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Patient demographics
Source publication
Purpose
The availability of intraoperative parathyroid hormone (IOPTH) monitoring allows successful focused parathyroidectomy for primary hyperparathyroidism (pHPT). The objective of this study was to report our initial experience in IOPTH monitoring during parathyroid surgery for primary hyperparathyroidsim.
Methods
Between May 2011 and February...
Contexts in source publication
Similar publications
Background:
Primary hyperparathyroidism is a common endocrine disorder produced by the increase of parathyroid hormone (PTH) due to a benign adenoma of a single parathyroid gland, or as multiple gland hyperplasia, or as a rare malignant tumor. Preoperative imaging scans are frequently necessary for the minimally invasive parathyroidectomies to ide...
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The aim of this study was to evaluate the possible association among sestamibi uptake and the main histopathological characteristics of parathyroid lesions related to aggressiveness such as the proliferation index (Ki67 expression and mitosis), angiogenesis (number of vessels), and vascular invasion in hyperparathyroidism patients. To this end, 26...
Objective:
To investigate the differences in biochemical marker levels and the extent of lesion visualization on technetium 99m methoxyisobutylisonitrile (99mTc-MIBI) imaging between primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT).
Methods:
Nineteen patients with PHPT and 14 patients with SHPT were enrolled in the stu...
Background:
18F-fluorocholine (FCH) PET/CT is a promising technique for visualizing hyperfunctioning parathyroid glands in hyperparathyroidism. It is still under debate whether to use this technique as a first-line imaging modality or to use it when conventional techniques such as 99mTc-sestamibi scintigraphy or ultrasonography are inconclusive. T...
Primary hyperparathyroidism (PHPT) is a rare endocrine disorder in children and adolescents. Surgery is curative in most pediatric patients with PHPT. PHPT due to ectopic parathyroid adenoma (EPA) presents the difficulty of their exact topographic diagnosis and there is no consensus for the optimal imaging modality. The 99mTc-sestamibi (99mTechneti...
Citations
... In that case, thyroid lobectomy of the suspected side should be performed. 10 This happened in our case where parathyroid adenoma was lying within the right lobe of thyroid gland and hemithyroidectomy explored the lesion. ...
We report a case of 66-year-old female, who presented with features of hypercalcemia and developed acute kidney injury (AKI). Parathyroid hormone level was raised up to 740 pg/ml. Ultrasound and sestamibi scan suggested presence of a right sided parathyroid adenoma. A decision of right sided parathyroidectomy was taken. The sample that was sent for frozen section showed only thyroid tissue. No macroscopically visible or palpable nodule suspected to be parathyroid adenoma could be found. So, a decision of right hemithyroidectomy was taken and done accordingly. On routine histopathology a solid gray white nodule was found within thyroid tissue and it was confirmed microscopically as parathyroid adenoma. BIRDEM Med J 2023; 13(2): 116-118
... The use of preoperative localization techniques has made the minimally focused approach to parathyroidectomy successful. When these localization techniques are concordant, they have a sensitivity as high as 94% (14,15); however, when they are discordant, the sensitivity can drop down to 77% (15). It is in these situations that IOPTH can be overtly useful. ...
... The use of preoperative localization techniques has made the minimally focused approach to parathyroidectomy successful. When these localization techniques are concordant, they have a sensitivity as high as 94% (14,15); however, when they are discordant, the sensitivity can drop down to 77% (15). It is in these situations that IOPTH can be overtly useful. ...
Background and aim:
The aim of the study was to determine the sensitivity, specificity and diagnostic accuracy of intra-operative parathyroid hormone (IOPTH) in patients undergoing surgery for primary hyperparathyroidism based on Miami criteria.
Methods:
A total of 107 medical records of patients who underwent surgery for primary hyperparathyroidism were reviewed from August 2018 to December 2021. Patients that underwent surgery for recurrent or persistent pHPT were excluded from the study and the following data was analysed: sex, age, pre-operative PTH and 10 minutes post excision PTH levels, type of surgery and histopathological features.
Results:
There was a greater number of women (79.5%) in the study with a mean age of 65.14 years. The mean preoperative PTH were 17.7 pmol/L while the mean intra-operative PTH following excision was 6.5 pmol/L. The sensitivity, specificity and diagnostic accuracy of intra-operative PTH were 86.14%, 100% and 86.9%, respectively.
Conclusion:
Intra-operative PTH is a valuable investigation that can guide successful parathyroidectomy.
... Because the incidence of HPT is very low, parathyroid surgery is performed in very few institutions in Korea [12,13,[15][16][17][18][19][20]. There are even fewer centers that use the IOPTH assay for monitoring for parathyroid surgery in Korea [21][22][23][24]. A single endocrine surgeon at our hospital has been performing parathyroid surgery using IOPTH since 2018, and we report our initial results of parathyroid surgery in this paper. ...
