Primary hyperparathyroidism: Intraoperative PTH-measurements

Abstract

Background: With the development of rapid assays and intraoperative measurement of intact parathyroid hormone (PTH), new strategies in the handling of patients with primary hyperparathyroidism (PHPT) have evolved. Aim: The aim of our study was to illustrate the performance of the intraoperative PTH measurement as a predictor of successful cure. Material and Methods: From September 1999 to April 2002 143 patients with pHPT underwent a parathyroid operation (bilateral neck exploration with identification of all parathyroid glands) with intraoperative measurements of plasma PTH (immediately prior to surgery (T0) and 5 minutes after gland excision (T5)). A positive test result was defined as plasma PTH values at T5 below 20% of T0 or a value in the normal range below 7.6 pmol/l. Hence T5 values above 20% of T0 and above 7.6 pmol/l were considered test negative. Results: 122 patients (85%) were test positive and cured, 11 patients (8%) were test negative but cured, and 10 patients (7%) were test negative and not cured by the primary operation. Consequently, the sensitivity of the test was 0.92 and the specificity 1.00. Conclusions: The rapid PTH test used is a reliable predictor of a successful outcome in PHPT patients undergoing parathyroid surgery.