COULD THE RATE OF DECREASE IN INTRAOPERATIVE PARATHYROID HORMONE LEVEL BE A DETERMINANT OF SURGICAL TECHNIQUE IN...

Area of Science:

• Endocrinology
• Surgical Oncology
• Nephrology

Background:

• Tertiary hyperparathyroidism (tHPT) management often involves surgery.
• Intraoperative parathyroid hormone (IO PTH) monitoring is crucial for guiding surgical decisions in tHPT.
• Optimizing surgical extent via IO PTH monitoring can improve outcomes for tHPT patients.

Purpose of the Study:

• To evaluate the efficacy of IO PTH monitoring in determining the surgical approach for tHPT.
• To assess if IO PTH levels can guide the decision to conclude surgery in tHPT patients.
• To correlate IO PTH monitoring results with surgical success rates in tHPT.

Main Methods:

• Retrospective analysis of 41 renal transplantation (RTX) recipients with tHPT.
• Pre-operative and post-operative data were analyzed.
• IO PTH levels were monitored during surgery to guide intervention extent.

Main Results:

• A decrease of 70% or more in IO PTH levels correlated with favorable outcomes (89% surgical success).
• Surgical success rates were comparable (75%) whether IO PTH monitoring was used or not.
• Subtotal parathyroidectomy (PTX) and total PTX with autotransplantation (AT) achieved 100% success in specific patient groups.

Conclusions:

• IO PTH monitoring is recommended for tHPT surgery.
• A 70% or greater decline in IO PTH levels suggests successful surgery completion.
• If the PTH decrease is below 70%, continued surgical exploration is necessary.