IS INTRAOPERATIVE PTH (IOPTH) ADVANTAGEOUS IN SURGICAL TREATMENT OF PRIMARY HYPERPARATHYROIDISM? A LARGE SERIES FROM ENDOCRINE SURGICAL UNIT OF UNIVERSITY OF FLORENCE

AUTHORS:
G. Ripamonti (Azienda Ospedaliero-Universitaria Careggi, Italy) , D.s. Simona (Azienda ospedaliero -universitaria Careggi, Italy) , M. Alessio (Azienda Ospedaliero- Universitaria Careggi, Italy) , O. Merve (Azienda Ospedaliero-Universitaria Careggi, Italy) , L. Fortuna (Firenze, Italy) , B. Benedetta (Azienda Ospedaliero-Universitaria Careggi, Italy) , C. Fabio (Azienda Ospedaliero-Universitaria Careggi, Italy) , G. Perigli (azienda Ospedaliero-Universitaria Careggi, Italy) , F. Giudici (Azienda Ospedaliero-Universitaria Careggi, Italy)
Background:
Surgery in parathyroid pathology is mainly focused on lesions that cause primary hormonal hyperfunction .
Methods:
In this study, we describe a single-centered and well-documented case series of sporadic primary hyperparathyroidism, surgically treated at the Endocrine Surgery Unit of Florence-Careggi University Hospital. 636 patients with a clinical and instrumental diagnosis of primary hyperparathyroidism were recorded in a database and updated from January 2000 to November 2023.
Results:
The patients were divided into two groups; group A which consisted of 74 patients on which intraoperative parathyroid hormone (ioPTH) was used and group B with 562 patients without the use of ioPTH. In group B there were 14 (2,49%) patients, whereas in group A 3 (4%) patients with permanent post-operative hyperparathyroidism.
Conclusions:
The analysis showed that the use of ioPTH does not have an advantage in helping surgeons in primary operations, especially when ultrasound and scintigraphy are concordant. The advantages obtained by not using intraoperative PTH are not only economic but also shorter operating and general anesthesia times and hospital stays, having an important impact on patient's biological commitment. Furthermore, the significant reduction in operating time makes it possible to almost triple the volume of activity in the same amount of time available, with an undeniable advantage on the reduction of waiting lists.