Retrospective analysis of sequential changes in serum intact parathyroid hormone levels during conventional parathyroid exploration

Background, The purpose of this study was to assess sequential changes in s erum parathyroid hormone (PTH) levels during conventional parathyroidectomy . Methods. Sera were collected before and 10 minutes after resection of each parathyroid tumor from 112 consecutive patients and assayed postoperatively within 48 hours for PTH. Results, PTH reductions corroborated cures for 94 of 112 cases (84%), inclu ding 70 of 71 patients with solitary adenomas (SAs). However, there were 15 false positives (13%), in which PTH decreased more than 50% within 10 minu tes of resection of 1 parathyroid tumor while additional parathyroid tumors remained in situ (1 of 71 SAs, 4 of 6 double adenomas, 7 of 15 primary hyp erplasias, and 3 of 17 tertiary hyperplasias). There were 3 false negatives (3%), with PTH unchanged, even though Post operative PTH and calcium value s confirmed cure (1 SA, 1 primary hyperplasia, and 1 tertiary hyperplasia). There were only 2 of 112 failed explorations (1.8%), which would not have been avoided by PTH monitoring because both subsequently were found to have mediastinal parathyroid adenomas. Conclusions, We conclude that intraoperative PTH changes corroborated outco me in SA but nay under estimate the extent of resection required in parathy roid hyperplasia.