World Journal of Surgery

, Volume 33, Issue 8, pp 1665–1673 | Cite as

When Initial Postexcision PTH Level Does Not Fall Appropriately During Parathyroidectomy: What to Do Next?

  • Patrick B. O’Neal
  • Vitaliy Poylin
  • Peter Mowschenson
  • Sareh Parangi
  • Gary Horowitz
  • Pravin Pant
  • Per-Olof Hasselgren



Inadequate fall in the intraoperative parathyroid hormone (PTH) level after removing enlarged parathyroid gland(s) typically signifies additional hyperfunctioning gland(s), prompting further neck dissection, but it may also be a false negative result. We analyzed intraoperative management of patients with an inadequate fall on PTH after excision of enlarged parathyroid gland(s).


Analysis involved a prospective database of 189 patients undergoing 193 procedures for primary hyperparathyroidism. The PTH level was determined before neck incision and 10–15 min after excision of enlarged parathyroid gland(s). A PTH decrease > 50% and into normal range was used as the criterion of successful parathyroidectomy.


In 48 of 193 operations, initial postexcision PTH level did not fall appropriately. That inadequate fall in PTH level was a false negative result in 16 patients (33%) and cure was achieved without additional neck exploration in all but one patient, who had additional (negative) neck exploration after excision of a parathyroid adenoma. In all patients with false negative postexcision PTH assay, operative findings concurred with preoperative imaging tests.


Inadequate fall in intraoperative PTH may be false negative, particularly after removal of an adenoma found in the location determined by preoperative imaging. Repeat PTH may confirm the initial assay as false negative, obviating the need for additional neck dissection. Importantly, if repeat PTH does not fall appropriately, additional neck exploration needs to be performed.


Parathyroid Gland Parathyroid Adenoma Neck Exploration Enlarge Parathyroid Gland Successful Parathyroidectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Patrick B. O’Neal
    • 1
  • Vitaliy Poylin
    • 1
  • Peter Mowschenson
    • 1
  • Sareh Parangi
    • 3
  • Gary Horowitz
    • 2
  • Pravin Pant
    • 1
  • Per-Olof Hasselgren
    • 1
  1. 1.Section of Endocrine Surgery, Department of SurgeryBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Department of PathologyBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  3. 3.Department of SurgeryMassachusetts General HospitalBostonUSA

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