Can the use of intraoperative intact parathyroid hormone monitoring be abandoned in patients with hyperparathyroidism?

BACKGROUND Ultrasound (US) and technetium-99m sestamibi scintigraphy (MIBI) are used to determine the localization of abnormal glands in cases of primary hyperparathyroidism (PHPT). Intraoperative intact parathyroid hormone (iPTH) monitoring is a reliable examination used to cure PHPT. The aim was to assess the necessity of intraoperative iPTH monitoring. METHODS Sixty patients were examined using preoperative MIBI and US. iPTH was measured at 3 time points: (1) at the start of surgery; (2) 10 minutes after gland resection; and (3) more than 60 minutes after surgery. We defined a decreased iPTH level as an iPTH measured 10 minutes after resection that was less than 50% of the preoperative level. RESULTS The iPTH of 55 patients with concordant lesions decreased to within the normal range more than 60 minutes after surgery. CONCLUSIONS It is not necessary to monitor intraoperative iPTH when single concordant lesions are preoperatively identified on both MIBI and US.