Endocrine Abstracts

Introduction: Sestamibi (SM) and ultrasound (US) are routinely used for preoperative localisation of abnormal parathyroids in patients with hyperparathyroidism. Minimally invasive parathyroidectomy (MIP) is recommended if localisation is concordant, otherwise neck exploration is the method of choice.

Aim: To assess whether introduction of intraoperative parathormone (IOPTH) monitoring allows us to perform MIP successfully in patients with non concordant findings.

Method: Retrospective review of patients operated between 2006–2011.

Results: 158 patients with hyperparathyroidism (120 female, 38 male) with median age 60 (13–85) had parathyroidectomies with IOPTH monitoring.

152 patients had US of which 118 identified an abnormal parathyroid and 153 patients had SM of which 106 identified an abnormal parathyroid. 73 (46.2%) patients had concordant imaging qualifying them for MIP but 85 patients (53.8%) with non-concordant findings were also scheduled for MIP.

114 patients (72.1%) had MIP of which 6 were converted to neck explorations (5%). 44 patients (27.8%) who had simultaneous thyroidectomies, sternotomies or mediastinoscopies for ectopic glands or all 4 glands removed had neck exploration.

Overall, 154 patients (97.4%) were cured. 107 (99%) of patients who underwent MIP and 41 (93%) patients who had neck explorations were cured.

Conclusions: Introduction of IOPTH monitoring allowed successful MIP not only in patients with concordant findings but also in patients with non concordant preoperative imaging. Use of IOPTH monitoring doubled the number of Minimally Invasive Parathyroidectomies in our series.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.