Selective intra-operative parathyroid hormone in re-do neck exploration in parathyroidectomy: A case report. (2019)

• Record Type: Journal Article
• Authors: To, Henry; Otto, Gregory
• Is Part Of: International journal of surgery case reports. Volume 57(2019)
• Page Start: 1
• Page End: 4
• Publication Date: 2019
• Subjects: Parathyroidectomy -- Parathyroid adenoma -- Intra-operative assay -- Non-localised parathyroid -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.02.031
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Intra-operative parathyroid hormone (I-OPTH) measurement is essential in challenging cases, where there has not been localisation of the hyperfunction gland/s and/or redo neck surgery. The difficulty of the case is compounded by these factors. Appropriate methodology is required to perform and interpret I-OPTH, which includes specific and consistent location of sampling (ipsilateral internal jugular vein), and application of verified protocols. Appropriate use of I-OPTH can reduce operative time, cost and complications. Abstract: Introduction: Intra-operative parathyroid hormone (I-OPTH) levels are an adjunct used in parathyroid surgery which provides assurance that parathyroidectomy surgery is complete and has removed the hypersecreting gland. Presentation of case: A 78 year old female with no localisation on pre-operative imaging and had previous hemithyroidectomy. I-OPTH was used to guide the side and timing for completion of exploration, factors which reduced operative time, operative cost and avoided potential complications. Discussion: Routine and selective I-OPTH may be used to guide parathyroidectomy, and this case highlights the methodology of use in a selective challenging case. Appropriate application and interpretation of results must be achieved to ensure adequate completion of surgery and cure for the patient. Conclusion: Selective use of I-OPTH guides parathyroidectomy in challenging cases, and can be time and cost-effective when used appropriately.