Selective intra-operative parathyroid hormone in re-do neck exploration in parathyroidectomy: A case report

INTRODUCTION: Intra-operative parathyroid hormone (I-OPTH) levels are an adjunct used in parathyroid surgery which provides assurance that parathyroidectomy surgery is complete and has removed the hypersecreting gland. PRESENTATION OF CASE: A 78 year old female with no localisation on pre-operative imaging and had previous hemithyroidectomy. I-OPTH was used to guide the side and timing for completion of exploration, factors which reduced operative time, operative cost and avoided potential complications. DISCUSSION: Routine and selective I-OPTH may be used to guide parathyroidectomy, and this case highlights the methodology of use in a selective challenging case. Appropriate application and interpretation of results must be achieved to ensure adequate completion of surgery and cure for the patient. CONCLUSION: Selective use of I-OPTH guides parathyroidectomy in challenging cases, and can be time and cost-effective when used appropriately.