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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