Published online Mar 28, 2016. doi: 10.5412/wjsp.v6.i1.1
Peer-review started: September 6, 2015
First decision: October 30, 2015
Revised: December 3, 2015
Accepted: December 29, 2015
Article in press: January 4, 2016
Published online: March 28, 2016
With the development of imaging and localization studies, focused parathyroidectomy with use of intraoperative parathormone monitoring (IPM) is the mainstay of treatment for primary hyperparathyroidism at many health care centers both nationally and internationally. Focused parathyroidectomy guided by IPM allows for surgical excision of the offending parathyroid gland through smaller incisions. The Miami criterion is a protocol that uses a “> 50% parathormone (PTH) drop” from either the greatest pre-incision or pre-excision measurement of PTH in a blood sample taken 10 min following resection of hyperfunctioning glands. Following removal of the hyperfunctioning parathyroid gland, a > 50% PTH drop at 10 min indicates completion of parathyroidectomy, and predicts operative success at 6 mo. IPM using the Miami criterion has demonstrated equal curative rates of > 97%, which is comparable to the traditional bilateral neck exploration. The focused approach, however, is associated with shorter recovery times, improved cosmesis, and lower risk of postoperative hypocalcemia.
Core tip: Intraoperative parathormone monitoring (IPM) is vital component of the focused parathyroidectomy, the management of choice for primary hyperparathyroidism at the authors’ institution. IPM is used to confirm complete removal of hyperfunctioning glands while preserving any remaining normally functioning glands before the operation is finished, guide the surgeon to continue neck exploration for additional hyperfunctioning glands when the intraoperative parathormone (PTH) levels do not drop sufficiently, identify parathyroid tissue by measurement of intraoperative PTH levels in fine needle aspiration samples, and lateralize hypersecreting parathyroid(s) through differential jugular venous sampling when preoperative localization studies are equivocal.