Intraoperative parathyroid hormone testing in primary hyperparathyroidism surgery: time for giving up?

Eur Arch Otorhinolaryngol. 2019 Jan;276(1):267-272. doi: 10.1007/s00405-018-5179-x. Epub 2018 Oct 24.


Purpose: Intraoperative PTH testing (IOPTH) in treatment of primary hyperparathyroidism (PH) is debated. Some authors advise against IOPTH in patients with concordant preoperative imaging undergoing focused parathyroidectomy. This study aims to compare focused parathyroidectomy success rates with and without IOPTH in patients with concordant preoperative imaging.

Methods: Retrospective cohort study involving 599 consecutive patients underwent surgery for PH from 2012 to 2017. Patients with discordant preoperative imaging were excluded. 426 patients underwent focused parathyroidectomy (214 patients without IOPTH and 212 with IOPTH) and were considered for the statistical analysis. In case of insufficient IOPTH decay (less than 50%), a bilateral exploration was carried out.

Results: The IOPTH group and the non-IOPTH group were similar for demographics and preoperative PTH and calcaemia. 413 patients were cured and disease persistence rates between groups were not significantly different (p > 0.05).

Conclusions: Although further testing and randomized-controlled trials are required to validate our findings, our data show that IOPTH does not seem to improve the outcome in patients with concordant preoperative imaging undergoing focused parathyroidectomy.

Keywords: Minimally invasive surgery; PTH level; Parathyroid hormone; Parathyroidectomy; Primary hyperparathyroidism.

MeSH terms

  • Biomarkers / blood
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperparathyroidism, Primary / blood*
  • Hyperparathyroidism, Primary / surgery
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / methods*
  • Parathyroid Hormone / blood*
  • Parathyroidectomy*
  • Retrospective Studies


  • Biomarkers
  • Parathyroid Hormone