Efficacy of surgical treatment of primary hyperparathyreoidism using intraoperative PTH monitoring – one center experience

Abstract

SUMMARY Introduction Primary hyperparathyreoidism is treated surgically. The extent and efficacy of surgery depend on the precision of preoperative diagnostic localization and intraoperative confirmation of high PTH source removal. Materials and methods Retrospective analysis was performed. We included patients treated in the University Hospital for Tumors between 2012 and 2019. Fifty-four patients with primary hyperparathyroidism were included, of whom one patient had two surgeries. Normal range for intact PTH is 15–65 pg/mL, and for calcium 2.14–2.53 mmol/L. Preoperative PTH was measured after general anesthesia induction. Intraoperative PTH was measured 15 minutes after the suspected gland removal. PTH decrease more than 50% of the initial value was considered a proof of sufficient surgery. In cases of persistent PTH levels, according to surgeons’ decision, based on the intraoperative finding, surgery was extended to find the altered gland and to repeat intact PTH level measuring. Results Average preoperative PTH value was 117.4 (39.6–305.4) pg/mL and calcium 2.75 (2.45–3.15) mmol/L. Average intraoperative PTH value was 35.6 (8.1–198.6) pg/mL. Intraoperative value was 67.6% lower than preoperative. In 44 patients one intraoperative PTH measurement was sufficient, and in 11 patients more than one measurement was needed. Average calcium value six months after surgery was 2.39 (1.96–2.7) mmol/L. Surgery with intraoperative PTH monitoring was successful in 53 patients (98.14%). Intraoperative PTH decrease has high sensitivity (88.7%) and positive predictive value (97.9%). Conclusion Intraoperative PTH monitoring increases the efficacy of surgical treatment of primary hyperparathyreoidism, especially in the group of patients with multiglandular disease. The conclusion is based on the group of patients with more than one intraoperative PTH measurement.