Hyperparathyroidism other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]


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.[1]
  • 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.[2]
  • 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.[3]

Intraoperative parathyroid hormone (IOPTH)

Technique for intraoperative parathyroid hormone (IOPTH) monitoring

  • When the enlarged parathyroid gland is first visualized intraoperatively, a baseline sample should be obtained.[9]
  • 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:


  1. Lebastchi AH, Aruny JE, Donovan PI, Quinn CE, Callender GG, Carling T; et al. (2015). "Real-Time Super Selective Venous Sampling in Remedial Parathyroid Surgery". J Am Coll Surg. 220 (6): 994–1000. doi:10.1016/j.jamcollsurg.2015.01.004. PMID 25868412.
  2. Sugg SL, Fraker DL, Alexander R, Doppman JL, Miller DL, Chang R; et al. (1993). "Prospective evaluation of selective venous sampling for parathyroid hormone concentration in patients undergoing reoperations for primary hyperparathyroidism". Surgery. 114 (6): 1004–9, discussion 1009-10. PMID 8256203.
  3. Powell AC, Alexander HR, Chang R, Marx SJ, Skarulis M, Pingpank JF; et al. (2009). "Reoperation for parathyroid adenoma: a contemporary experience". Surgery. 146 (6): 1144–55. doi:10.1016/j.surg.2009.09.015. PMC 3467310. PMID 19958942.
  4. Nussbaum SR, Thompson AR, Hutcheson KA, Gaz RD, Wang CA (1988). "Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism". Surgery. 104 (6): 1121–7. PMID 3194839.
  5. Bergenfelz A, Isaksson A, Ahrén B (1994). "Intraoperative monitoring of intact PTH during surgery for primary hyperparathyroidism". Langenbecks Arch Chir. 379 (1): 50–3. PMID 8145618.
  6. Irvin III, George L.; Dembrow, Victor D.; Prudhomme, David L. (December 1993). "Clinical usefulness of an intraoperative "quick parathyroid hormone" assay". Surgery. 114 (6): 1019–1023.
  7. 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.
  8. Boggs JE, Irvin GL, Molinari AS, Deriso GT (1996). "Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy" (PDF). Surgery. 120 (6): 954–8. doi:10.1016/S0039-6060(96)80040-7. PMID 8957480.
  9. 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.

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