Abstract
We examined the usefulness of intraoperative monitoring of intact-PTH (I-PTH) in 21 consecutive patiets operated on for primary hyperparathyroidism. Two out of 21 patients had a history of undergoing a thyroidectomy. Parathyroidectomy was performed through mini-incision in four patients who were diagnosed as having single adenoma. Blood samples were drawn before excision of the enlarged parathyroid gland (s) and 2, 5, 10, and 15 minutes afterward. Twelve patients demonstrated a single gland disease, and nine patients showed multiple gland disease. All patients underwent successful parathyroidectomies. The values of plasma I-PTH significantly dropped to 42±32pg/ml (20.7±9.6% of pre-excision I-PTH) from the pre-excision values of 209±213pg/ml. In one patient who had undergone thyroidectomy for thyroid papillary cancer, no gland enlargement was present in the area where the lesion had been suggested by a preoperative localization study. Based on the results of intraoperative measurements of I-PTH in the bilateral internal jugular veins, a 9×8mm ectopic parathyroid tumor was successfully indentified and removed.
We conclude that quick measurement of intraoperative I-PTH is a valuable adjunctive method for decision making, especially in more limited surgery after previous thyroidectomy, or in patients whose unilateral neck exploration or single gland approach is scheduled based on the preoperative localization.
