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Retrospective analysis of the role of intra-operative parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism: a single center experience over 2 decades

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Role of intra-operative parathyroid hormone (IOPTH) monitoring during parathyroidectomy for primary hyperparathyroidism (PHPT) has long been debated. Our main goal was to investigate the cure rates of parathyroidectomy for primary hyperparathyroidism with and without IOPTH monitoring. Our secondary goal was to investigate if operating room time can be saved when IOPTH monitoring is not used.

Methods

A retrospective analysis of patients who underwent parathyroidectomy for PHPT due to a single adenoma between 2004 and 2019 was performed. Cure rates and operating room time were compared.

Results

423 patients were included. IOPTH was used in 248 patients (59%). Four patients were not cured, two from each group, with no significant difference between the groups (98.8% vs. 99.1%, p = 0.725). Surgery time was significantly longer in the IOPTH group, p < 0.001.

Conclusions

There is no advantage for using IOPTH during parathyroidectomy in suitable clinical settings. The procedure may be safely performed without IOPTH while achieving non-inferior success rates and reducing operative time.

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References

  1. Yeh MW, Ituarte PHG, Zhou HC, Nishimoto S, Liu I-LA, Harari A, Haigh PI, Adams AL (2013) Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 98:1122–1129. https://doi.org/10.1210/jc.2012-4022

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ruda JM, Hollenbeak CS, Stack BC (2005) A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol-Head Neck Surg 132:359–372. https://doi.org/10.1016/j.otohns.2004.10.005

    Article  PubMed  Google Scholar 

  3. Day KM, Elsayed M, Monchik JM (2015) No need to abandon focused unilateral exploration for primary hyperparathyroidism with intraoperative monitoring of intact parathyroid hormone. J Am Coll Surg 221:518–523. https://doi.org/10.1016/j.jamcollsurg.2015.04.013

    Article  PubMed  Google Scholar 

  4. Udelsman R, Lin Z, Donovan P (2011) The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg 253:585–591. https://doi.org/10.1097/SLA.0b013e318208fed9

    Article  PubMed  Google Scholar 

  5. Carneiro-Pla DM, Solorzano CC, Irvin GL (2006) Consequences of targeted parathyroidectomy guided by localization studies without intraoperative parathyroid hormone monitoring. J Am Coll Surg 202:715–722. https://doi.org/10.1016/j.jamcollsurg.2006.02.003

    Article  PubMed  Google Scholar 

  6. Bachar G, Mizrachi A, Hadar T, Feinmesser R, Shpitzer T (2011) Role of parathyroid hormone monitoring during parathyroidectomy. Head Neck 33:1754–1757. https://doi.org/10.1002/hed.21666

    Article  PubMed  Google Scholar 

  7. Gawande AA, Monchik JM, Abbruzzese TA, Iannuccilli JD, Ibrahim SI, Moore FD (2006) Reassessment of parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism after 2 preoperative localization studies. Arch Surg (Chic Ill 1960) 141:381–384. https://doi.org/10.1001/archsurg.141.4.381 (discussion 384)

    Article  CAS  Google Scholar 

  8. Grant CS, Thompson G, Farley D, van Heerden J (2005) Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg (Chic Ill 1960) 140:472–478. https://doi.org/10.1001/archsurg.140.5.472 (discussion 478-479)

    Article  Google Scholar 

  9. Levy JM, Kandil E, Yau LC, Cuda JD, Sheth SN, Tufano RP (2011) Can ultrasound be used as the primary screening modality for the localization of parathyroid disease prior to surgery for primary hyperparathyroidism? A review of 440 cases. ORL J Oto-Rhino-Laryngol Its Relat Spec 73:116–120. https://doi.org/10.1159/000323912

    Article  Google Scholar 

  10. Bhansali A, Masoodi SR, Bhadada S, Mittal BR, Behra A, Singh P (2006) Ultrasonography in detection of single and multiple abnormal parathyroid glands in primary hyperparathyroidism: comparison with radionuclide scintigraphy and surgery. Clin Endocrinol (Oxf) 65:340–345. https://doi.org/10.1111/j.1365-2265.2006.02601.x

    Article  CAS  Google Scholar 

  11. Stern S, Tzelnick S, Mizrachi A, Cohen M, Shpitzer T, Bachar G (2018) Accuracy of neck ultrasonography in predicting the size and location of parathyroid adenomas. Otolaryngol-Head Neck Surg 159:968–972. https://doi.org/10.1177/0194599818792236

    Article  PubMed  Google Scholar 

  12. Coan KE, Yen TWF, Carr AA, Evans DB, Wang TS (2020) Confirmation of parathyroid tissue: are surgeons aware of new and novel techniques? J Surg Res 246:139–144. https://doi.org/10.1016/j.jss.2019.08.006

    Article  PubMed  Google Scholar 

  13. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 99:3561–3569. https://doi.org/10.1210/jc.2014-1413

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Riss P, Scheuba C, Asari R, Bieglmayer C, Niederle B (2009) Is minimally invasive parathyroidectomy without QPTH monitoring justified? Langenbecks Arch Surg 394:875–880. https://doi.org/10.1007/s00423-009-0505-9

