Focused Parathyroidectomy for Primary H yperparathyroidism...,,

2011 ◽  
pp. 195-196
Keyword(s):  
Focused Parathyroidectomy

Factors Influencing Time to Decrease in Intraoperative Parathyroid Hormone (ioPTH) Levels in Patients Undergoing Focused Parathyroidectomy (FP)

2018 ◽  
Vol 84 (6) ◽  
pp. 772-775 ◽  
Author(s):  
Neal Bhutiani ◽  
Beunca Graffree ◽  
Robert C.G. Martin ◽  
Amy R. Quillo
Keyword(s):  
Parathyroid Hormone ◽  
Normal Range ◽  
Factors Affecting ◽  
Time Period ◽  
Lower Baseline ◽  
Focused Parathyroidectomy ◽  
Potential Factors ◽  
One Year ◽  
Intraoperative Parathyroid Hormone ◽  
Cure Rates

The aim of this study was to evaluate potential factors affecting the time period in which a 50 per cent parathyroid hormone (PTH) drop is observed. Eight-seven patients undergoing focused parathyroidectomy between 2011 and 2015, whose PTH values dropped to within normal range, were grouped according to whether they required > or ≤15 minutes after gland excision to achieve a 50 per cent PTH. Groups were compared according to preoperative PTH, calcium, age, glomer-ular filtration rate, and adenoma weight. Lower preoperative and preincision PTH levels were associated with requiring >15 minutes to achieve a >50 per cent drop in ioPTH. Time to >50 per cent ioPTH drop did not affect cure rates at one year, though a >15 minutes requirement was associated with higher serum calcium levels (P = 0.015). Lower baseline PTH and preincision PTH levels are significantly associated with a >15 minutes postexcision time to achieve a >50 per cent drop in ioPTH. Future analyses are warranted to determine whether a longer postexcision time threshold before proceeding with four-gland exploration is warranted in patients with primary hyperparathyroidism and mildly elevated preoperative PTH.

scholarly journals Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

2015 ◽  
Vol 97 (8) ◽  
pp. 603-607 ◽  
Author(s):  
OA Mownah ◽  
G Pafitanis ◽  
WM Drake ◽  
JN Crinnion
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Frozen Section ◽  
Lateral Approach ◽  
Preoperative Imaging ◽  
Surgical Cure ◽  
Focused Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Iopth Measurement

Introduction Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement. Methods Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment. Results Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia. Conclusions This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.

No Need to Abandon Focused Parathyroidectomy

2015 ◽  
Vol 261 (5) ◽  
pp. 991-996 ◽  
Author(s):  
Olov Norlén ◽  
Kuan Chi Wang ◽  
Yeng Kwang Tay ◽  
William R. Johnson ◽  
Simon Grodski ◽  
...  
Keyword(s):  
Focused Parathyroidectomy

scholarly journals FOCUSED PARATHYROIDECTOMY

2004 ◽  
Vol 33 (1) ◽  
pp. 99-111
Author(s):  
Yasser El-Sayed ◽  
Atif Abdelatif
Keyword(s):  
Focused Parathyroidectomy

Operative Failure Rate and Documentation of Family History in Young Patients Undergoing Focused Parathyroidectomy for Primary Hyperparathyroidism

2015 ◽  
Vol 81 (6) ◽  
pp. 585-590
Author(s):  
Elsa T. Stephen ◽  
Amy R. Quillo ◽  
Kelsey E. Lewis ◽  
Farrah L. Harden ◽  
Jeffrey M. Bumpous ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Older Patients ◽  
Multiple Endocrine Neoplasia ◽  
Multiple Endocrine Neoplasia Type ◽  
Type I ◽  
Syndrome Type ◽  
Endocrine Neoplasia ◽  
Younger Patient ◽  
Multiple Endocrine Neoplasia Syndrome ◽  
Focused Parathyroidectomy

Primary hyperparathyroidism in multiple endocrine neoplasia type I usually affects all parathyroid glands, making focused parathyroidectomy (FP) inappropriate. The risk of previously undiagnosed multiple endocrine neoplasia type I in a younger patient with primary hyperparathyroidism is higher than in an older patient. We hypothesized that FP may lead to a higher failure rate in younger versus older patients. A retrospective review was performed of a single-institution database of patients who underwent parathyroidectomy for primary hyperparathyroidism. Routine statistical analysis was performed, including Fisher's exact test. A total of 635 patients were included. Operative failure occurred in 7/55 (13%) younger patients and 21/580 (4%) older patients ( P = 0.007). In conclusion, operative failure occurred in a statistically significantly higher percentage of younger versus older patients undergoing FP. This is partly explained by undiagnosed multiple endocrine neoplasia syndrome type I in the younger patient group. Endocrine surgeons must make every effort to preoperatively identify multiple endocrine neoplasia syndrome type I in the younger patient population.

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