USE OF A RAPID INTRAOPERATIVE PARATHYROID-HORMONE ASSAY IN THE SURGICAL-MANAGEMENT OF PARATHYROID DISEASE

Objective: To evaluate the utility of a rapid intraoperative parathyro id hormone (PTH) immunoradiometric assay in the surgical management of parathyroid disease, particularly with reference to limiting extent o f cervical exploration. Design: Nonrandomized prospective study. Setti ng: Academic tertiary care center. Patients: Forty-three consecutive p atients undergoing parathyroid exploration for adenoma or hyperplasia had rapid PTH assays performed from blood drawn at induction and 7 min utes after resection of all hyperfunctioning parathyroid tissue. Outco me Measures: Excision of all hyperfunctioning parathyroid tissue as as sessed by bilateral. neck exploration, postoperative normalization of serum calcium and PTH levels, and resolution of clinical symptoms. Res ults: The intraoperative rapid PTH assay accurately reflected whether all hyperfunctioning parathyroid tissue was excised in every patient. In 41 patients, all. hyperfunctioning parathyroid tissue was resected at the time of surgery and confirmed by a corresponding decrease in th e intraoperative postexcision rapid PTH determination as well as by su bsequent normalization of postoperative serum calcium and PTH levels a nd resolution of clinical symptoms. In 2 patients, the postexcision ra pid PTH assay determination was not consistent with removal of all hyp erfunctioning parathyroid disease and both patients demonstrated persi stent hyperparathyroidism postoperatively. Conclusions: The intraopera tive rapid PTH assay may be of significant benefit in permitting direc ted unilateral parathyroid explorations for adenoma when combined with preoperative localization with a technetium-99m sestamibi scan. Addit ionally, the rapid PTH assay has proved to be of benefit in confirming excision of all hyperfunctioning parathyroid tissue in patients with multiple gland hyperplasia, particularly those who may harbor ectopic parathyroid tissue.