    Article  PubMed  Google Scholar 

  15. Bergenfelz AOJ, Hellman P, Harrison B, Sitges-Serra A, Dralle H, European Society of Endocrine Surgeons (2009) Positional statement of the European Society of Endocrine Surgeons (ESES) on modern techniques in pHPT surgery. Langenbecks Arch Surg 394:761–764. https://doi.org/10.1007/s00423-009-0533-5

    Article  PubMed  Google Scholar 

  16. Helbrow J, Owais AE, Sidwell AG, Frank LM, Lucarotti ME (2016) The use of intraoperative parathyroid hormone monitoring in minimally invasive parathyroid surgery. Ann R Coll Surg Engl 98:516–519. https://doi.org/10.1308/rcsann.2016.0201

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Sartori PV, Saibene AM, Leopaldi E, Boniardi M, Beretta E, Colombo S, Morenghi E, Pauna J, De Pasquale L (2019) Intraoperative parathyroid hormone testing in primary hyperparathyroidism surgery: time for giving up? Eur Arch Oto-Rhino-Laryngol 276:267–272. https://doi.org/10.1007/s00405-018-5179-x

    Article  Google Scholar 

  18. Suliburk JW, Sywak MS, Sidhu SB, Delbridge LW (2011) 1000 minimally invasive parathyroidectomies without intra-operative parathyroid hormone measurement: lessons learned. ANZ J Surg 81:362–365. https://doi.org/10.1111/j.1445-2197.2010.05488.x

    Article  PubMed  Google Scholar 

  19. Najafian A, Kahan S, Olson MT, Tufano RP, Zeiger MA (2017) Intraoperative PTH may not be necessary in the management of primary hyperparathyroidism even with only one positive or only indeterminate preoperative localization studies. World J Surg 41:1500–1505. https://doi.org/10.1007/s00268-017-3871-4

    Article  PubMed  Google Scholar 

  20. Nair CG, Babu MJC, Jacob P, Menon R, Mathew J (2016) Is intraoperative parathyroid hormone monitoring necessary in symptomatic primary hyperparathyroidism with concordant imaging? Indian J Endocrinol Metab 20:512–516. https://doi.org/10.4103/2230-8210.183451

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Norman J, Lopez J, Politz D (2012) Abandoning unilateral parathyroidectomy: why we reversed our position after 15,000 parathyroid operations. J Am Coll Surg 214:260–269. https://doi.org/10.1016/j.jamcollsurg.2011.12.007

    Article  PubMed  Google Scholar 

  22. Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin GL (2003) Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery 134:973–979. https://doi.org/10.1016/j.surg.2003.06.001 (discussion 979-981)

    Article  PubMed  Google Scholar 

  23. Morris LF, Zanocco K, Ituarte PHG, Ro K, Duh Q-Y, Sturgeon C, Yeh MW (2010) The value of intraoperative parathyroid hormone monitoring in localized primary hyperparathyroidism: a cost analysis. Ann Surg Oncol 17:679–685. https://doi.org/10.1245/s10434-009-0773-1

    Article  PubMed  Google Scholar 

  24. Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA (2011) Would scan, but which scan? A cost-utility analysis to optimize preoperative imaging for primary hyperparathyroidism. Surgery 150:1286–1294. https://doi.org/10.1016/j.surg.2011.09.016

    Article  PubMed  Google Scholar 

  25. Badii B, Staderini F, Foppa C, Tofani L, Skalamera I, Fiorenza G, Qirici E, Cianchi F, Perigli G (2017) Cost-benefit analysis of the intraoperative parathyroid hormone assay in primary hyperparathyroidism. Head Neck 39:241–246. https://doi.org/10.1002/hed.24567

    Article  PubMed  Google Scholar 

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Funding

The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel

    Yehonatan Adler, Sharon Tzelnick, Yoni Shopen, Ella Reifen, Gideon Bachar, Thomas Shpitzer & Aviram Mizrachi

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yehonatan Adler, Sharon Tzelnick, Yoni Shopen, Ella Reifen, Gideon Bachar, Thomas Shpitzer & Aviram Mizrachi

Authors
  1. Yehonatan Adler
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  2. Sharon Tzelnick
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  3. Yoni Shopen
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  5. Gideon Bachar
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  6. Thomas Shpitzer
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  7. Aviram Mizrachi
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Contributions

YA contributed to the study conception and design; acquisition, analyses and interpretation of the data; and drafting of the article. ST contributed to the design of the work; acquisition, analyses and interpretation of the data. YS, ER, GB and TS contributed to the acquisition, analyses and interpretation of the data. AM contributed to the study conception and design; acquisition, analyses and interpretation of the data; and drafting of the article. All authors read and approved the final manuscript.

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Correspondence to Aviram Mizrachi.

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Adler, Y., Tzelnick, S., Shopen, Y. et al. Retrospective analysis of the role of intra-operative parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism: a single center experience over 2 decades. Eur Arch Otorhinolaryngol 279, 5375–5380 (2022). https://doi.org/10.1007/s00405-022-07440-5

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  • DOI: https://doi.org/10.1007/s00405-022-07440-5

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