A Spike in Parathyroid Hormone During Neck Exploration May Cause a False-Negative Intraoperative Assay Result

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Abstract
SURGERY FOR hyperparathyroidism by an experienced parathyroid surgeon has a success rate of 95% to 98%.1,2 Localization studies with high-resolution ultrasound and technetium-99m sestamibi have been used in an attempt to shorten the operative time and limit exploration of normal parathyroid glands.3,4 Preoperative localization allows a unilateral approach in most patients with a solitary adenoma.5-7 However, 5% to 20% of patients with primary hyperparathyroidism have multigland disease and require bilateral neck exploration.6,8 In patients with multigland disease, imaging studies can be misleading. In addition, parathyroid gland enlargement in the setting of multigland disease is commonly asymmetric and may not be obvious after unilateral exploration. Intraoperative parathyroid hormone (IOPTH) monitoring has been introduced as a physiologic assay to determine if adequate parathyroid tissue has been removed.9,10 A 50% reduction in the parathyroid hormone (PTH) value from baseline is often used as an indication that the exploration has been successful.10,11