Intraoperative parathyroid hormone assays
- Carmen C Solorzano, MD, FACS
Carmen C Solorzano, MD, FACS
- Professor of Surgery
- Vanderbilt University Medical Center
- Denise M Carneiro-Pla, MD, FACS
Denise M Carneiro-Pla, MD, FACS
- Associate Professor of Surgery
- Medical University of South Carolina
Surgical resection of abnormal parathyroid glands is the only curative treatment for primary hyperparathyroidism [1,2]. Abnormal parathyroid glands can be removed via bilateral neck exploration or focused parathyroidectomy.
The bilateral neck exploration approach relies on visual inspection of all parathyroid glands to ensure that all abnormal ones are removed [3,4]. The focused approach, however, does not require exposure of all glands. Thus, a focused parathyroidectomy requires nonvisual confirmation that all abnormal glands have been removed.
Intraoperative parathyroid hormone (PTH) monitoring leverages the short half-life of the PTH hormone (three to five minutes) to provide the necessary assurance that a focused parathyroidectomy has been adequately performed (ie, all hypersecreting glands have been removed) before concluding the surgery [5-8]. In addition, intraoperative PTH measurements accurately predict postoperative calcium levels [7,9-16].
The use of intraoperative PTH monitoring in patients with sporadic primary hyperparathyroidism will be reviewed here. Parathyroid surgery techniques, preoperative localization of parathyroid glands, and the medical management of hyperparathyroidism are discussed elsewhere. (See "Parathyroid exploration for primary hyperparathyroidism" and "Preoperative localization for parathyroid surgery in patients with primary hyperparathyroidism" and "Primary hyperparathyroidism: Management".)
INTRAOPERATIVE PTH ASSAY
Parathyroid hormone (PTH) assays measure circulating levels of parathyroid hormone. Because the half-life of the parathyroid hormone is very short (three to five minutes), the PTH level becomes a reliable surrogate for in vivo parathyroid function. (See "Parathyroid hormone assays and their clinical use".)
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- INTRAOPERATIVE PTH ASSAY
- INTRAOPERATIVE PTH MONITORING PROTOCOLS
- Commonly used protocols
- - Miami criterion protocol
- - Dual criteria protocol
- Other protocols
- - More stringent protocol
- - Less stringent protocol
- Technical and patient factors affecting all protocols
- Patients with secondary or hereditary hyperparathyroidism
- OTHER USES OF RAPID PTH ASSAYS
- Lateralization of hyperfunctioning parathyroid gland
- Missing glands
- Identifying parathyroid tissue
- SUMMARY AND RECOMMENDATIONS