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A Study of 352 Consecutive Patients

Bill Chiu, MD; Cord Sturgeon, MD; Peter Angelos, MD, PhD

Arch Surg. 2006;141:483-488.

Hypothesis  The 6 published criteria for predicting curative parathyroid resection by means of intraoperative parathyroid hormone (IOPTH) assay are not equivalent.

Design  Retrospective review of 352 patients undergoing parathyroidectomy for primary hyperparathyroidism from January 1, 1999, to December 31, 2004. We evaluated 6-month postoperative IOPTH values and serum calcium levels.

Setting  Tertiary referral center.

Main Outcome Measures  The IOPTH values at baseline (preincision and preexcision) and at 5 and 10 minutes after parathyroidectomy were reviewed according to the Miami criterion (>50% drop from highest baseline IOPTH level at 10 minutes after excision), criterion 1 (>50% drop from preincision IOPTH level at 10 minutes), criterion 2 (>50% drop from highest baseline IOPTH level at 10 minutes and final IOPTH level within the reference range), criterion 3 (>50% drop from highest baseline IOPTH level at 10 minutes and final IOPTH level less than the preincision value), criterion 4 (>50% drop from highest baseline IOPTH level at 5 minutes), and criterion 5 (>50% drop from preexcision IOPTH level at 10 minutes).

Results  Criterion 2 had sensitivity of 88%, specificity of 22%, positive predictive value of 97%, and negative predictive value of 6%. Criterion 2 had good agreement with criteria 1 and 3. Of patients whose IOPTH level drop satisfied criterion 2 but not criterion 1, 14% had postoperative hypercalcemia at 6 months. When criterion 2 was not satisfied but criteria 1, 3, 4, and 5 and the Miami criterion were, failure rates were 0%, 4%, 7%, 6%, and 9%, respectively.

Conclusions  Satisfying criterion 2 had a high operative success but resulted in additional unnecessary surgical exploration. Criterion 1 was better at predicting postoperative normocalcemia than criterion 2.

Author Affiliations: Section of Endocrine Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.