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Difficult Decisions in Endocrine Surgery pp 291–300Cite as

The Value of Intraoperative Parathyroid Hormone Monitoring in Primary Hyperparathyroidism Cases That Are Localized with Two Imaging Studies

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Minimally invasive parathyroidectomy has become a preferred approach for primary hyperparathyroidism in patients with a single parathyroid adenoma. Preoperative localization studies and intraoperative parathyroid hormone (ioPTH) are important adjuncts, with surgeons often relying on ioPTH to confirm cure. The utility of ioPTH in patients with two concordant preoperative localization studies that accurately predict single parathyroid adenomas, remains controversial. This chapter explores the evidence for the use of ioPTH is this setting.

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References

  1. Yeh MW, Ituarte PH, Zhou HC, Nishimoto S, Liu IL, Harari A, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122–9. https://doi.org/10.1210/jc.2012-4022. PMID: 23418315; PMCID: PMC3590475.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  2. Press DM, Siperstein AE, Berber E, Shin JJ, Metzger R, Monteiro R, et al. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery. 2013;154(6):1232–7. discussion 7-8. PMID: 24383100.

    Article  PubMed  Google Scholar 

  3. Bilezikian JP, Khan AA, Potts JT Jr. Third International Workshop on the Management of Asymptomatic Primary H. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94(2):335–9. https://doi.org/10.1210/jc.2008-1763. PMID: 19193908; PMCID: PMC3214274.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  4. Silverberg SJ, Bilezikian JP. Asymptomatic primary hyperparathyroidism: a medical perspective. Surg Clin North Am. 2004;84(3):787–801. https://doi.org/10.1016/j.suc.2004.03.002. PMID: 15145235.

    Article  PubMed  Google Scholar 

  5. Irvin GL 3rd, Prudhomme DL, Deriso GT, Sfakianakis G, Chandarlapaty SK. A new approach to parathyroidectomy. Ann Surg. 1994;219(5):574–9. discussion 9-81. PMID: 8185406; PMCID: PMC1243192.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Irvin GL 3rd, Solorzano CC, Carneiro DM. Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg. 2004;28(12):1287–92. https://doi.org/10.1007/s00268-004-7708-6. PMID: 15517474.

    Article  PubMed  Google Scholar 

  7. Norman J, Chheda H, Farrell C. Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results. Am Surg. 1998;64(5):391–5. discussion 5-6. PMID: 9585770.

    CAS  PubMed  Google Scholar 

  8. Smith N, Magnuson JS, Vidrine DM, Kulbersh B, Peters GE. Minimally invasive parathyroidectomy: use of intraoperative parathyroid hormone assays after 2 preoperative localization studies. Arch Otolaryngol Head Neck Surg. 2009;135(11):1108–11. https://doi.org/10.1001/archoto.2009.160. PMID: 19917923.

    Article  PubMed  Google Scholar 

  9. Lew JI, Solorzano CC, Montano RE, Carneiro-Pla DM, Irvin GL 3rd. Role of intraoperative parathormone monitoring during parathyroidectomy in patients with discordant localization studies. Surgery. 2008;144(2):299–306. https://doi.org/10.1016/j.surg.2008.03.039. PMID: 18656639.

    Article  PubMed  Google Scholar 

  10. Carneiro DM, Irvin GL 3rd. Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration. Surgery. 2000;128(6):925–9. https://doi.org/10.1067/msy.2000.109964. discussion 35-6. PMID: 11114625.

    Article  CAS  PubMed  Google Scholar 

  11. Sokoll LJ, Drew H, Udelsman R. Intraoperative parathyroid hormone analysis: a study of 200 consecutive cases. Clin Chem. 2000;46(10):1662–8. PMID: 11017947.

    CAS  PubMed  Google Scholar 

  12. Delbridge LW, Dolan SJ, Hop TT, Robinson BG, Wilkinson MR, Reeve TS. Minimally invasive parathyroidectomy: 50 consecutive cases. Med J Aust. 2000;172(9):418–22. PMID: 10870533.

    CAS  PubMed  Google Scholar 

  13. Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin GL 3rd. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery. 2003;134(6):973–9. https://doi.org/10.1016/j.surg.2003.06.001. discussion 9-81. PMID: 14668730.

    Article  PubMed  Google Scholar 

  14. Di Stasio E, Carrozza C, Pio Lombardi C, Raffaelli M, Traini E, Bellantone R, et al. Parathyroidectomy monitored by intra-operative PTH: the relevance of the 20 min end-point. Clin Biochem. 2007;40(9–10):595–603. https://doi.org/10.1016/j.clinbiochem.2006.12.007. PMID: 17349989.

    Article  CAS  PubMed  Google Scholar 

  15. Morris LF, Zanocco K, Ituarte PH, Ro K, Duh QY, Sturgeon C, et al. The value of intraoperative parathyroid hormone monitoring in localized primary hyperparathyroidism: a cost analysis. Ann Surg Oncol. 2010;17(3):679–85. https://doi.org/10.1245/s10434-009-0773-1. Epub 2009/11/04. PMID: 19885701; PMCID: PMC2820694.

    Article  PubMed  Google Scholar 

  16. Irvin GL 3rd, Dembrow VD, Prudhomme DL. Clinical usefulness of an intraoperative “quick parathyroid hormone” assay. Surgery. 1993;114(6):1019–22. discussion 22-3. PMID: 8256205.

    PubMed  Google Scholar 

  17. Richards ML, Thompson GB, Farley DR, Grant CS. An optimal algorithm for intraoperative parathyroid hormone monitoring. Arch Surg. 2011;146(3):280–5. https://doi.org/10.1001/archsurg.2011.5. PMID: 21422358.

