Intraoperative PTH spikes during parathyroidectomy may be associated with multiglandular disease

Richard Teo, Josefina C. Farrá, Zahra F. Khan, Andrea R. Marcadis, John Lew

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3 Citations (Scopus)

Abstract

Background: The importance of intraoperative parathormone (ioPTH) "spikes" during parathyroidectomy (PTX) remains unclear. This study compared patients with and without ioPTH spikes during PTX using the criterion of a > 50% PTH, and determined the effect of ioPTH spikes on operative outcome. Methods: We performed a retrospective review of prospectively collected data of 683 patients who underwent PTX guided by ioPTH monitoring. An ioPTH "spike value' (SV) was calculated by subtracting the pre-incision ioPTH value (PI) from pre-excision ioPTH value (PE) (SV = PE - PI). An ioPTH spike was defined as having a positive SV ≥9 pg/ml (≥10th percentile of all SVs). Results: Of 683 patients, 224 (33%) had ioPTH spikes, and a gretrate of multigland disease (MGD; 8%vs. 3%, p < 0.05) and bilateral neck exploration (BNE) (10% vs. 5%, p < 0.05) compared to patients without ioPTH spikes. Overall, there were no differences between PTX patients with and without ioPTH spikes in terms of operative success (98.2% vs. 98.0%), failure (1.8% vs. 2.0%) or recurrence rates (0.4% vs. 1.3%). Conclusions: While the presence of ioPTH spikes may increase suspicion for MGD, the ability of ioPTH monitoring in predicting operative success after PTX is not affected by spikes.

Original languageEnglish (US)
JournalSurgery (United States)
DOIs
StateAccepted/In press - Jan 1 2017

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Parathyroidectomy
Parathyroid Hormone
Intraoperative Monitoring

ASJC Scopus subject areas

  • Surgery

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Intraoperative PTH spikes during parathyroidectomy may be associated with multiglandular disease. / Teo, Richard; Farrá, Josefina C.; Khan, Zahra F.; Marcadis, Andrea R.; Lew, John.

In: Surgery (United States), 01.01.2017.

Research output: Contribution to journalArticle

Teo, Richard ; Farrá, Josefina C. ; Khan, Zahra F. ; Marcadis, Andrea R. ; Lew, John. / Intraoperative PTH spikes during parathyroidectomy may be associated with multiglandular disease. In: Surgery (United States). 2017.
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abstract = "Background: The importance of intraoperative parathormone (ioPTH) {"}spikes{"} during parathyroidectomy (PTX) remains unclear. This study compared patients with and without ioPTH spikes during PTX using the criterion of a > 50{\%} PTH, and determined the effect of ioPTH spikes on operative outcome. Methods: We performed a retrospective review of prospectively collected data of 683 patients who underwent PTX guided by ioPTH monitoring. An ioPTH {"}spike value' (SV) was calculated by subtracting the pre-incision ioPTH value (PI) from pre-excision ioPTH value (PE) (SV = PE - PI). An ioPTH spike was defined as having a positive SV ≥9 pg/ml (≥10th percentile of all SVs). Results: Of 683 patients, 224 (33{\%}) had ioPTH spikes, and a gretrate of multigland disease (MGD; 8{\%}vs. 3{\%}, p < 0.05) and bilateral neck exploration (BNE) (10{\%} vs. 5{\%}, p < 0.05) compared to patients without ioPTH spikes. Overall, there were no differences between PTX patients with and without ioPTH spikes in terms of operative success (98.2{\%} vs. 98.0{\%}), failure (1.8{\%} vs. 2.0{\%}) or recurrence rates (0.4{\%} vs. 1.3{\%}). Conclusions: While the presence of ioPTH spikes may increase suspicion for MGD, the ability of ioPTH monitoring in predicting operative success after PTX is not affected by spikes.",
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AU - Lew, John

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N2 - Background: The importance of intraoperative parathormone (ioPTH) "spikes" during parathyroidectomy (PTX) remains unclear. This study compared patients with and without ioPTH spikes during PTX using the criterion of a > 50% PTH, and determined the effect of ioPTH spikes on operative outcome. Methods: We performed a retrospective review of prospectively collected data of 683 patients who underwent PTX guided by ioPTH monitoring. An ioPTH "spike value' (SV) was calculated by subtracting the pre-incision ioPTH value (PI) from pre-excision ioPTH value (PE) (SV = PE - PI). An ioPTH spike was defined as having a positive SV ≥9 pg/ml (≥10th percentile of all SVs). Results: Of 683 patients, 224 (33%) had ioPTH spikes, and a gretrate of multigland disease (MGD; 8%vs. 3%, p < 0.05) and bilateral neck exploration (BNE) (10% vs. 5%, p < 0.05) compared to patients without ioPTH spikes. Overall, there were no differences between PTX patients with and without ioPTH spikes in terms of operative success (98.2% vs. 98.0%), failure (1.8% vs. 2.0%) or recurrence rates (0.4% vs. 1.3%). Conclusions: While the presence of ioPTH spikes may increase suspicion for MGD, the ability of ioPTH monitoring in predicting operative success after PTX is not affected by spikes.

AB - Background: The importance of intraoperative parathormone (ioPTH) "spikes" during parathyroidectomy (PTX) remains unclear. This study compared patients with and without ioPTH spikes during PTX using the criterion of a > 50% PTH, and determined the effect of ioPTH spikes on operative outcome. Methods: We performed a retrospective review of prospectively collected data of 683 patients who underwent PTX guided by ioPTH monitoring. An ioPTH "spike value' (SV) was calculated by subtracting the pre-incision ioPTH value (PI) from pre-excision ioPTH value (PE) (SV = PE - PI). An ioPTH spike was defined as having a positive SV ≥9 pg/ml (≥10th percentile of all SVs). Results: Of 683 patients, 224 (33%) had ioPTH spikes, and a gretrate of multigland disease (MGD; 8%vs. 3%, p < 0.05) and bilateral neck exploration (BNE) (10% vs. 5%, p < 0.05) compared to patients without ioPTH spikes. Overall, there were no differences between PTX patients with and without ioPTH spikes in terms of operative success (98.2% vs. 98.0%), failure (1.8% vs. 2.0%) or recurrence rates (0.4% vs. 1.3%). Conclusions: While the presence of ioPTH spikes may increase suspicion for MGD, the ability of ioPTH monitoring in predicting operative success after PTX is not affected by spikes.

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