A Retrospective Study of the Impact of Intraoperative Intact Parathyroid Hormone Monitoring During Total Parathyroidectomy for Secondary Hyperparathyroidism: STARD Study

Takahisa Hiramitsu, Yoshihiro Tominaga, Manabu Okada, Takayuki Yamamoto, Takaaki Kobayashi, Takahisa Hiramitsu, Yoshihiro Tominaga, Manabu Okada, Takayuki Yamamoto, Takaaki Kobayashi

Abstract

The study aimed to evaluate the diagnostic accuracy of intraoperative intact parathyroid hormone (IO-iPTH) in patients with secondary hyperparathyroidism (HPT). The cut-off for IO-iPTH monitoring remains unknown. This was a single-center retrospective review of 226 consecutive patients (107 males and 119 females) who underwent parathyroidectomy for secondary HPT between May 2010 and March 2014. The predetermined cut-off for IO-iPTH was a 70% IO-iPTH drop from baseline 10 minutes after total parathyroidectomy and thymectomy. We used <60 pg/mL iPTH value on postoperative day 1 (POD1) as an indicator of successful removal of parathyroid glands and reviewed the frequency of reoperation other than in autografted sites during the observation period. This study was based on the Standards for the Reporting of Diagnostic accuracy compliant. The reoperation rate in patients with >60 pg/mL iPTH value (POD1) was significantly higher than that in patients with <60 pg/mL iPTH value (POD1), (13.0% versus 0.5% P = 0.003). Sensitivity, specificity, and accuracy of >70% IO-iPTH drop were 97.5%, 52.2%, and 92.9%, respectively, this criterion was demonstrated to be beneficial in 26 patients. In 5 patients, <70% IO-iPTH drop was observed and further exploration enabled sufficient removal of parathyroid glands. In 21 patients, although fewer than 4 parathyroid glands were removed after enough explorations, >70% IO-iPTH drop enabled termination of operations and iPTH value (POD1) was <60 pg/mL.An iPTH value of <60 pg/mL (POD1) was a good predictor for successful parathyroidectomy. A 70% IO-iPTH drop from the baseline was appropriate to determine sufficient parathyroid gland removal during parathyroidectomy for patients with secondary HPT. [Corrected]

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Trend of IO-iPTH levels in relation to drop in iPTH values from the baseline in patients who underwent reoperation. Patients who underwent reoperations. Patients who did not undergo reoperations. IO-iPTH = intraoperative intact parathyroid hormone, iPTH = intact parathyroid hormone, POD1 = postoperative day 1.
FIGURE 2
FIGURE 2
Benefit of IO-iPTH monitoring in patients. IO-iPTH = intraoperative intact parathyroid hormone, iPTH = intact parathyroid hormone, POD1 = postoperative day 1.

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