Our Summary

This study looked at whether it’s necessary to monitor parathyroid hormone levels during surgery (known as ioPTH) for patients with positive preoperative imaging undergoing minimally invasive parathyroidectomy (MIP), a surgery to remove one or more of the parathyroid glands.

The researchers looked back at the medical records of patients who had this surgery at three different medical centers between 2012 and 2021. They focused on patients who were good candidates for MIP based on their preoperative imaging. They did not include patients with negative or confusing imaging results, or those who had also had surgery on their thyroid or previous neck surgery.

Out of 1013 patients who had the surgery, they found that 535 were good candidates for MIP. The surgery was successful for all of these patients. For the majority of patients (93.8%), they found and removed a single adenoma (a type of tumor) that matched what was found in the preoperative imaging. For a small number of patients (3.3%), the ioPTH monitoring changed the surgical plan, revealing additional abnormal glands that needed to be removed.

The researchers found that patients with additional lesions were significantly more likely to have smaller adenomas as indicated by preoperative imaging or by findings during the surgery. None of the patients with an adenoma larger than 13 mm had an additional abnormal gland.

Based on these findings, the researchers concluded that it might not be necessary to routinely use ioPTH monitoring during MIP for patients with an adenoma larger than 13 mm, even if they only have one positive preoperative imaging study. They suggest that this could be done without compromising the success of the surgery.

FAQs

  1. What is the purpose of intraoperative PTH monitoring during parathyroidectomy?
  2. What conclusions were drawn from the study about the use of ioPTH in minimally invasive parathyroidectomy candidates?
  3. How did the size of the adenoma affect the findings of the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about parathyroidectomy is that if their index adenoma is greater than 13 mm and corresponds to their preoperative imaging, intraoperative PTH monitoring may not be necessary. This can help streamline the surgical process and reduce unnecessary testing.

Suitable For

Patients who are typically recommended parathyroidectomy include those with primary hyperparathyroidism who have positive preoperative imaging studies, such as a single adenoma corresponding to the imaging, and are candidates for minimally invasive parathyroidectomy (MIP). In these cases, the routine use of intraoperative PTH monitoring may not be necessary if the index adenoma is greater than 13 mm and surgical success can be achieved without additional pathologic glands being identified. Patients with additional lesions may benefit from the use of ioPTH to guide operative management and ensure complete resection of all abnormal glands.

Timeline

Before parathyroidectomy:

  • Patient undergoes preoperative imaging to locate the affected parathyroid gland.
  • Patient may undergo blood tests to confirm elevated levels of parathyroid hormone (PTH) and calcium.
  • Surgeon evaluates imaging results and determines if patient is a candidate for minimally invasive parathyroidectomy (MIP).
  • Intraoperative PTH (ioPTH) monitoring may be considered based on preoperative imaging results.

After parathyroidectomy:

  • Patient undergoes parathyroidectomy surgery.
  • Intraoperative PTH (ioPTH) monitoring may be used to confirm successful removal of affected parathyroid gland.
  • Surgical success is achieved in all patients, with a single adenoma corresponding to preoperative imaging being identified in the majority of cases.
  • In a small percentage of cases, ioPTH may identify additional pathologic glands that need to be excised.
  • Patients with additional lesions are more likely to have a smaller index adenoma size.
  • Patients with an index adenoma greater than 13 mm may not require ioPTH monitoring in MIP without compromising surgical success.

What to Ask Your Doctor

  1. What is the purpose of intraoperative PTH (ioPTH) monitoring during parathyroidectomy?
  2. How does ioPTH monitoring affect surgical decision-making during parathyroidectomy?
  3. Are there specific criteria or factors that determine whether ioPTH monitoring is necessary for a patient undergoing parathyroidectomy?
  4. What are the potential risks or complications associated with ioPTH monitoring during parathyroidectomy?
  5. How accurate is preoperative imaging in identifying the location of the parathyroid adenoma?
  6. What is the success rate of parathyroidectomy without the use of ioPTH monitoring in patients with positive preoperative imaging?
  7. Are there any specific characteristics or features of the parathyroid adenoma that would indicate the need for ioPTH monitoring during surgery?
  8. How does the size of the index adenoma impact the necessity of ioPTH monitoring during parathyroidectomy?
  9. What are the potential benefits of omitting ioPTH monitoring in certain patients undergoing parathyroidectomy?
  10. Are there any alternative strategies or techniques that can be used in place of ioPTH monitoring during parathyroidectomy?

Reference

Authors: Eligal S, Mekel M, Weinberger JM, Neymark M, Hirshoren N, Mizrahi I, Eliashar R, Mazeh H. Journal: World J Surg. 2022 Aug;46(8):1908-1914. doi: 10.1007/s00268-022-06537-6. Epub 2022 Apr 11. PMID: 35403873