Impact of intraoperative parathyroid hormone monitoring on the management of patients with primary hyperparathyroidism

2018 ◽  
Vol 90 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Michael Shawky ◽  
Tarek Abdel Aziz ◽  
Simon Morley ◽  
Timothy Beale ◽  
Jamshed Bomanji ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone

Minimally Invasive Parathyroid Surgery, The Norman 20% Rule: Is It Valid?

2011 ◽  
Vol 77 (4) ◽  
pp. 484-487 ◽  
Author(s):  
Amy R. Quillo ◽  
Jeffery M. Bumpous ◽  
Richard E. Goldstein ◽  
Muffin M. Fleming ◽  
Ccrp ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Parathyroid Gland ◽  
Ex Vivo ◽  
Frozen Section ◽  
Postoperative Management ◽  
Average Percentage ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone

The 20 per cent rule proposed by Norman established a guideline using radioactivity in the minimally invasive radioguided parathyroidectomy (MIRP) technique to localize and confirm removal of an abnormal parathyroid gland in patients with primary hyperparathyroidism. If radioactivity in the resected gland was at least 20 per cent of excision site/background radioactivity, the 20 per cent rule was satisfied. Patients meeting these criteria underwent unilateral MIRP without intraoperative parathyroid hormone assay or intraoperative frozen section. The study aim was to independently evaluate the 20 per cent rule in MIRP patients with primary hyperparathyroidism. Using the University of Louisville Parathyroid Database from January 1, 1999 to December 31, 2007, 216 MIRP patients with complete radioguided and postoperative management data were identified. The average percentage of ex vivo parathyroid gland radioactivity compared with excision site/background radioactivity was 107 per cent with a range from 14 to 388 per cent. For 99 per cent (196/198) radioactivity recorded from the excised gland was at least 20 per cent of radioactivity recorded from the excision site. Normocalcemia was documented in 98.5 per cent (195/198) at 12 month follow-up. Our data supports the 20 per cent rule in that in 99 per cent of MIRP patients the resected gland radioactivity was at least 20 per cent of excision site radioactivity allowing localization and confirmation of an overactive gland without intraoperative parathyroid hormone monitoring or tissue analysis.

Unexpected Results Using Rapid Intraoperative Parathyroid Hormone Monitoring during Parathyroidectomy for Primary Hyperparathyroidism

2005 ◽  
Vol 29 (6) ◽  
pp. 785-788 ◽  
Author(s):  
Ignazio Emmolo ◽  
Herbert Dal Corso ◽  
Giorgio Borretta ◽  
Gianluca Visconti ◽  
Alessandro Piovesan ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Hormone Monitoring ◽  
Intraoperative Parathyroid Hormone
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