Focused Parathyroidectomy

  • Focused parathyroidectomy:
    • Is the preferred approach in patients who have a solitary lesion:
      • That is imaged conclusively by:
        • Ultrasound, sestamibi, or other appropriate imaging modalities
  • If the surgeon is not attempting to visualize all four glands:
    • The use of IOPTH:
      • To determine whether all hyperfunctioning tissue has been removed and to document an appropriate drop in PTH levels after the removal of the suspected gland:
        • Is the standard of care
  • The most common criterion used:
    • Is a 50% or greater reduction in the PTH level from the baseline 10 minute after parathyroidectomy
  • The best clinical marker of single-gland disease:
    • Is concordant preoperative imaging:
      • In combination with an appropriate correction of IOPTH levels
  • Previous neck surgery or lack of concordant imaging on two types of studies:
    • Is not a contraindication to attempting focused parathyroidectomy
  • Patients suspected of having multigland disease are managed by four-gland exploration via a smaller incision

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #Hypercalcemia #PHPT #Hyperparathyroidism #PrimaryHyperparathyroidism #EndocrineSurgery #HeadandNeckSurgeon #CancerSurgeon #Surgeon #Teacher #Miami #Mexico #MountSinaiMedicalCenter #MSMC

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