To Study the Utility of Intra Operative Parathyroid Hormone Levels in Management of Primary Hyperparathyroidism

Abstract

Introduction: Treatment of primary hyperparathyroidism, caused by single adenoma in atleast 80% of the cases, has undergone a change from traditional bilateral neck exploration to minimal invasive parathyroidectomy. With proper preoperative workup and intraoperative parathyroid monitoring, majority of patients can be successfully treated by minimally invasive parathyroidectomy. Aim: To compare the sensitivity of preoperative radiological investigation with IOPM to successfully diagnose the site of lesion. Materials and Methods: We conducted a retrospective review of 50 cases of primary hyperparathyroidism at our institute for a period of 4 years. The lesion was preoperatively localized with the help of diagnostic modalities such as USG neck, Sestamibi scan or CT neck. Intraoperative PTH level monitoring was done as per the decision of the operating surgeon. Results: A total of 50 parathyroidectomies were performed. 76% of the patients were female with the patients in the age range of 15 to 85 years. The findings of USG neck and Sestamibi scan were concordant in 88% cases.In the rest 12% of the patients USG and sestamibi scans were discordant and Intra operative PTH monitoring was helpful in performing minimally invasive parathyroidectomy. Intraoperative PTH monitoring was done in 52% of the patients. Only one patient had to undergo a bilateral neck exploration, following minimal invasive procedure. Except this case there was no intra-operative or post operative complication. Conclusion: Excellent results are achievable with minimal invasive parathyroidectomy. Preoperative localization is paramount before taking up the patient for this procedure. We recommend minimally invasive surgery as the procedure of choice in patients with concordant findings of USG neck and Sestamibi scan.

Keywords

• bilateral neck exploration
• intraoperative parathyroid hormone monitoring (iopm)
• parathyroidectom