Does the intact parathormone (iPTH) assessment affect the success rate of the operation in primary hyperparathyroid surgery?

Does the intact parathormone (iPTH) assessment affect the success rate of the operation in primary hyperparathyroid surgery? Introduction: Primary hyperparathyroidism (PHPT) occurs as a result of excessive parathyroid hormone release in one or more of the parathyroid glands. Uncontrolled release of this hormone causes hypercalcemia and some related symptoms and complications. Its incidence in the general population is between 0.1% and 0.3%, and is 4 times more common in women than men. The average age at diagnosis was reported to be 33-63 yr. The main treatment for PHPT is surgery. Due to the anatomical variations in the parathyroid glands, determining the preoperative localization may change the surgical approach and the success rate. Thanks to new methods such as different imaging techniques and intact PTH study, the approaches that have been extended, leave their place to focused surgery. Thus, the complications, duration and cost of the operation have been reduced. Although new imaging techniques have increased the success rate, in some cases such as multiple gland disease and goiter, this rate may not be achievable. Once the measurement of I-PTH was established , it was used by many surgeons and its usage criteria were standardized . In recent years, I-PTH measurement has been put into routine practice in our clinic based on the Miami criterion. The aim of this study was investigating whether the I-PTH measurement has an effect on increasing the success rate of the operation. Materials and methods: A total of 203 adult patients (age 54 ± 12 yr; men, 40; women, 163) who were operated with the diagnosis of PHPT between January 2010 and September 2020 in the Department of General Surgery, Gazi University, Faculty of Medicine, were included in this study. Demographic features, preoperative imaging and laboratory results, as well as postoperative laboratory and pathology reports were evaluated by examining the patient files retrospectively. The patients who had examined I-PTH were evaluated as group A and those hadn‟t evaluated as group B. Patients with continued postoperative calcium (Ca) elevation were accepted xii as persistence and after 6 months post operation elevation accepted as recurrence. The different parameters and variables between these two groups were examined, as well as the recurrence or persistence rate. The absence of recurrence or persistence was considered as an indicator for a successful operation. Results: There was no correlation between recurrence or persistence and patients age. The surgical success rate was 93.6%. Surgical success was achieved in 91 patients (97.8%) in group A and 99 patients (90%) in group B. There was a significant difference between the two groups in terms of the success rate of the surgery (P < , 05). Conclusion: The increase in the success rate of surgical methods in patients with primary hyperparathyroidism can be achieved via advanced imaging examinations and intra operative PTH studies. Intra operative PTH study significantly increases the success rate of the operation. Thus, the number of recurrence or persistent cases and the number of second operations related to it will decrease and the complications that may arise from the second operations will be prevented. Key Words: Intra operative parathyroid hormone, parathyroidectomy, primary hyperparathyroidism