Use of intraoperative measurement of parathyroid hormone levels to predict the success of parathyroidectomy for primary hyperparathyroidism

Summary

Introduction: Primary hyperparathyroidism is the third most common endocrine disorder, which is caused by overproduction of parathyroid hormone by hyperfunctioning parathyroid glands. Surgical removal of hyperfunctioning parathyroid glands is the definitive first-line treatment for primary hyperparathyroidism. Bilateral neck exploration has been the most frequently described approach in the literature. Due to the development of localization imaging, targeted parathyroidectomy is increasingly being approached. Many authors report the use of intraoperative measurement of parathyroid hormone levels (ioPTH) as an essential component of targeted parathyroidectomy to confirm intraoperative complete removal of all hyperfunctioning parathyroid tissue. Intraoperatively, the success of surgery is most often assessed according to the Miami criteria with a sensitivity of 97%. Aim: The aim of this study is to retrospectively analyze the perioperatively measured parathyroid hormone levels in our cohort formed between 2020 and 2023. To learn about the dynamics of parathyroid hormone levels during parathyroidectomy and to analyze with what sensitivity the definitive success of parathyroidectomy for primary hyperparathyroidism can be predicted according to the perioperative decrease in parathyroid hormone levels. Methodology and description of the cohort: The analyzed cohort includes 75 patients. The data available for this retrospective analysis are preoperative parathyroid hormone levels, perioperatively measured parathyroid hormone levels at 5^th, 10^th, and 15^th minutes, and parathyroid hormone levels on the third postoperative day. We evaluated the perioperative decrease in parathyroid hormone according to the Miam criteria and their modifications. We evaluated the sensitivity, specificity, and accuracy with which the criteria predicted the definitive success of the operation. Results: To analyze the data, we established six criteria for measuring perioperative parathyroid hormone. The resulting criterion has a sensitivity of 98%. Conclusion: Retrospective data analysis is useful for understanding the peroperative perioperative dynamics of parathyroid hormone levels and for the informed setting of criteria to predict intraoperative surgical success.

Keywords:

monitoring – Parathyroid hormone – parathyroidectomy – intraoperative