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Validation of selective use of intraoperative PTH monitoring in parathyroidectomy.
Journal of Otolaryngology - Head & Neck Surgery 2017 Februrary 7
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.
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.
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