Can We Do Away With Intra-Operative Parathyroid Hormone for Primary Hyperparathyroidism Patients With Concordant Pre-operative Imaging?
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Purpose: Parathyroidectomy is the definitive treatment for patients with primary hyperparathyroidism (PHPT), and the use of intra-operative parathyroid hormone (IoPTH) assay has led to high clinical success rates. However, it also resulted in longer operative duration as well as high false negative rates. This is a retrospective study of operative cases of PHPT performed in our institution. The aim is to audit the turnover time and evaluate the feasibility of omitting routine IoPTH in selected cases. Methods: All patients from Ng Teng Fong General Hospital who underwent parathyroidectomy for PHPT from 2015 to 2023 were included. All patients had routine IoPTH assessment based on Miami criteria. Patients were stratified into groups based on concordance of pre-operative imaging. Results: Forty-five patients were included in this study. Thirty-one (68.9%) patients had concordant pre-operative imaging. The 87.1% had adequate IoPTH reduction in this group and only one case (2.22%) had dual parathyroid adenoma. The remaining 14 (31.1%) patients had non-concordant imaging, of which 78.6% had adequate IoPTH reduction in this group with 2 cases (14.3%) of dual parathyroid adenoma. Patients with larger parathyroid adenoma (P=0.02) and higher PTH levels (P=0.008) are more likely to have concordant pre-operative imaging. The average additional wait time for IoPTH turnover is 36 minutes. Conclusion: Despite our limited study population, we believe it is safe and time effective to omit routine IoPTH for focused parathyroidectomy performed by experienced endocrine surgeons in cases with concordant imaging. However, IoPTH should still be recommended for patients with non-concordant imaging.
Abstract
Purpose: Parathyroidectomy is the definitive treatment for patients with primary hyperparathyroidism (PHPT), and the use of intra-operative parathyroid hormone (IoPTH) assay has led to high clinical success rates. However, it also resulted in longer operative duration as well as high false negative rates. This is a retrospective study of operative cases of PHPT performed in our institution. The aim is to audit the turnover time and evaluate the feasibility of omitting routine IoPTH in selected cases. Methods: All patients from Ng Teng Fong General Hospital who underwent parathyroidectomy for PHPT from 2015 to 2023 were included. All patients had routine IoPTH assessment based on Miami criteria. Patients were stratified into groups based on concordance of pre-operative imaging. Results: Forty-five patients were included in this study. Thirty-one (68.9%) patients had concordant pre-operative imaging. The 87.1% had adequate IoPTH reduction in this group and only one case (2.22%) had dual parathyroid adenoma. The remaining 14 (31.1%) patients had non-concordant imaging, of which 78.6% had adequate IoPTH reduction in this group with 2 cases (14.3%) of dual parathyroid adenoma. Patients with larger parathyroid adenoma (P=0.02) and higher PTH levels (P=0.008) are more likely to have concordant pre-operative imaging. The average additional wait time for IoPTH turnover is 36 minutes. Conclusion: Despite our limited study population, we believe it is safe and time effective to omit routine IoPTH for focused parathyroidectomy performed by experienced endocrine surgeons in cases with concordant imaging. However, IoPTH should still be recommended for patients with non-concordant imaging.
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