Abstract
Objective: Better understand the relationships of parathyroid hormone production (PTH), adenoma gamma counts, and adenoma weight in patients undergoing minimally invasive parathyroidectomy for primary hyperparathyroidism due to single gland disease.
Method: A retrospective review of 68 patients that had minimally invasive parathyroid surgery for single gland disease. All patients underwent intraoperative PTH monitoring as well as radioguided parathyroid surgery. All glands were weighed and examined by a pathologist.
Results: Adenoma weight was 0.58 gms ± 0.44 gms. Day of surgery preoperative PTH was 132 ± 68 pg/mL. Intraoperative PTH level dropped to 35 ± 22 pg/mL. The drop in PTH was 72.1 ± 17.2 %. Ex-vivo gamma counts of the adenomas were 2233 counts per second ± 2058. Percentage of background for the adenoma was 107.2 ± 86.8%. Correlations between the preoperative PTH and percentage of background gamma counts showed a likely correlation. There were significant correlations between both percentage of background and preoperative PTH levels with adenoma weight and preoperative PTH and adenoma weight.
Conclusion: Correlation exists between gland weight, radioactivity, and PTH. Radiation counts are not a proxy for changes in PTH levels as claimed by some authors. A radioguided parathyroid surgery technique and intraoperative parathyroid hormone measurements can provide complementary information in making an assessment of completion of focused/minimally invasive parathyroid procedures.
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