IS IT POSSIBLE TO PREDICT MULTIGLANDULAR DISEASE BASED ON INTRAOPERATIVE PARATHORMONE SPIKES DURING FOCUSED PARATHYROIDECTOMY?

AUTHORS:
N. Voloudakis (Thessaloniki, Greece) , A. Basios (Thessaloniki, Greece) , E. Bellou (Thessaloniki, Greece) , M. Velikoudi (Thessaloniki, Greece) , T. Pavlidis (Thessaloniki, Greece) , S. Atmatzidis (Thessaloniki, Greece) , B. Papaziogas (Thessaloniki, Greece) , I. Koutelidakis (Thessaloniki, Greece)
Background:
The role of intraoperative parathormone (ioPTH) elevation ("spikes") during parathyroidectomy (PTX) remains controversial. This study compared patients with and without ioPTH spikes during PTX using the criterion of a > 50% PTH drop and normal PTH levels at 20 min post-excision as a successful operation endpoint. The role of spikes in the presence of multigland disease (MGD) was investigated.
Methods:
We performed a retrospective review of prospectively collected data of patients with primary hyperparathyroidism who were scheduled for ioPTH guided focused PTX from May 2022 to November 2023. Spike values (SV) were determined by subtracting the pre-anesthesia from the pre-excision PTH value. An ioPTH spike was defined as having a positive difference ≥10th percentile of all SVs, either as an absolute number (≥29 pg/ml) or an increase in PTH levels percentage (≥15.2%).
Results:
Of 74 patients, 51(69%) exhibited ioPTH spikes and 5 patients had MGD. All patients with MGD exhibited a spike both as an absolute PTH increase (median: 56, range: 40-61 pg/ml) and as a percentage (median: 27, range: 16-32%), but no difference was observed between patients with spikes or without (MGD; 9.8%vs.0%, p = 0.326). Concerning patients' baseline characteristics and gland features, the only difference observed was patients' age (spike: 54.1±13.1 vs no-spike:61.9±10.4,p=0.012). There were no cases of operative failure or recurrence in this series.
Conclusions:
The presence of ioPTH spikes may increase suspicion for MGD, however larger series are needed to verify this observation