Operative success is achieved regardless of ioPTH criterion used during focused parathyroidectomy for sporadic primary hyperparathyroidism

• Published in: The American journal of surgery Vol. 226; no. 5; pp. 604 - 608
• Main Authors: Vaghaiwalla, Tanaz M., Armstrong, Valerie L., Saghira, Cima, Lew, John I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2023; Elsevier Limited
• Subjects: Criteria; Endocrine system; Failure; Failure rates; Hyperparathyroidism; Intraoperative PTH monitoring; ioPTH criterion; Localization; Monitoring; Parathyroidectomy; Sporadic primary hyperparathyroidism; Surgical outcomes; Telemedicine; Tumors; Ultrasonic imaging; ioPTH criterion; Sporadic primary hyperparathyroidism; Intraoperative PTH monitoring; Parathyroidectomy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2023.06.031

Focused parathyroidectomy (F-PTX) guided by intraoperative parathormone (ioPTH) monitoring may result in higher operative failure rates from missed multiglandular disease (MGD) in patients with sporadic primary hyperparathyroidism (spHPT) when ioPTH levels do not reach normal range.
A retrospective review included 690 patients with spHPT who underwent F-PTX and ioPTH monitoring were divided into 2 groups: >50% ioPTH decrease to normal range, and >50% ioPTH decrease to above normal range. Operative success, recurrence, bilateral/unilateral neck exploration (BNE/UNE), MGD were evaluated.
533 patients demonstrated >50% ioPTH decrease to normal range, and 157 patients >50% ioPTH decrease to above normal range. There were no differences in operative success 99% vs. 97%, recurrence 2.5% vs. 5%, BNE 12% vs. 11%, UNE 4% vs. 5%, or MGD 4% vs. 4%, (p > 0.05) with 46 months mean follow-up.
There were no differences in operative success, failure, BNE, UNE or MGD regardless of ioPTH criterion used for F-PTX.
[Display omitted]
•Primary sporadic hyperparathyroidism is a common cause of hypercalcemia.•Parathyroid surgery remains the only cure for primary sporadic hyperparathyroidism.•Miami criterion achieves operative success rates of 99% after parathyroidectomy.•Stricter criterion was not superior to Miami criterion to predict surgical success.