A NEW APPROACH FOR PERIOPERATIVE PARATHYROID HORMONE (PTH) MEASUREMENT TO ESTABLISH CURE IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

AUTHORS:
B. Sperotto (Wuppertal, Germany) , M. Natalie (Wuppertal, Germany) , A. Meyer (Wuppertal, Germany) , N. Bösing (Wuppertal, Germany) , N. Lange (Wuppertal, Germany) , C. Dotzenrath (Wuppertal, Germany) , P.F. Alesina (Wuppertal, Germany)
Background:
None of the actual criteria proposed for defining cure after parathyroidectomy for primary hyperparathyrodism is universally accepted. We propose a simplified protocol with the aim to avoid multiple intraoperative blood tests
Methods:
A total of 435 patients operated for pHPT between April 2018 and November 2023 were enrolled. In our setting, all patients scheduled for surgery for pHPT underwent pre-surgical blood test (including PTH) as part of the pre-admission preparation to surgery. Intraoperative PTH was routinely performed using two blood samples: the first pre-incision PTH, the second 15 minutes after resection of the enlarged gland(s). Calcium and PTH levels were routinely checked on the 1st POD. Cure was defined as a drop of the PTH of > 50% or PTH level in the range of normality on 1st POD.
Results:
The median values of the pre-operative and pre-incision PTH were both 127 pg/ml (p=ns). Thirty-two patients exhibited a not appropriate drop of post-operative PTH level. Nevertheless, twenty-three showed a satisfying PTH drop on 1st POD. Ten patients experienced a persistent disease with five achieving cured through reoperation. Three patients apparently deemed cured after an adequate PTH-drop on the day of surgery, showed persistence. Cure rate at primary surgery was 97%. Accuracy of our simplified protocol is 99%.
Conclusions:
The pre-incision PTH blood test provides no additional value compared to the preoperative PTH test. A single blood sample 15 minute after resection, along with the postoperative PTH value on the day after surgery, is sufficient to predict the surgical outcome.