Background and Objectives: Hyperparathyroidism (HPT) is a rare endocrine disease associated with the elevated metabolism of calcium, vitamin D, and phosphate by the hyperfunctioning of the parathyroid glands. Here, we report our experience of parathyroidectomy using intraoperative parathyroid hormone (IOPTH) monitoring in a single tertiary hospital. Materials and Methods: From October 2018 to January 2022, a total of 47 patients underwent parathyroidectomy for HPT. We classified the patients into two groups—primary HPT (PHPT, n = 37) and renal HPT (RHPT, n = 10)—and then reviewed the patients’ data, including their general characteristics, laboratory results, and perioperative complications. Results: Thirty-five of the thirty-seven patients in the PHPT group underwent focused parathyroidectomy, while all ten patients in the RHPT group underwent subtotal parathyroidectomy. IOPTH monitoring based on the Milan criteria was used in all cases. Preoperative and 2-week, 6-month, and 12-month postoperative parathyroid hormone (PTH) levels were within the normal range in the PHPT group, whereas they were higher than normal in the RHPT group. Transient hypocalcemia occurred only in the RHPT group, with calcium levels returning to normal levels 12 months after surgery. Conclusions: Parathyroidectomy with IOPTH monitoring in our hospital showed favorable clinical outcomes. However, owing to the small number of patients due to the low frequency of parathyroid disease, long-term, prospective studies are needed in the future.
... The development and use of diagnostic imaging tools before surgery and ability to assess intraoperative PTH (IOPTH) during surgery have greatly contributed to minimally invasive surgery. The high success rate of minimally invasive surgery has been reported in several studies [5,6]. ...
Purpose:
The surgical success rate for primary hyperparathyroidism (PHPT) is currently 95%-98%. However, 3%-24% of patients show persistently elevated (Pe) parathyroid hormone (PTH) levels after parathyroidectomy (PTX). This single-center retrospective study aimed to compare the outcomes of patients with normal PTH and PePTH levels after successful PTX and to identify the factors associated with PePTH.
Methods:
The normal group, defined as patients with normal serum calcium and PTH levels immediately after PTX, was compared with the PePTH group (patients with normal or low serum calcium and increased serum PTH levels up to 6 months postoperatively) to determine the causes of disease in the PePTH group.
Results:
There were no significant differences in age, sex, or preoperative estimated glomerular filtration rate between the normal PTH group (333 of 364, 91.5%) and the PePTH group (31 of 364, 8.5%). However, there were significant differences in preoperative 25-hydroxyvitamin D (17.9 and 11.8 ng/mL, respectively; P = 0.003) and PTH levels (125.5 and 212.4 pg/mL, respectively; P < 0.001) between the 2 groups. Among the 31 cases of the PePTH group, 18 were attributed to vitamin D deficiency.
Conclusion:
Preoperative vitamin D deficiency is a predictive factor for PePTH. Therefore, preoperative administration of vitamin D supplements may reduce the probability of postoperative disease persistence. Patients with temporary laboratory abnormalities within 6 months after successful PTX should be monitored, and appropriate vitamin D and calcium supplementation may reduce the effort and cost of various examinations or reoperations.
... The iPTH was measured intraoperatively, and it was found to decreased from 140 pg/mL before incision to 26.69 pg/mL following the left thyroid resection. 4) In pathology, biopsies revealed an intrathyroidal parathyroid adenoma within the normal thyroid gland, with colloid follicles on the periphery. This was separated from fibrous tissue (Fig. 5A). ...
... To define the Bcured^status, we used the serum calcium normalization for normohormonal pHPT, and normalization of PTH in the normocalcemic form. Most studies used only normal serum calcium, therefore reporting much better cure rates [10], even those reporting MGD specifically [11] despite that the normocalcemic form is more represented in MGD than in SGD (26% versus 4.5% in our series). ...
Background
Mild primary hyperparathyroidism (serum calcium ≤ 2.85 mmol/L) is the most representative form of pHPT nowadays. The aim of this study was to evaluate its subtypes and the multiglandular disease (MGD) rate as it may lower the sensitivity of preoperative parathyroid scintigraphy and the surgical cure rate.
Methods
We retrospectively included patients with mild pHPT who underwent parathyroid dual-tracer scintigraphy with 99mTc-MIBI SPECT/CT and surgery between January 2013 and December 2015. Cure was defined as normalization of serum calcium (or PTH in the normocalcemic form) at 6 months. MGD was defined by either two abnormal resected glands or persistent disease after resection of at least one abnormal gland.
Results
We included 121 patients. Median preoperative serum calcium was 2.68 mmol/L and median PTH was 83.4 pg/mL. A total of 141 glands were resected (95 adenomas, 33 hyperplasias). The subtypes were 57% classic, 32.2% normohormonal, and 10.7% normocalcemic. MGD occurred in 23.5% of patients divided as 13%, 30%, and 64% respectively (p = 0.0011). The surgical cure rate was 85.2%.
The normocalcemic form had lower cure rate than the normohormonal (45% vs 84%, p = 0.018) and classic forms (45% vs 93%, p = 0.0006). MIBI scintigraphy identified at least one abnormal lesion, later confirmed by the pathologist in 90/98 patients, making the sensitivity per patient 91.8% (95% CI 84.1–96.2%).
