Rapid Intra-operative Parathyroid Hormone Measurements

        Developed by Dr. George Irvin at the University of Miami in the mid-90’s, the rapid measurement of blood parathyroid hormone levels has revolutionized the surgical treatment of hyperparathyroidism (HPT).  Using a kit developed by Future Diagnostics of the Netherlands, we are able to measure blood parathyroid hormone levels in the operating room before removal of abnormal parathyroid glands, and 5 and 10 minutes after removal.  If we see a greater than 50% reduction in the blood parathyroid hormone concentration with removal of the abnormal gland, we know that there is a very high likelihood of surgical cure and can stop searching for other enlarged glands. Our PTH assay takes 8 minutes to complete and is highly accurate. 

Without this test, minimally invasive radioguided parathyroid surgery (MIRP) is doomed to failure about 10% of the time.  Remember that 10% of  HPT patients have more than one enlarged parathyroid.  Quite often, the extra abnormal glands are not recognized by pre-operative Sestamibi scanning or the intra-operative Sestamibi-guided probe. The best way to recognize multiple abnormal glands in the operating room is by observing an inadequate drop in blood parathyroid hormone levels after removal of the first abnormal gland.  Thus, rapid intra-operative parathyroid hormone measurements are really like an insurance policy that maximizes your chances for successful MIRP.