October - December 2024, Volume 20, Issue 4

Guzel G, Saridemir Unal D, Ozen A, Sacin YE, Yilmaz N, Boz A, Arici C

Could the Rate of Decrease in Intraoperative Parathyroid Hormone Level Be a Determinant of Surgical Technique in Tertiary Hyperparathyroidism?

Acta Endo (Buc) 2024, 20 (4): 471-476
doi: 10.4183/aeb.2024.471

Context. Intraoperative parathyroid hormone (IO PTH) monitoring has determinative role in surgery for tertiary hyperparathyroidism (tHPT). Objective. We tried to find out whether the extent of surgery to be performed can be dedicated via IO PTH monitoring in tHPT. Design. Renal transplantation (RTX) recipients who had been operated and followed up because of tHPT between 9/2014 and 5/2021 at our institution were retrospectively analysed. Subjects and Methods. We analysed the preoperative and postoperative data of 41 patients with tHPT. Results. Considering IO PTH monitoring; 70% and more decrease of the hormone level leaded us favourable results (89% surgical success) regardless of the PTX method (p<0.05). We obtained the same surgical success rate (75%) in patients in whom monitoring was done and was not done. We observed high success ratios (100%) in the latter group via subtotal PTX and total PTX plus autotransplantation (AT) (p<0.05). Conclusions. In surgery for tHPT, IO PTH monitoring should be maintained. When we observe 70% or more decline in the hormone level, we can decide to finish the operation regardless of the surgical technique. If hormone level decrease is below 70%, we have to continue exploration.

Keywords: intraoperative parathyroid hormone monitoring, parathyroidectomy, renal transplantation, tertiary hyperparathyroidism.

Correspondence: Demet Saridemir Ünal, Akdeniz University, Faculty of Medicine, Department of General Surgery, Konyaalti, Antalya, Turkiye, 07070, E-mail: demetsaridemir@hotmail.com