):1376–1381. [PubMed] [Google Scholar]
  2. Brasier A. R., Wang C. A., Nussbaum S. R. Recovery of parathyroid hormone secretion after parathyroid adenomectomy. J Clin Endocrinol Metab. 1988 Mar;66(3):495–500. doi: 10.1210/jcem-66-3-495. [DOI] [PubMed] [Google Scholar]
  3. Brown R. C., Aston J. P., Weeks I., Woodhead J. S. Circulating intact parathyroid hormone measured by a two-site immunochemiluminometric assay. J Clin Endocrinol Metab. 1987 Sep;65(3):407–414. doi: 10.1210/jcem-65-3-407. [DOI] [PubMed] [Google Scholar]
  4. Christensson T., Hellström K., Wengle B., Alveryd A., Wikland B. Prevalence of hypercalcaemia in a health screening in Stockholm. Acta Med Scand. 1976;200(1-2):131–137. doi: 10.1111/j.0954-6820.1976.tb08208.x. [DOI] [PubMed] [Google Scholar]
  5. Cusumano R. J., Mahadevia P., Silver C. E. Intraoperative histologic evaluation in exploration of the parathyroid glands. Surg Gynecol Obstet. 1989 Dec;169(6):506–510. [PubMed] [Google Scholar]
  6. Edis A. J., Beahrs O. H., van Heerden J. A., Akwari O. E. "Conservative" versus "liberal" approach to parathyroid neck exploration. Surgery. 1977 Oct;82(4):466–473. [PubMed] [Google Scholar]
  7. Egdahl R. H., Canterbury J. M., Reiss E. Measurement of circulating parathyroid hormone concentration before and after parathyroid surgery for adenoma or hyperplasia. Ann Surg. 1968 Oct;168(4):714–719. doi: 10.1097/00000658-196810000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Flentje D., Schmidt-Gayk H., Fischer S., Stern J., Blind E., Buhr H., Herfarth C. Intact parathyroid hormone in primary hyperparathyroidism. Br J Surg. 1990 Feb;77(2):168–172. doi: 10.1002/bjs.1800770217. [DOI] [PubMed] [Google Scholar]
  9. Foldes J., Halperin Y., Kidroni G., Menczel J. Medical treatment of primary hyperparathyroidism: effects on parathormone and vitamin D metabolites. Isr J Med Sci. 1987 Nov;23(11):1148–1151. [PubMed] [Google Scholar]
  10. Gaz R. D., Doubler P. B., Wang C. A. The management of 50 unusual hyperfunctioning parathyroid glands. Surgery. 1987 Dec;102(6):949–957. [PubMed] [Google Scholar]
  11. Kaplan E. L., Bartlett S., Sugimoto J., Fredland A. Relation of postoperative hypocalcemia to operative techniques: deleterious effect of excessive use of parathyroid biopsy. Surgery. 1982 Nov;92(5):827–834. [PubMed] [Google Scholar]
  12. Levin K. E., Clark O. H. The reasons for failure in parathyroid operations. Arch Surg. 1989 Aug;124(8):911–915. doi: 10.1001/archsurg.1989.01410080041006. [DOI] [PubMed] [Google Scholar]
  13. Liechty R. D., Teter A., Suba E. J. The tiny parathyroid adenoma. Surgery. 1986 Dec;100(6):1048–1052. [PubMed] [Google Scholar]
  14. Lindall A. W., Elting J., Ells J., Roos B. A. Estimation of biologically active intact parathyroid hormone in normal and hyperparathyroid sera by sequential N-terminal immunoextraction and midregion radioimmunoassay. J Clin Endocrinol Metab. 1983 Nov;57(5):1007–1014. doi: 10.1210/jcem-57-5-1007. [DOI] [PubMed] [Google Scholar]
  15. Mundy G. R., Cove D. H., Fisken R. Primary hyperparathyroidism: changes in the pattern of clinical presentation. Lancet. 1980 Jun 21;1(8182):1317–1320. doi: 10.1016/s0140-6736(80)91783-3. [DOI] [PubMed] [Google Scholar]
  16. Newman D. J., Ashby J. P. Clinical and laboratory evaluation of a two-site immunoradiometric assay for intact parathyroid hormone. Ann Clin Biochem. 1988 Nov;25(Pt 6):654–660. doi: 10.1177/000456328802500610. [DOI] [PubMed] [Google Scholar]
  17. Nussbaum S. R., Thompson A. R., Hutcheson K. A., Gaz R. D., Wang C. A. Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism. Surgery. 1988 Dec;104(6):1121–1127. [PubMed] [Google Scholar]
  18. Nussbaum S. R., Zahradnik R. J., Lavigne J. R., Brennan G. L., Nozawa-Ung K., Kim L. Y., Keutmann H. T., Wang C. A., Potts J. T., Jr, Segre G. V. Highly sensitive two-site immunoradiometric assay of parathyrin, and its clinical utility in evaluating patients with hypercalcemia. Clin Chem. 1987 Aug;33(8):1364–1367. [PubMed] [Google Scholar]
  19. Prey M. U., Vitale T., Martin S. A. Guidelines for practical utilization of intraoperative frozen sections. Arch Surg. 1989 Mar;124(3):331–335. doi: 10.1001/archsurg.1989.01410030081013. [DOI] [PubMed] [Google Scholar]
  20. Russell C. F., Edis A. J. Surgery for primary hyperparathyroidism: experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient. Br J Surg. 1982 May;69(5):244–247. doi: 10.1002/bjs.1800690503. [DOI] [PubMed] [Google Scholar]
  21. Ryan M. F., Jones S. R., Barnes A. D. Modification to a commercial immunoradiometric assay permitting intraoperative monitoring of parathyroid hormone levels. Ann Clin Biochem. 1990 Jan;27(Pt 1):65–68. doi: 10.1177/000456329002700113. [DOI] [PubMed] [Google Scholar]
  22. Stevenson J. C., Lynn J. A. Time to end a conservative treatment for mild hyperparathyroidism. Br Med J (Clin Res Ed) 1988 Apr 9;296(6628):1016–1017. doi: 10.1136/bmj.296.6628.1016-a. [DOI] [PMC free article] [PubMed] [Google Scholar]

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