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Invited Critique
Nov 2012

Need for Randomized Clinical Trials on Intraoperative Parathyroid Hormone Kinetics: Comment on “Impact of Race on Intraoperative Parathyroid Hormone Kinetics”

Arch Surg. 2012;147(11):1041. doi:10.1001/archsurg.2012.1496

The use of intraoperative PTH testing to assure that no abnormally functioning parathyroids remain in the patient after removal of 1 parathyroid adenoma has slipped into widespread clinical use. In my opinion, this is unfortunate since the outcomes of this strategy have not been subjected to randomized clinical trials. Observational studies from the active, experienced, and world-renowned endocrine surgeons at the University of California, San Francisco have demonstrated less than 50% predictive success rate in patients with double parathyroid adenomas, a 13% false-negative rate with single parathyroid adenomas, a negative influence of hemolysis on the reliability of IOPTH measurement, and now the suggestion that race and BMI may impact PTH kinetics.1