Faculty Collaboration Database

Reoperative parathyroidectomy: an algorithm for imaging and monitoring of intraoperative parathyroid hormone levels that results in a successful focused approach. Surgery 2008 Oct;144(4):611-9; discussion 619-21

Date

10/14/2008

Pubmed ID

18847646

DOI

10.1016/j.surg.2008.06.017

Scopus ID

2-s2.0-51449107220 (requires institutional sign-in at Scopus site)   94 Citations

Abstract

BACKGROUND: Advances in preoperative imaging and use of intraoperative parathyroid hormone (IOPTH) levels are changing the approach to reoperative parathyroidectomy (ReopPTX). We sought to develop a protocol for imaging and IOPTH monitoring that allows for a focused, successful operative approach.

METHODS: We reviewed our prospective database of consecutive patients with primary hyperparathyroidism who underwent ReopPTX with IOPTH monitoring between December 1999 and June 2007.

RESULTS: Thirty-nine patients underwent 43 ReopPTXs for persistent (79%)/recurrent (21%) disease. All underwent ultrasonography and sestamibi imaging; 24 cases (56%) underwent additional imaging studies. Sensitivity of ultrasonography was 56%, sestamibi 53%, both studies 67%, computed tomography (CT) 48%, magnetic resonance imaging (MRI) 67%, and selective venous sampling (SVS) 50%. IOPTH monitoring predicted accurately cure in 100% and failure in 78%. A focused/unilateral approach was performed in 60%; median operative time was 45 minutes (range, 12-127). At last follow-up, 36 (92%) patients were normocalcemic.

CONCLUSIONS: We propose that ultrasonography and sestamibi studies should be done before all ReopPTXs; failure to localize should prompt sequential CT, MRI, and SVS until localization is achieved. IOPTH monitoring defines cure and is recommended for all ReopPTXs. This algorithm allows for a focused operative approach in >50% of ReopPTXs with operative times comparable with first-time, minimally invasive parathyroidectomy.

Author List

Yen TW, Wang TS, Doffek KM, Krzywda EA, Wilson SD

Authors

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Algorithms
Diagnostic Imaging
Female
Follow-Up Studies
Humans
Hyperparathyroidism
Magnetic Resonance Imaging
Male
Middle Aged
Monitoring, Intraoperative
Parathyroid Hormone
Parathyroidectomy
Preoperative Care
Prospective Studies
Recurrence
Registries
Reoperation
Risk Assessment
Safety Management
Sensitivity and Specificity
Severity of Illness Index
Technetium Tc 99m Sestamibi
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Doppler