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Year : 2022  |  Volume : 28  |  Issue : 2  |  Page : 178-181

Intraoperative parathyroid hormone assay to guide completion of parathyroid surgery

Department of General Surgery, KIMSHEALTH Hospital, Thiruvananthapuram, Kerala, India

Correspondence Address:
Dr. S Shaju
Department of General Surgery, KIMSHEALTH Hospital, Thiruvananthapuram - 695 029, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ksj.ksj_40_22

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Introduction: Primary hyperparathyroidism (pHPT) is characterised by an autonomous production of parathyroid hormone (PTH), which causes hypercalcemia. It is classified into adenoma, glandular hyperplasia and carcinoma. The standard treatment for the pHPT has been bilateral neck exploration (BNE) and the visualisation of all parathyroid glands. However, the increasing sensitivity of pre-operative localisation methods such as 99Tc-sestamibi scanning and ultrasound in combination with intra-operative PTH monitoring (ioPTH) assay can be utilised to decrease the need of BNE and subsequent complications. The aim of the study was to determine the effectiveness of ioPTH during parathyroidectomy and to assess the effectiveness of ioPTH in surgery for pHPT. Materials and Methods: Thirty-one patients admitted to the general surgery department in our tertiary care centre with hyper-parathyroidism and underwent parathyroidectomy, whose ioPTH evaluation was done were considered for the study. Their pre-operative and post-excision (10 min after excision of suspicious gland) values of PTH were as noted. Reduction in ioPTH value, based on MIAMI criteria was considered as the eradication of hyper-functioning tissues and its effectiveness in confirming the success of pHPT-surgery in terms of post-operative serum calcium level, thereby evaluating MIAMI criteria. Results: Twenty-nine (90.6%) patients showed a reduction of more than 50% in PTH following excision of suspicious glands from pre-operative PTH which is statistically significant, whereas only 21 (65.6%) patient shows normal PTH value following excision of suspicious gland. However, all 31 patients showed decline in PTH value as compared to pre-excision value. Conclusion: When the abnormal parathyroid gland is excised, there will be the reduction of PTH more than 50% from their pre-excisional value. Hence, by utilising ioPTH assay to confirm the excision of pathological gland, we can reduce BNE.

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