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World Journal of Surgery

, Volume 36, Issue 5, pp 1175–1181 | Cite as

A Predictive Model of Suitability for Minimally Invasive Parathyroid Surgery in the Treatment of Primary Hyperthyroidism

  • Dara O. Kavanagh
  • Patricia Fitzpatrick
  • Eddie Myers
  • Rory Kennelly
  • Stephen J. Skehan
  • Robert G. Gibney
  • Arnold D. K. Hill
  • Denis Evoy
  • Enda W. McDermott
Article

Abstract

Background

Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient’s suitability for minimally invasive surgery.

Methods

For the purposes of the present study, 180 consecutive patients were included for analysis. A 5-variable model based on preoperative ionized serum calcium (>1.4 mmol/l), intact parathyroid hormone level (≥2 times the upper limit of normal), positive sestamibi scan for a single affected gland, positive ultrasound scan for a single gland, and concordance between the two imaging modalities for single-gland disease at a similar location was employed, where a score of 1 was allocated for each variable present.

Results

Of the 180 patients, 62 (34%) underwent bilateral exploration, 63 (36%) underwent unilateral exploration, and 55 (30%) underwent minimally invasive parathyroidectomy. The results showed that 92% had single-gland disease, 3% had double adenomas, and 5% had hyperplasia. Biochemical cure was achieved in 98.9%. Mean follow-up was 153 days (range: 80–342 days). With the predictive scoring model, a score of ≥3 had a positive predictive value of 100% for single-gland disease.

Conclusions

A scoring model encompassing preoperative biochemical and imaging data can be successfully employed to predict suitability for minimally invasive surgery in the majority of patients with single-gland disease.

Keywords

IOPTH Measurement Minimally Invasive Parathyroidectomy Bilateral Neck Exploration Invasive Parathyroidectomy Enlarge Parathyroid Gland 
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 2011

Authors and Affiliations

  • Dara O. Kavanagh
    • 1
  • Patricia Fitzpatrick
    • 2
    • 3
  • Eddie Myers
    • 1
  • Rory Kennelly
    • 1
  • Stephen J. Skehan
    • 4
  • Robert G. Gibney
    • 4
  • Arnold D. K. Hill
    • 1
  • Denis Evoy
    • 1
  • Enda W. McDermott
    • 1
  1. 1.Department of Breast & Endocrine SurgerySt. Vincents University HospitalDublin 4Ireland
  2. 2.Department of Medicine, Physiotherapy & Population Science, School of Public Health MedicineUniversity College DublinDublin 4Ireland
  3. 3.School of Medicine & Medical ScienceUniversity College DublinDublin 4Ireland
  4. 4.Department of RadiologySt. Vincents University HospitalDublin 4Ireland

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