Significance of biochemical parameters in differentiating uniglandular from multiglandular disease and limiting use of intraoperative parathormone assay.

Abstract

We studied whether serum calcium and parathormone (PTH) levels are significantly different for uniglandular disease (UGD) and multiglandular disease (MGD) and whether intraoperative rapid intact parathormone (IOPTH) monitoring can be avoided in some cases of minimally invasive parathyroidectomy (MIP) without affecting cure rates, substantiating various previous published studies. This is a single-referral-center retrospective review of prospectively collected data for 281 patients with sporadic primary hyperparathyroidism (sPHPT) from January 1999 to February 2005. The calcium and PTH values were categorized using the following parameters: calcium > or = 3 mmol/l = 1, < 3 mmol/l = 0, PTH > or = 100 pg/ml = 1, PTH < 100 = 1. P values for serum calcium and PTH by ANOVA were 0.0547 and 0.3936, respectively, and by the Mann-Whitney test were 0.1606 and 0.6208, respectively. We had 118 patients with concordant technetium 99 m sestamibi scintigraphy (MIBI) and neck ultrasonography (US) and UGD was confirmed in 118 (100%) cases. No significant difference between serum calcium and PTH for UGD and MGD was found. IOPTH monitoring could be avoided when there is concordant positive MIBI and neck US for single, unilateral, hyperfunctioning gland without affecting cure rates.