- 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
- That is imaged conclusively by:
- Is the preferred approach in patients who have a solitary lesion:
- 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
- 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:
- The use of IOPTH:
- 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
- Is concordant preoperative imaging:
- 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
Rodrigo Arrangoiz MS, MD, FACS, FSSO 