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. 1995 Jan;77(1):28–30.

Limited role for intraoperative intact PTH measurement in parathyroid surgery.

P Tan 1, S H Leveson 1, H Wilkinson 1
PMCID: PMC2502514  PMID: 7717640

Abstract

Primary hyperparathyroidism may be cured surgically by complete excision of abnormal parathyroid tissue. Reoperation for persistent hypercalcaemia due to residual abnormal parathyroid tissue may be associated with a high complication rate. It is possible to assay intact parathormone (iPTH) intraoperatively and as iPTH has a relatively short half-life, its measurement intraoperatively may be used to predict successful parathyroidectomy. We have studied intraoperative iPTH levels in a consecutive series of 33 patients undergoing surgery for primary hyperparathyroidism. We found that iPTH levels fell significantly (P < 0.05) from a median pre-excision level of 122 pg/ml to a median level of 36 pg/ml 20 min after excision. However, in 3/31 successful parathyroidectomies, the intraoperative iPTH levels either remained unchanged or had risen. Reliance on intraoperative iPTH levels in these patients may have resulted in unnecessary re-exploration. We conclude that intraoperative iPTH measurement has limited usefulness as a predictor of successful parathyroidectomy for primary hyperparathyroidism.

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Selected References

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

  1. Cheung P. S., Borgstrom A., Thompson N. W. Strategy in reoperative surgery for hyperparathyroidism. Arch Surg. 1989 Jun;124(6):676–680. doi: 10.1001/archsurg.1989.01410060038008. [DOI] [PubMed] [Google Scholar]
  2. Dudley N. E. Methylene blue for rapid identification of the parathyroids. Br Med J. 1971 Sep 18;3(5776):680–681. doi: 10.1136/bmj.3.5776.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Harrison B. J., Wheeler M. H. Asymptomatic primary hyperparathyroidism. World J Surg. 1991 Nov-Dec;15(6):724–729. doi: 10.1007/BF01665306. [DOI] [PubMed] [Google Scholar]
  4. Madira W., Robertson G. S., London N. J., Iqbal S. J., Bell P. R., Veitch P. S. Comparison of 'intraoperative' parathormone measurement with frozen section during parathyroid surgery. Ann R Coll Surg Engl. 1993 Jan;75(1):26–29. [PMC free article] [PubMed] [Google Scholar]
  5. 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]
  6. Proye C. A., Goropoulos A., Franz C., Carnaille B., Vix M., Quievreux J. L., Couplet-Lebon G., Racadot A. Usefulness and limits of quick intraoperative measurements of intact (1-84) parathyroid hormone in the surgical management of hyperparathyroidism: sequential measurements in patients with multiglandular disease. Surgery. 1991 Dec;110(6):1035–1042. [PubMed] [Google Scholar]
  7. 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]
  8. 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]
  9. Wang C. A., Rieder S. V. A density test for the intraoperative differentiation of parathyroid hyperplasia from neoplasia. Ann Surg. 1978 Jan;187(1):63–67. doi: 10.1097/00000658-197801000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]

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