Abstract
F Zawawi, AM Mlynarek, A Cantor, et al.
J Otolaryngol Head Neck Surg 2013; 19: 42–56
Intraoperative parathyroid hormone (ioPTH) measurement is widely used to confirm the successful gland excision during parathyroidectomy. However, ioPTH measurement is costly and its use may contribute to increased operating theatre time. This study aimed to determine whether the use of ioPTH is justified for all routine cases.
A total of 211 patients undergoing parathyroidectomies for PHPT for were recruited from McGill University Thyroid Cancer Centre between January 2007 and December 2012. Patients were imaged by ultrasound and Technetium (99mTc) sestamibi scan prior to surgery with non-concordant results confirmed by magnetic resonance imaging. Serum PTH was measured prior to the initiation of surgery and at 12 min post-gland excision using a Cobas 8000 analyser. A decrease in ioPTH to less than 50% of the pre-excision level indicated successful removal of the hyperactive gland. On excision, the suspected adenoma was also sent for frozen section analysis.
ioPTH measurement led to a change in management in only four of 211 (2%) patients. Patients in whom an adenoma was localised preoperatively by two concordant imaging results (186 of 211 patients) benefited less from ioPTH compared to patients whose imaging did not confirm adenoma localisation. ioPTH was considered useful in two of 186 (1.08%) patients with preoperative localisation and two of 25 patients (8%) without adequate preoperative localisation (P = 0.017).
These results raise questions regarding the clinical utility of ioPTH measurement in patients where preoperative localisation of the hyperactive gland has been confirmed by two modalities of investigation.