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Validation of selective use of intraoperative PTH monitoring in parathyroidectomy

BACKGROUND: The objective of this study was to validate our approach of treating primary hyperparathyroidism using sestamibi scan directed parathyroidectomy, without routine use of intraoperative parathyroid hormone measurements (ioPTH). METHODS: We prospectively established a protocol limiting the...

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Detalles Bibliográficos
Autores principales: Thielmann, Alexandra, Kerr, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294871/
https://www.ncbi.nlm.nih.gov/pubmed/28166819
http://dx.doi.org/10.1186/s40463-017-0188-0
Descripción
Sumario:BACKGROUND: The objective of this study was to validate our approach of treating primary hyperparathyroidism using sestamibi scan directed parathyroidectomy, without routine use of intraoperative parathyroid hormone measurements (ioPTH). METHODS: We prospectively established a protocol limiting the use of ioPTH to patients with negative or equivocal sestamibi scans, and those who had risk factors for multi-gland disease. We then performed a retrospective review to determine our disease control rate. RESULTS: 128 patients underwent sestamibi-guided parathyroidectomy without (111/128 = 87%) or with (17/128 = 13%) ioPTH. The overall disease control (eucalcemia) rate was 95%. 3/111 (3%) of patients who had surgery without ioPTH measurements required re-exploration. CONCLUSIONS: Selective use of ioPTH is an effective strategy. ioPTH is best reserved for patients who have non-localizing preoperative imaging, are at risk for multi-gland disease, or require revision surgery.