Intraoperative PTH for hyperparathyroidism

The parathyroids are small, oval glands located in the neck. The parathyroids produce parathyroid hormone (PTH), which regulates the levels of calcium and phosphorus in the body. It is essential that the proper amount of parathyroid hormone is produced, and parathyroid hormone, calcium and phosphorus levels are tightly regulated by the body. This regulation is important because high serum calcium levels or low calcium levels in the body can have devastating consequences to almost every organ and tissue in the body.

Hyperparathyroidism is a disorder of the parathyroid glands in which too much parathyroid hormone is produced, raising the calcium blood levels. The goal of treatment for hyperparathyroidism is to lower the parathyroid hormone levels in the blood. The most common treatment is surgical removal of the abnormal parathyroid glands.

During surgery, the surgeon will examine some or all of the parathyroid glands, looking for one that appears to be enlarged. Once an abnormal gland is located, the surgeon removes the gland and sends it to the pathology lab for diagnosis. The surgeon will also measure the parathyroid hormone blood level approximately 10 minutes following removal of the gland. If the parathyroid hormone level returns to normal, the surgeon can feel confident that all abnormal parathyroid glands have been removed. If the parathyroid hormone level remains high, the surgeon will need to re-examine the neck, looking for additional abnormal parathyroid glands. Intraoperative parathyroid hormone level monitoring, therefore, is important to ensure that all abnormal parathyroids will be removed.

Intraoperative parathyroid hormone level monitoring is also very important to decrease the risk of removing too much parathyroid tissue, causing low parathyroid hormone and calcium levels. Low calcium level can cause serious, life threatening problems. If during surgery, the doctor determines that the parathyroid hormone has fallen too low, he or she will re-implant part of a parathyroid gland into one of the muscles in the neck.

Following surgery, doctors will continue to monitor the parathyroid hormone level to ensure that it remains in the normal range. Calcium levels will also be monitored, especially in the weeks following surgery. Advancing technology such as intraoperative parathyroid hormone level monitoring has increased surgical success rates and minimized the risks of complications.