Conclusions
MGD is strongly associated with mild pHPT, especially the normocalcemic form where it accounts for 64% of cases. Bilateral neck exploration should be performed in this population to improve the cure rate, even if the scintigraphy shows a single focus.
... This is a very reliable and fast technique, as PTH is rapidly metabolized. 32 If the levels do not drop to a normal range within 15 to 20 minutes, the surgeon generally considers exploring for a second adenoma. 32 These techniques are most useful when the adenoma is difficult to localize preoperatively, when it is not in the suspected location, or if there is a second adenoma. ...
... 32 If the levels do not drop to a normal range within 15 to 20 minutes, the surgeon generally considers exploring for a second adenoma. 32 These techniques are most useful when the adenoma is difficult to localize preoperatively, when it is not in the suspected location, or if there is a second adenoma. ...
Localization of parathyroid adenomas for treatment of primary hyperparathyroidism can be challenging. This retrospective study compared single-photon emission computed tomography/computed tomography (SPECT/CT), 4D-CT, and US studies in detection of adenomas prior to surgery. A retrospective chart review was performed on all consecutive patients with parathyroid adenoma presenting to an urban tertiary care medical center. A total of 58 patients (45 female, 13 male) underwent surgery for parathyroid adenoma. Patients aged 28 to 80 years (mean: 58.8) with parathyroid hormone levels ranging from 42 to 424 pg/mL (mean: 168). All patients underwent preoperative SPECT/CT with 20 mCi technetium-99m MIBI ( 99m Tc-MIBI). Fifty-three patients had additional US imaging and 14 patients had 4D-CT scans. Additionally, 34 patients had injection of 20 mCi 99m Tc-MIBI on the day of surgery. Pathological correlation was performed. Comparing SPECT/CT versus 4D-CT resulted in sensitivity (77% vs 80%), specificity (71% vs 75%), and accuracy (77% vs 79%). Ultrasound was less sensitive with similar specificity (44%, 86%, respectively). Combination of SPECT/CT and 4D-CT increased sensitivity to 88%, specificity to 100%, and accuracy to 89%. Combining SPECT/CT with US resulted in sensitivity of 85%, specificity of 83%, and accuracy of 85%. Intraoperative localization substantially improved in patients who received preoperative injections. The SPECT/CT remains the best imaging modality for preoperative localization of parathyroid adenomas with high sensitivity. Combining SPECT/CT with US resulted in increased sensitivity and accuracy. For suspicion of ectopic cases or suspicion of unidentifiable adenoma with negative scintigraphy, addition of 4D-CT is recommended. Intraoperative localization and adjunctive imaging may improve surgical management of patients with hyperparathyroidism.
... PTH is produced only in the parathyroid glands and the intact PTH has a half-life of <5 minutes. Therefore, blood concentrations of PTH will rapidly decrease shortly after removal of all overexpressing parathyroid tissues (37). Previous studies have shown that IOPTH levels can be used to predict surgical treatment. ...
Objective
To report findings of pilot study using a novel point of care (POC) intraoperative parathyroid hormone (IOPTH) assay for parathyroid hormone (PTH) using whole blood during surgery for primary hyperparathyroidism (PHPT).
Methods
Patients undergoing surgery for primary hyperparathyroidism from March to November 2022 where intraoperative PTH assay was performed using the NBCL CONNECT IOPTH and the laboratory PTH assay were included (group 1). The biochemistry results were reviewed to determine concordance between NBCL and lab PTH values and diagnostic test parameters of the NBCL CONNECT assay. ‘In-theatre’ times were then compared with a historical cohort (group 2) where the lab-based IOPTH assay alone was used.
Results
Of the 141 paired samples in group I, correlation between NBCL and the lab assay was high (rho=0.82; p<0.001). PTH levels using the NBCL assay dropped satisfactorily (>50% of the basal or 0 min sample; whichever was lower – i.e. positive test) in 23 patients; giving a positive predictive value of 100%. Of the 9 patients that did not demonstrate a drop, two were true negative (negative predictive value of 22%) leading to cure after excision of another gland. Group 1 (150 mins) had a significantly shorter ‘in-theatre’ time compared to group 2 (167 mins) (p=0.007); despite much higher use of near infra-red autofluorescence (NIRAF) (72% vs 11.6% in group I and 2 respectively).
Conclusion
The NBCL CONNECT POC IOPTH assay gives comparable results to lab based PTH assays and can be performed without need for a centrifuge or qualified technicians. Surgeons, however, need to be aware of the potential for false-negative results.
Intraoperative PTH monitoring (IOPTH) made minimally invasive parathyroidectomy in patients with primary HPT possible. However, with the increasing accuracy of preoperative localization studies there is a growing discussion if IOPTH is necessary in patients with localized single gland disease (concordant preoperative localization studies). Different interpretation criteria have been developed – each with their particular advantages and disadvantages, but the “perfect” criterion is still missing.
Despite several pitfalls, which can be recognized intraoperatively and do not necessarily lead to a more extensive surgery, IOPTH seems to be a useful adjunct in surgery for PHPT. However, according to current guidelines, selected patients may be operated without IOPTH but need to be informed about the possibly increased risk of recurrent disease.
