Impact of intraoperative intact PTH monitoring on reoperation rates and surgical success in primary hyperparathyroidism.

Abstract

Background: Primary hyperparathyroidism (PHPT) is caused by excessive parathormone secretion from one or more parathyroid glands. The primary treatment for PHPT is surgery. Due to anatomical variations in the parathyroid glands, preoperative localization, surgical approaches, and success rates can vary. With the development of advanced imaging techniques and the introduction of intraoperative intact PTH (i-PTH) measurement, traditional extended surgical approaches have increasingly been replaced by focused surgeries.

Objective: Intraoperative i-PTH measurement has been applied by different surgeons using various criteria. This study aims to evaluate the effectiveness of intraoperative i-PTH measurement in improving surgical success, particularly in cases with inconclusive preoperative imaging results.

Methods: Between January 2010 and September 2020, 203 adult patients who underwent surgery for PHPT in our clinic were included in the study. Patients were categorized into two groups: Group A (with intraoperative i-PTH measurement) and Group B (without i-PTH measurement). Persistent hyperparathyroidism was defined as elevated calcium levels occurring shortly after surgery, whereas recurrence was defined as calcium elevation after the 6th postoperative month. The absence of recurrence or persistent hypercalcemia was considered an indicator of surgical success.

Results: The mean age of the patients was 54.6 ± 12.7 years. Of the 203 patients, 40 (19.7%) were male and 163 (80.3%) were female. No correlation was found between recurrence or persistence and patient age. The overall success rate was 93.6%. Surgical success was achieved in 97.8% of patients in Group A and 90% in Group B, indicating a statistically significant difference between the groups (p = 0.023).

Conclusion: Intraoperative i-PTH measurement significantly increases the success rate of PHPT surgery, reducing the incidence of recurrent or persistent cases and the need for secondary operations. Consequently, it helps prevent complications associated with reoperations. These findings highlight the pivotal role of intraoperative i-PTH monitoring in optimizing surgical outcomes, especially in complex PHPT cases.