Use of a Rapid Intraoperative Parathyroid Hormone Assay in the Surgical Management of Parathyroid Disease | Endocrine Surgery | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Biller  HFStrashun  AGoldsmith  SJBergman  D Preoperative parathyroid adenoma localization by the technetium-thallium subtraction scan.  Laryngoscope. 1986;961363- 1365Google Scholar
Russell  CFJLaird  JDFerguson  WR Scan-directed unilateral cervical exploration for parathyroid adenoma: a legitimate approach?  World J Surg. 1990;14406- 409Google ScholarCrossref
Sofferman  RANathan  MHFairbank  JTFoster  RSKrag  DN Preoperative technetium Tc 99m sestamibi imaging: paving the way to minimal-access parathyroid surgery.  Arch Otolaryngol Head Neck Surg. 1996;122369- 374Google ScholarCrossref
Proye  CAGCarnaille  BBizard  JPQuievreux  JLLecomte-Houcke  M Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited: where are we in the early 1990s? a plea against unilateral parathyroid exploration.  Surgery. 1992;1121118- 1122Google Scholar
Bonjer  HJBruining  HABirkenhager  JC  et al.  Single and multigland disease in primary hyperparathyroidism: clinical follow-up, histopathology, and flow cytometric DNA analysis.  World J Surg. 1992;16737- 744Google ScholarCrossref
Shaha  ARJaffe  BM Cervical exploration for primary hyperparathyroidism.  J Surg Oncol. 1993;5214- 17Google ScholarCrossref
Nussbaum  SRThompson  ARHutcheson  KAGaz  RDWang  C Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism.  Surgery. 1988;1041121- 1127Google Scholar
Irvin  GLDembrow  VDPrudhomme  DL Clinical usefulness of an intraoperative "quick parathyroid hormone" assay.  Surgery. 1993;1141019- 1023Google Scholar
Irvin  GLPrudhomme  DLDeriso  GTSfakianakis  GChandarlapaty  SKC A new approach to parathyroidectomy.  Ann Surg. 1994;219574- 581Google ScholarCrossref
Fleetwood  MKQuinton  LWolfe  JMaturani  DSpandra  BLebo  R Rapid PTH assay by simple modification of nichols intact PTH-parathyroid hormone assay kit.  Clin Chem. 1996;421498Google Scholar
Kao  PCVan Heerden  JATaylor  RL Intraoperative monitoring of parathyroid procedures by a 15-minute parathyroid hormone immunochemiluminometric assay.  Mayo Clin Proc. 1994;69532- 537Google ScholarCrossref
Shaha  ARSarkar  SStrashun  AYeh  S Sestamibi scan for preoperative localization in primary hyperparathyroidism.  Head Neck. 1997;1987- 91Google ScholarCrossref
Wei  JPBurke  GJMansberger  AP  Jr Prospective evaluation of the efficacy of technetium 99m sestamibi and iodine 123 radionuclide imaging of abnormal parathyroid glands.  Surgery. 1992;1121111- 1117Google Scholar
Original Article
May 1998

Use of a Rapid Intraoperative Parathyroid Hormone Assay in the Surgical Management of Parathyroid Disease

Author Affiliations

From the Departments of Otolaryngology–Head and Neck Surgery (Drs P. C. Patel, Pellitteri, and N. M. Patel) and Laboratory Medicine (Dr Fleetwood), Penn State Geisinger Health System, Danville, Pa.

Arch Otolaryngol Head Neck Surg. 1998;124(5):559-562. doi:10.1001/archotol.124.5.559

Objective  To evaluate the utility of a rapid intraoperative parathyroid hormone (PTH) immunoradiometric assay in the surgical management of parathyroid disease, particularly with reference to limiting extent of cervical exploration.

Design  Nonrandomized prospective study.

Setting  Academic tertiary care center.

Patients  Forty-three consecutive patients undergoing parathyroid exploration for adenoma or hyperplasia had rapid PTH assays performed from blood drawn at induction and 7 minutes after resection of all hyperfunctioning parathyroid tissue.

Outcome Measures  Excision of all hyperfunctioning parathyroid tissue as assessed by bilateral neck exploration, postoperative normalization of serum calcium and PTH levels, and resolution of clinical symptoms.

Results  The intraoperative rapid PTH assay accurately reflected whether all hyperfunctioning parathyroid tissue was excised in every patient. In 41 patients, all hyperfunctioning parathyroid tissue was resected at the time of surgery and confirmed by a corresponding decrease in the intraoperative postexcision rapid PTH determination as well as by subsequent normalization of postoperative serum calcium and PTH levels and resolution of clinical symptoms. In 2 patients, the postexcision rapid PTH assay determination was not consistent with removal of all hyperfunctioning parathyroid disease and both patients demonstrated persistent hyperparathyroidism postoperatively.

Conclusions  The intraoperative rapid PTH assay may be of significant benefit in permitting directed unilateral parathyroid explorations for adenoma when combined with preoperative localization with a technetium-99m sestamibi scan. Additionally, the rapid PTH assay has proved to be of benefit in confirming excision of all hyperfunctioning parathyroid tissue in patients with multiple gland hyperplasia, particularly those who may harbor ectopic parathyroid tissue.