Intraoperative Parathyroid Hormone Monitoring In the Surgical Management of Primary Hyperparathyroidism

Abstract

Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by autonomous overproduction of parathyroid hormone (PTH), leading to hypercalcaemia and its systemic complications. Surgical excision remains the definitive treatment. In recent years, intraoperative parathyroid hormone (ioPTH) monitoring has emerged as a valuable adjunct in parathyroid surgery, particularly in minimally invasive approaches. This article reviews the principles, indications, methodology, and clinical utility of ioPTH monitoring in the management of PHPT, with special reference to its relevance in the Indian healthcare setting. We planned the present study to evaluate the level of PTH intraoperatively and postoperatively and determine the outcome of the surgery. Materials & Methods: A total of 36 patients scheduled to undergo parathyroidectomy for hyperparathyroidism were involved in the present study. Complete physical examination of all the subjects was carried out. Pre-surgical assessment of all the subjects was done. Minimally invasive parathyroidectomy (MIP) was done in all the patients. A 50% reduction in PTH level from baseline was used as an indication that the exploration was successful. If a parathyroid adenoma was not found or if the PTH did not drop sufficiently after the removal of the gland, the incision was extended and bilateral neck exploration was done. Results: MIP was carried out in 33 patients, while bilateral neck exploration was required in 3 patients. A significant decline in the mean PTH concentration was seen during surgery and postoperatively. Also we observed a significant fall in the postoperative calcium levels in comparison to the preoperative calcium levels. Conclusion: Intraoperative PTH monitoring plays a significant and crucial role in assessing the surgical treatment of primary hyperparathyroidism.