Surgical Management of Normocalcemic Primary Hyperparathyroidism and the Impact of Intraoperative Parathyroid Hormone Testing on Outcome

Gina Trinh, Eleni Rettig, Salem I. Noureldine, Jonathon Russell, Nishant Agrawal, Aarti Mathur, Jason D Prescott, Martha A. Zeiger, Ralph P Tufano

Research output: Contribution to journalArticle

Abstract

Objective: To review our surgical experience and the impact of intraoperative parathyroid hormone (IOPTH) testing among patients with normocalcemic primary hyperparathyroidism. Study Design: Case series with chart review. Setting: Academic referral hospital. Subject and Methods: Normocalcemic hyperparathyroidism (NCHPT) patients were identified with normal-range blood ionized calcium and serum elevated parathyroid hormone. Patient demographics, intraoperative findings, IOPTH dynamics, and biochemical outcomes were compared with those of classic primary hyperparathyroidism (PHPT) patients. Results: Of the 2120 patients who underwent parathyroidectomy, 616 patients met the inclusion criteria: 119 (19.5%) patients had NCHPT, and 497 (80.5%) had classic PHPT. NCHPT patients had higher rates of multigland hyperplasia as compared with classic PHPT (12% vs 4%, P =.002) and smaller gland size (P <.001). Of 119 NCHPT patients, 114 (97%) achieved >50% drop in IOPTH intraoperatively, as opposed to 492 (99%) among 497 classic PHPT patients (P =.014). IOPTH drop >50% had an equivalent positive predictive value for long-term cure in both groups. Conclusions: Surgeons treating NCHPT patients should suspect the presence of multigland disease and have a low threshold for converting to bilateral exploration depending on IOPTH decay dynamics.

Original languageEnglish (US)
JournalOtolaryngology - Head and Neck Surgery (United States)
DOIs
StateAccepted/In press - Jan 1 2018

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Primary Hyperparathyroidism
Parathyroid Hormone
Hyperparathyroidism
Parathyroidectomy
Hyperplasia
Reference Values
Referral and Consultation
Demography
Calcium

Keywords

  • hyperparathyroidism
  • intraoperative parathyroid hormone monitoring
  • mild
  • normocalcemic
  • primary
  • PTH

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

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title = "Surgical Management of Normocalcemic Primary Hyperparathyroidism and the Impact of Intraoperative Parathyroid Hormone Testing on Outcome",
abstract = "Objective: To review our surgical experience and the impact of intraoperative parathyroid hormone (IOPTH) testing among patients with normocalcemic primary hyperparathyroidism. Study Design: Case series with chart review. Setting: Academic referral hospital. Subject and Methods: Normocalcemic hyperparathyroidism (NCHPT) patients were identified with normal-range blood ionized calcium and serum elevated parathyroid hormone. Patient demographics, intraoperative findings, IOPTH dynamics, and biochemical outcomes were compared with those of classic primary hyperparathyroidism (PHPT) patients. Results: Of the 2120 patients who underwent parathyroidectomy, 616 patients met the inclusion criteria: 119 (19.5{\%}) patients had NCHPT, and 497 (80.5{\%}) had classic PHPT. NCHPT patients had higher rates of multigland hyperplasia as compared with classic PHPT (12{\%} vs 4{\%}, P =.002) and smaller gland size (P <.001). Of 119 NCHPT patients, 114 (97{\%}) achieved >50{\%} drop in IOPTH intraoperatively, as opposed to 492 (99{\%}) among 497 classic PHPT patients (P =.014). IOPTH drop >50{\%} had an equivalent positive predictive value for long-term cure in both groups. Conclusions: Surgeons treating NCHPT patients should suspect the presence of multigland disease and have a low threshold for converting to bilateral exploration depending on IOPTH decay dynamics.",
keywords = "hyperparathyroidism, intraoperative parathyroid hormone monitoring, mild, normocalcemic, primary, PTH",
author = "Gina Trinh and Eleni Rettig and Noureldine, {Salem I.} and Jonathon Russell and Nishant Agrawal and Aarti Mathur and Prescott, {Jason D} and Zeiger, {Martha A.} and Tufano, {Ralph P}",
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T1 - Surgical Management of Normocalcemic Primary Hyperparathyroidism and the Impact of Intraoperative Parathyroid Hormone Testing on Outcome

AU - Trinh, Gina

AU - Rettig, Eleni

AU - Noureldine, Salem I.

AU - Russell, Jonathon

AU - Agrawal, Nishant

AU - Mathur, Aarti

AU - Prescott, Jason D

AU - Zeiger, Martha A.

AU - Tufano, Ralph P

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N2 - Objective: To review our surgical experience and the impact of intraoperative parathyroid hormone (IOPTH) testing among patients with normocalcemic primary hyperparathyroidism. Study Design: Case series with chart review. Setting: Academic referral hospital. Subject and Methods: Normocalcemic hyperparathyroidism (NCHPT) patients were identified with normal-range blood ionized calcium and serum elevated parathyroid hormone. Patient demographics, intraoperative findings, IOPTH dynamics, and biochemical outcomes were compared with those of classic primary hyperparathyroidism (PHPT) patients. Results: Of the 2120 patients who underwent parathyroidectomy, 616 patients met the inclusion criteria: 119 (19.5%) patients had NCHPT, and 497 (80.5%) had classic PHPT. NCHPT patients had higher rates of multigland hyperplasia as compared with classic PHPT (12% vs 4%, P =.002) and smaller gland size (P <.001). Of 119 NCHPT patients, 114 (97%) achieved >50% drop in IOPTH intraoperatively, as opposed to 492 (99%) among 497 classic PHPT patients (P =.014). IOPTH drop >50% had an equivalent positive predictive value for long-term cure in both groups. Conclusions: Surgeons treating NCHPT patients should suspect the presence of multigland disease and have a low threshold for converting to bilateral exploration depending on IOPTH decay dynamics.

AB - Objective: To review our surgical experience and the impact of intraoperative parathyroid hormone (IOPTH) testing among patients with normocalcemic primary hyperparathyroidism. Study Design: Case series with chart review. Setting: Academic referral hospital. Subject and Methods: Normocalcemic hyperparathyroidism (NCHPT) patients were identified with normal-range blood ionized calcium and serum elevated parathyroid hormone. Patient demographics, intraoperative findings, IOPTH dynamics, and biochemical outcomes were compared with those of classic primary hyperparathyroidism (PHPT) patients. Results: Of the 2120 patients who underwent parathyroidectomy, 616 patients met the inclusion criteria: 119 (19.5%) patients had NCHPT, and 497 (80.5%) had classic PHPT. NCHPT patients had higher rates of multigland hyperplasia as compared with classic PHPT (12% vs 4%, P =.002) and smaller gland size (P <.001). Of 119 NCHPT patients, 114 (97%) achieved >50% drop in IOPTH intraoperatively, as opposed to 492 (99%) among 497 classic PHPT patients (P =.014). IOPTH drop >50% had an equivalent positive predictive value for long-term cure in both groups. Conclusions: Surgeons treating NCHPT patients should suspect the presence of multigland disease and have a low threshold for converting to bilateral exploration depending on IOPTH decay dynamics.

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