Kristen L. Kraimer, MD: No relevant relationships to disclose.
Maisie L. Shindo, MD: No relevant relationships to disclose.
Introduction: While intraoperative parathyroid hormone (ioPTH) assay is a widely used practice in parathyroid surgeries, recent retrospective studies have shown that its use resulted in conversion to further exploration in only 3% of patients with preoperatively localized single adenomas. In this study, we aimed to evaluate failure rates when ioPTH was not utilized during targeted parathyroidectomies.
Methods: This is a retrospective review of prospectively collected data from a single tertiary care institution. The electronic medical record (EMR) was reviewed on consecutive patients selected to undergo targeted parathyroidectomy for primary hyperparathyroidism between 2016-2022. All patients were selected based on no risk of multiglandular disease on clinical assessment and identification of only a single adenoma on ultrasound performed by the senior surgeon. The patients’ identifying information was recorded in an IRB approved database. IoPTH assays were not used for these patients. Postoperative calcium and PTH were checked 3-5 days postoperatively. The EMR was queried for initial and at least six month lab results to determine rates of persistent and recurrent disease.
Results: 152 patients were included in the study. Mean age was 64 years and 86% were female. The mean preoperative PTH was 122.2 (STD 46.3). Average volume of the adenoma was 0.33 ml (STD 0.35 ml). All of the patients had a preoperative ultrasound that demonstrated an adenoma. Forty percent of patients also had a prior sestamibi scan. Of these, 43% did not localize an adenoma candidate. Follow up calcium data was available for a mean of 27 months (STD 23.3 months, range 0-87 months). None of the patients required re-operation or additional workup for primary hyperparathyroidism. All patients had immediate biochemical cure and none developed recurrent disease during the follow up period of the study.
Conclusions: This study demonstrates that in carefully selected patients, in which a single targeted lesion is identified on ultrasound performed by experienced surgeons, ioPTH may not be necessary. This approach can decrease operating room time and cost.
