Can the outpatient parathormone value be used instead of the initial value in intraoperative parathormone measurement during primary hyperparathyroidism surgery?

Abstract Background Intraoperative parathyroid hormone (IOPTH) measurement is widely used to confirm surgical success in primary hyperparathyroidism (PHPT). The Miami criteria are the most widely used. Despite the significant advantages of IOPTH, its cost remains a matter of debate. This study aimed to investigate the necessity of pre-excision parathyroid hormone (PTH) measurement during parathyroidectomy in PHPT patients. Methods The files of 159 patients who underwent parathyroidectomy in our department between January 2022 and December 2023 were retrospectively reviewed. Patients aged 18 years and older who underwent parathyroidectomy for PHPT were included. Patients with secondary/tertiary hyperparathyroidism and those with incomplete data were excluded. PTH levels were measured in all patients at the outpatient clinic, during surgery (IOPTH preexcision (1) and 10-minute postexcision (2)), and on the first postoperative day. Achieving postoperative normocalcemia was considered a cure. Outpatient PTH/10-minute postexcision PTH and IOPTH1/IOPTH2 results were compared, and a decrease of 50% was considered a successful excision. Results 122 patients who met the study criteria were included. The median age was 55 years (20-80 years). 103 (84.4%) were female and 19 (15.6%) were male. A total of 3 (2.5%) patients had persistent disease. The accuracy rates for outpatient PTH/10-minute postexcision PTH and IOPTH1/IOPTH2 for cure prediction were 91% and 93.4%, respectively, and no statistically significant difference was found between methods (p=0.474). Conclusion Evaluating outpatient PTH levels with post-excision PTH levels can be used to confirm surgical success with high accuracy. Using this method can offer advantages in terms of both operative time and cost.