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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1442972
This article is part of the Research Topic Primary and secondary hyperparathyroidism: from etiology to treatment View all 3 articles

Is intraoperative parathyroid monitoring during minimally invasive parathyroidectomy still justified?

Provisionally accepted
Lindsay Hargitai Lindsay Hargitai *Daniela Boryshchuk Daniela Boryshchuk Melisa Arikam Melisa Arikam Teresa Binter Teresa Binter Christian Scheuba Christian Scheuba Philipp Riss Philipp Riss
  • Medical University of Vienna, Vienna, Austria

The final, formatted version of the article will be published soon.

    Introduction: Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. With parathyroidectomy, a cure rate of over 95% at initial surgery is reported. Localization of the abnormal parathyroid gland is critical for the operation to be successful. The aim of this study is to analyze data of patients with single gland disease (SGD) and positive concordant localization imaging undergoing minimally invasive parathyroidectomy (MIP) and intraoperative parathyroid hormone monitoring (IOPTH) to evaluate if IOPTH is still justified in patients with localized SGD. Methods: A retrospective database analysis of all minimally invasive operations with IOPTH for PHPT and positive concordant localization in ultrasound (US) and 99m Tc-sestamibi scintigraphy (MIBI) between 2016-2021. When both US and MIBI were negative, patients underwent either choline or methionine PET-CT. The patients were also analyzed a second time without applying IOPTH. Results: In total, 198 patients were included in the study. The sensitivity of US, MIBI and PET-CT was 96%, 94% and 100%, respectively. Positive predictive value was 88%, 89% and 94% with US, MIBI and PET-CT, respectively. IOPTH was true positive in 185 (93.4%) patients. In 13 (6.6%) patients, no adequate IOPTH decline was observed after localizing and extirpating the assumed enlarged parathyroid gland. Without IOPTH, the cure rate decreased from 195 (98.5%) to 182 (92%) patients and the rate of persisting disease increased from 2 (1.0%) to 15 (7.5%) patients. Conclusion: Discontinuing IOPTH significantly increases the persistence rate by a factor of 7.5 in patients with concordantly localized adenoma. Therefore, IOPTH appears to remain necessary even for this group of patients.

    Keywords: primary hyperparathyroidism, Minimal invasive parathyroidectomy, Intraoperative parathyroid hormone assay, Parathyroid adenoma, preoperative localization studies, ultrasound, MIBI, PET-CT

    Received: 03 Jun 2024; Accepted: 04 Jul 2024.

    Copyright: © 2024 Hargitai, Boryshchuk, Arikam, Binter, Scheuba and Riss. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Lindsay Hargitai, Medical University of Vienna, Vienna, Austria

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