Contemporary and practical uses of intraoperative parathyroid hormone monitoring.

ABSTRACT

OBJECTIVE: To describe the evolution and current applications of intraoperative parathyroid hormone (PTH) monitoring along with a detailed description of intraoperative protocol and assay methodology. METHODS: Review of the literature regarding the role of intraoperative PTH monitoring in parathyroidectomy, controversies associated with its use in the treatment of hyperparathyroidism, and outcomes using this operative approach. The technologies currently available for "quick" PTH measurement are summarized. RESULTS: Since its inception, intraoperative PTH monitoring has become an essential tool in the endocrine surgeon's armamentarium for treatment of sporadic primary hyperparathyroidism. Intraoperative PTH monitoring changed the operative approach to this disease from bilateral neck exploration with identification of all parathyroid glands and excision based on size, to a highly successful procedure achieved with a limited dissection and gland excision guided by hormone hypersecretion instead of morphologic characteristics. Intraoperative PTH monitoring accuracy is directly associated with the intraoperative criteria used. Although controversy exists regarding the best intraoperative PTH monitoring criteria to be used, most specialized centers have shown excellent results with this intraoperative guidance. Currently, most parathyroid surgeons use intraoperative PTH monitoring, selectively or routinely, during parathyroidectomy. CONCLUSION: Parathyroidectomy guided by intraoperative PTH monitoring to treat sporadic primary hyperparathyroidism is a highly successful and less-invasive approach associated with lower risks than bilateral neck exploration, and it has become the surgical treatment of choice for this disease.