Introduction. Surgery is the definitive treatment for primary hyperparathyroidism (PHP). Focused approaches for excision of single gland pathology are gaining popularity. Preoperative parathyroid localization and intraoperative parathormone (IOPTH) assay are essential components of successful parathyroidectomy using focused approach. Objective. To evaluate the efficacy of IOPTH in patients undergoing surgery for PHP. Methods. Retrospective review of twelve patients who underwent surgery for PHP at tertiary corporate hospital in Mumbai, India, between January 2009 and December 2012. Results. IOPTH had true results in 10 patients (83%) and led to unnecessary further exploration in 1 patient (8%). The concordance rate between ultrasonogram, sestamibi, and IOPTH was 66%. The mean decay of IOPTH was 65%, and all patients were normocalcemic at the end of six months. Conclusion. IOPTH is a useful adjunct to predict successful removal of the involved gland. 1. Introduction Primary hyperparathyroidism (PHP) is due to excessive parathormone secreted by one or more parathyroid glands and leads to varied manifestations due to hypercalcemia. Parathyroid adenoma is the most common cause of primary hyperparathyroidism and as much as 85% are single adenomas [1]. Surgery is the definitive therapy for PHP, which includes removal of affected parathyroid gland(s) [2]. Success rates for surgical treatment depend on the skill and experience of the surgeon in finding and recognizing the pathologic changes and excising the correct amount of hyperfunctioning parathyroid tissue [3]. Cure rate has been reported to be in the range of 94–100% for bilateral neck, as well as a less invasive surgery, more than 6 months after parathyroidectomy [4–13]. Bilateral neck exploration (BNE) has been traditionally performed where routine identification of all enlarged (involved) and normal parathyroid is mandatory and only enlarged gland(s) is/are excised. Of late, focused approaches for excision of single gland pathology are gaining popularity. Preoperative parathyroid localization imaging study and IOPTH are essential components of focused approach. Various techniques are described and the open procedure seems to be the most common and either uses a standard collar incision with unilateral dissection only or uses a minimal incision just over the location of the abnormal parathyroid gland. Imperfect preoperative localization, the intrinsic rate of bilateral multiglandular disease, and operative complications have been implicated as causes of a failed minimally invasive parathyroidectomy
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