The following is a summary of “Operative success is achieved regardless of ioPTH criterion used during focused parathyroidectomy for sporadic primary hyperparathyroidism,” published in the NOVEMBER 2023 issue of Surgery by Vaghaiwalla, et al.

In patients with sporadic primary hyperparathyroidism (spHPT), focused parathyroidectomy (F-PTX) guided by intraoperative parathormone (ioPTH) monitoring may encounter challenges, potentially leading to higher operative failure rates, especially when ioPTH levels fail to reach the normal range.

A retrospective review encompassed 690 patients with spHPT who underwent F-PTX and ioPTH monitoring. The patients were categorized into two groups based on ioPTH responses: those with >50% ioPTH decrease to the normal range and those with >50% ioPTH decrease to above the normal range. The evaluation focused on operative success, recurrence, and the nature of neck exploration (bilateral/unilateral) and multiglandular disease (MGD).

Out of the total cohort, 533 patients exhibited >50% ioPTH decrease to the normal range, while 157 patients demonstrated >50% ioPTH decrease to above the normal range. No significant differences were observed in operative success rates (99% vs. 97%), recurrence (2.5% vs. 5%), bilateral neck exploration (BNE) (12% vs. 11%), unilateral neck exploration (UNE) (4% vs. 5%), or multiglandular disease (MGD) (4% vs. 4%) between the two groups (P > 0.05). The mean follow-up period was 46 months.

Irrespective of the ioPTH criterion used for focused parathyroidectomy, there were no discernible differences in operative success, failure, BNE, UNE, or MGD.

Source: americanjournalofsurgery.com/article/S0002-9610(23)00305-7/fulltext