    Article  PubMed  Google Scholar 

  18. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery. 2012;152(6):1008–15. https://doi.org/10.1016/j.surg.2012.08.022. PMID: 23063313; PMCID: PMC3501613.

    Article  PubMed  Google Scholar 

  19. Greene AB, Butler RS, McIntyre S, Barbosa GF, Mitchell J, Berber E, et al. National trends in parathyroid surgery from 1998 to 2008: a decade of change. J Am Coll Surg. 2009;209(3):332–43. https://doi.org/10.1016/j.jamcollsurg.2009.05.029. PMID: 19717037.

    Article  PubMed  Google Scholar 

  20. Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005;138(4):583–7.; discussion 7-90. Epub 2005/11/05. PMID: 16269285. https://doi.org/10.1016/j.surg.2005.06.046.

    Article  PubMed  Google Scholar 

  21. Gawande AA, Monchik JM, Abbruzzese TA, Iannuccilli JD, Ibrahim SI, Moore FD Jr. Reassessment of parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism after 2 preoperative localization studies. Arch Surg. 2006;141(4):381–4. https://doi.org/10.1001/archsurg.141.4.381. discussion 4. Epub 2006/04/19. PMID: 16618896.

    Article  CAS  PubMed  Google Scholar 

  22. Cho NL, Gawande AA, Sheu EG, Moore FD Jr, Ruan DT. Critical role of identification of the second gland during unilateral parathyroid surgery: a prospective review of 119 patients with concordant localization. Arch Surg. 2011;146(5):512–6. https://doi.org/10.1001/archsurg.2011.91. Epub 2011/05/18. PMID: 21576603.

    Article  PubMed  Google Scholar 

  23. Mihai R, Palazzo FF, Gleeson FV, Sadler GP. Minimally invasive parathyroidectomy without intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism. Br J Surg. 2007;94(1):42–7. Epub 2006/11/04. PMID: 17083106. https://doi.org/10.1002/bjs.5574.

    Article  CAS  PubMed  Google Scholar 

  24. Zawawi F, Mlynarek AM, Cantor A, Varshney R, Black MJ, Hier MP, et al. Intraoperative parathyroid hormone level in parathyroidectomy: which patients benefit from it? J Otolaryngol Head Neck Surg. 2013;42:56. https://doi.org/10.1186/1916-0216-42-56. Epub 2013/12/20. PMID: 24350891; PMCID: PMC3878236.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Deutmeyer C, Weingarten M, Doyle M, Carneiro-Pla D. Case series of targeted parathyroidectomy with surgeon-performed ultrasonography as the only preoperative imaging study. Surgery. 2011;150(6):1153–60. Epub 2011/12/06. PMID: 22136835. https://doi.org/10.1016/j.surg.2011.09.041.

    Article  PubMed  Google Scholar 

  26. Solorzano CC, Lee TM, Ramirez MC, Carneiro DM, Irvin GL. Surgeon-performed ultrasound improves localization of abnormal parathyroid glands. Am Surg. 2005;71(7):557–62. discussion 62-3. Epub 2005/08/11. PMID: 16089118.

    PubMed  Google Scholar 

  27. Aliyev S, Agcaoglu O, Aksoy E, Birsen O, Milas M, Mitchell J, et al. An analysis of whether surgeon-performed neck ultrasound can be used as the main localizing study in primary hyperparathyroidism. Surgery. 2014;156(5):1127–31. Epub 2014/12/03. PMID: 25444313. https://doi.org/10.1016/j.surg.2014.05.009.

    Article  PubMed  Google Scholar 

  28. Adler JT, Chen H, Schaefer S, Sippel RS. What is the added benefit of cervical ultrasound to (9)(9)mTc-sestamibi scanning in primary hyperparathyroidism? Ann Surg Oncol. 2011;18(10):2907–11. Epub 2011/04/22. PMID: 21509629. https://doi.org/10.1245/s10434-011-1724-1.

    Article  PubMed  Google Scholar 

  29. Alkhalili E, Tasci Y, Aksoy E, Aliyev S, Soundararajan S, Taskin E, et al. The utility of neck ultrasound and Sestamibi scans in patients with secondary and tertiary hyperparathyroidism. World J Surg. 2014;39(3):701–5. Epub 2014/11/21. PMID: 25409841. https://doi.org/10.1007/s00268-014-2878-3.

    Article  Google Scholar 

  30. Morita SY, Somervell H, Umbricht CB, Dackiw AP, Zeiger MA. Evaluation for concomitant thyroid nodules and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Surgery. 2008;144(6):862–6.; discussion 6-8. Epub 2008/12/02. PMID: 19040989. https://doi.org/10.1016/j.surg.2008.07.029.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of GI/Endocrine Surgery, Columbia University, New York, NY, USA

    Jennifer H. Kuo

  2. Department of Surgery, University of California, San Francisco/Mt. Zion Medical Center, San Francisco, CA, USA

    Wen T. Shen

Authors
  1. Jennifer H. Kuo
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  2. Wen T. Shen
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Corresponding author

Correspondence to Wen T. Shen .

Editor information

Editors and Affiliations

  1. Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA

    Peter Angelos

  2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Raymon H. Grogan

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Kuo, J.H., Shen, W.T. (2018). The Value of Intraoperative Parathyroid Hormone Monitoring in Primary Hyperparathyroidism Cases That Are Localized with Two Imaging Studies. In: Angelos, P., Grogan, R. (eds) Difficult Decisions in Endocrine Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-92860-9_24

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  • DOI: https://doi.org/10.1007/978-3-319-92860-9_24

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92858-6

  • Online ISBN: 978-3-319-92860-9

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