Abstract
Background and aims
Parathyroid hormone (PTH) spikes caused by unintentional manipulation of the hypersecreting glands may lead to interpretation problems in intraoperative PTH monitoring. Their frequency and surgical consequences were evaluated.
Materials and methods
Intraoperative PTH values of 401 patients with primary hyperparathyroidism and single gland disease were analysed. Patients were divided into four groups: extensive increase (>150 pg/ml), moderate PTH increase (<150 pg/ml), no increase (±50 pg/ml) and decrease before excision as referred to the baseline level before skin incision. PTH was measured before and up to 25 min after removal of the enlarged gland.
Results
Twenty-two (5.5%) patients had an extensive and 36 (9%) a moderate intraoperative PTH increase. The PTH decline was prolonged to 15 min in 7 (31.8%) and to 25 min in 12 (54.5%) patients after extensive manipulation and in 9 patients (25%) each after moderate manipulation, respectively. No increase occurred in 162 (40.4%) and a decrease in 181 (45.1%) patients. The surgical approach (bilateral exploration vs open, minimally invasive parathyroidectomy) did not show a difference in the rate of PTH spikes.
Conclusion
PTH spikes often cause a prolonged PTH decline but, when recognized, do not lead to a change in the surgical strategy.
Similar content being viewed by others
References
Prager G, Czerny C, Ofluoglu S, Kurtaran A, Passler C, Kaczirek K et al (2003) Impact of localization studies on feasibility of minimally invasive parathyroidectomy in an endemic goiter region. J Am Coll Surg 196(4):541–548
Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin GL III (2003) Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery 134(6):973–979 (discussion 979–981)
Gauger PG, Mullan MH, Thompson NW, Doherty GM, Matz KA, England BG (2004) An alternative analysis of intraoperative parathyroid hormone data may improve the ability to detect multiglandular disease. Arch Surg 139(2):164–169
Libutti SK, Alexander HR, Bartlett DL, Sampson ML, Ruddel ME, Skarulis M et al (1999) Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism. Surgery 126(6):1145–1150 (discussion 1150–1151)
Yang GP, Levine S, Weigel RJ (2001) A spike in parathyroid hormone during neck exploration may cause a false-negative intraoperative assay result. Arch Surg 136(8):945–949
Prager G, Czerny C, Kurtaran A, Passler C, Scheuba C, Bieglmayer C et al (2001) Minimally invasive open parathyroidectomy in an endemic goiter area: a prospective study. Arch Surg 136(7):810–816
Bieglmayer C, Prager G, Niederle B (2002) Kinetic analyses of parathyroid hormone clearance as measured by three rapid immunoassays during parathyroidectomy. Clin Chem 48(10):1731–1738
Prager G, Riss P, Bieglmayer C, Niederle B (2003) The role of intraoperative quick PTH measurements in primary hyperparathyroidism. Ann Ital Chir 74(4):395–399
Riss P, Prager G, Passler C, Kaczirek K, Bieglmayer C, Niederle B (2004) QPTH-monitoring bei patienten mit primären hyperparathyreoidismus-standardinterpretation. European Surg 36(3):67
Sippel RS, Becker YT, Odorico JS, Springman SR, Chen H (2004) Does propofol anesthesia affect intraoperative parathyroid hormone levels? A randomized, prospective trial. Surgery 136(6):1138–1142
Riss P, Kaczirek K, Bieglmayer C, Niederle B (2005) Secretion of PTH fragments during parathyroid exploration. Langenbecks Arch Surg 390(6):565
Acknowledgement
The study was supported by “Jubiläumsfonds der Österreichischen Nationalbank” Grant 9307.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Riss, P., Kaczirek, K., Bieglmayer, C. et al. PTH spikes during parathyroid exploration—a possible pitfall during PTH monitoring?. Langenbecks Arch Surg 392, 427–430 (2007). https://doi.org/10.1007/s00423-006-0125-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-006-0125-6