Hyperparathyroidism other diagnostic studies
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Other diagnostic study useful for preoperative localization of hyper-functioning parathyroid glands include super selective venous sampling. Another diagnostic study include measurement of intraoperative parathyroid hormone (IOPTH) by using a modified sensitive assay (immunoradiometric assay). IOPTH is beneficial for predicting long term surgical outcomes.
Other Diagnostic Studies
Super Selective Venous Sampling
- Real-time super selective venous sampling (sSVS) is the most common invasive modality for preoperative localization of hyper-functioning parathyroid glands.
- Real-time sSVS is a highly sensitive and specific technique used when traditional non-invasive imaging studies fail to localize hyper-functioning parathyroid glands preoperatively in patients with persistent or recurrent primary hyperparathyroidism.
- Patients with a 2-fold gradient or more in cervical vein drainage locations (inferior, middle, and superior thyroid veins; thymic and vertebral veins) compared to the baseline value in the iliac vein are considered for exploration.
Intraoperative parathyroid hormone (IOPTH)
- Measurement of intraoperative parathyroid hormone (IOPTH) by using a modified sensitive assay (immunoradiometric assay) is beneficial for predicting long term surgical outcomes. Post-surgical success is defined as postoperative normocalcemia.
- Patients with hyperparathyroidism due to lesion in a single gland shows a rapid decline of intact parathyroid hormone after resection. The levels of intact parathyroid hormone becomes undetectable within hours of resection.
- After resection of parathyroid adenoma, intact parathyroid hormone levels decrease by 85% in first 15 minutes. This fall in parathyroid hormone levels is due to its short half-life.
- The fall in parathyroid hormone level is significantly more after resection of parathyroid adenoma than after resection of parathyroid hyperplasia.
- A fall in level of parathyroid hormone 15 minutes after resection of hyper-functioning parathyroid glands may help differentiating single gland disease from multiple gland disease.
- IOPTH monitoring has a predictive accuracy of 97%. 
Technique for intraoperative parathyroid hormone (IOPTH) monitoring
- When the enlarged parathyroid gland is first visualized intraoperatively, a baseline sample should be obtained.
- The baseline sample should never be obtained before induction of anesthesia. It is due to the fact that an increase in parathyroid hormone level may be observed after general anesthesia.
- After excision of enlarged gland, 2nd and 3rd samples are collected at 5 and 10 minutes respectively.
- Several criteria are used for predicting post-operative normocalcemia including:
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- Bergenfelz A, Isaksson A, Lindblom P, Westerdahl J, Tibblin S (1998). "Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery". Br J Surg. 85 (8): 1129–32. doi:10.1046/j.1365-2168.1998.00824.x. PMID 9718013.
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- Westerdahl J, Lindblom P, Bergenfelz A (2002). "Measurement of intraoperative parathyroid hormone predicts long-term operative success". Arch Surg. 137 (2): 186–90. doi:10.1001/archsurg.137.2.186. PMID 11822958.