Does the final intraoperative PTH level really have to fall into the normal range to signify cure?

Area of Science:

• Endocrinology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Intraoperative parathyroid hormone (IOPTH) monitoring is crucial for parathyroidectomy success.
• A 50% decrease in IOPTH is widely accepted, but its target range remains debated.
• Optimizing IOPTH monitoring can improve surgical outcomes and efficiency.

Purpose of the Study:

• To evaluate the efficacy of IOPTH monitoring in primary hyperparathyroidism surgery.
• To determine if IOPTH needs to normalize, or just decrease by 50%, for surgical cure.
• To assess the impact of IOPTH trends on surgical success rates.

Main Methods:

• Retrospective review of a prospective database of 155 patients with primary hyperparathyroidism.
• Inclusion criteria: IOPTH fall >50% by 10 or 15 min, but not into the normal range (≥ 60 pg/ml).
• Exclusion criteria: prior neck surgery, known multiple endocrine neoplasia.

Main Results:

• Overall surgical cure rate was 98.7% in the studied cohort.
• 117 patients showed a 50% IOPTH drop by 10 min; 38 by 15 min.
• Low recurrence rate (0.6%) and normal mean follow-up calcium levels (9.4 mg/dl) were observed.

Conclusions:

• A 50% IOPTH decrease by 15 minutes, irrespective of normalization, achieves high surgical success rates.
• This strategy by experienced surgeons reduces intraoperative time and avoids unnecessary bilateral neck exploration.
• The findings support a refined approach to IOPTH interpretation in parathyroid surgery.