J Korean Surg Soc.  2012 Jul;83(1):1-6. 10.4174/jkss.2012.83.1.1.

Efficacy of intraoperative parathyroid hormone monitoring to predict success of parathyroidectomy for secondary hyperparathyroidism

• Kim WY
• Lee JB
• Kim HY

• KMID: 2212272
• DOI: http://doi.org/10.4174/jkss.2012.83.1.1

Abstract

PURPOSE
In secondary hyperparathyroidism (sHPT), it is unclear which criterion for intraoperative parathyroid hormone (ioPTH) decline performs best and whether ioPTH monitoring is sufficiently efficacious in predicting postoperative surgical cure by retrospective review.
METHODS
In 80 parathyroidectomies for sHPT, patients with ioPTH monitoring and follow-up PTH assay were categorized into physiologically accepted and failed groups. Receiver operating characteristic (ROC) curves were used to identify the criterion with the best performance and to determine the regression equation for prediction of surgical success.
RESULTS
There was a statistically significant difference in the percentage reduction of ioPTHs between the two groups (P < 0.05). With our criterion, cure was predicted with a sensitivity of 86% and specificity that could be improved to 60% using an 85% ioPTH decrease as cut-off level when this value was compared to the Miami Criterion. There was a slightly negative correlation between the natural logarithm of percentage reduction of ioPTH and percentage reduction of PTH at follow-up (R2 = 0.109, P = 0.003).
CONCLUSION
ioPTH measurements are a useful tool for improvement of the cure rate of operations for sHPT. Because this study aimed at 40 minutes (ioPTH3) as an optimal process in the operation, we recommend using a criterion of more than 85% ioPTH decline at 40 minutes by use of the ROC curve, and the use of the presently calculated regression equation may enable prediction of success.

Keyword

Hyperparathyroidism; Secondary; Parathyroidectomy

MeSH Terms

Follow-Up Studies
Humans
Hyperparathyroidism
Hyperparathyroidism, Secondary
Parathyroid Hormone
Parathyroidectomy
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Parathyroid Hormone

Figure

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  Fig. 1 Box and whiskers plot of parathyroid hormone (PTH) assays for all patients who underwent a parathyroidectomy during the study period. Intraoperative PTH (ioPTH), ioPTH2, and ioPTH3 were performed perioperatively; PTH assays were performed at the 1-year follow-up. ioPTH1, baseline levels of ioPTH; ioPTH2, ioPTH levels at 20 minutes after excision; ioPTH3, ioPTH levels at 40 minutes after excision.

• 

  Fig. 2 Box and whiskers plot comparing the percentage intraoperative parathyroid hormone (ioPTH) reduction between the two groups.

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  Fig. 3 Receiver operating characteristic curves from the percentage decline based on the ioPTH2 and ioPTH3 assay results. ioPTH2, ioPTH levels at 20 minutes after excision; ioPTH3, ioPTH levels at 40 minutes after excision.

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  Fig. 4 Scatterplot showing the percentage reduction of intraoperative parathyroid hormone (ioPTH) vs. the natural logarithm of PTH after 1 year expressed as a percentage of ioPTH1. ioPTH1, baseline levels of ioPTH.

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