INTRAOPERATIVE PARATHYROID-HORMONE MONITORING DURING PARATHYROIDECTOMY FOR SECONDARY HYPERPARATHYROIDISM

Background. The surgical management of secondary hyperparathyroidism b y experienced surgeons is associated with excellent results. The prese nce of supernumerary glands and inadequate initial parathyroidectomy c an lead to reoperations for recurrence. Intraoperative parathyroid hor mone monitoring (qPTH), which has been described parathyroidectomy for primary hyperparathyroidism, may be helpful in preventing or predicti ng the need for reoperation. This report describes the use of qPTH ass ays during parathyroidectomy in patients with secondary hyperparathyro idism. Methods, Intraoperative parathyroid hormone (PTH) levels were d etermined in 13 patients with secondary hyperparathyroidism undergoing total parathyroidectomy with autotransplantation (n = 3) or subtotal parathyroidectomy (n = 10). Levels were determined using a modified im munochemiluminometric assay (qPTH). Results, The average PTH levels be fore and after parathyroidectomy were 1599 pg/ml (620 to 2486 pg/ml) a nd 230.3 pg/ml (129 to 345 pg/ml), respectively. All patients had sign ificant decreases in PTH levels after parathyroidectomy (mean, 84.6%). Symptoms were improved in all patients after operation. PTH levels at early follow-up were consistently below intraoperative levels. Conclu sions. Intraoperative PTH monitoring reproducibly demonstrates the cli nically relevant decrease in PTH levels after parathyroidectomy for se condary hyperparathyroidism similar to those previously documented in patients with primary hyperparathyroidism. Long-term follow-up and inc reasing numbers of patients are crucial in defining the role of qPTH m onitoring during parathyroidectomy for secondary hyperparathyroidism.