INTRA-OPERATIVE PTH TESTING
Our philosophy at the CENTER for Advanced Parathyroid Surgery is to be as thorough and comprehensive as possible. Traditionally, parathyroid surgery was always plagued by not having reliable results because it depended on:
- All four glands being found and biopsied.
- All four glands being looked at and compared under the microscope to see which glands appeared normal and which ones were abnormal (a very unreliable method of assessing parathyroids).
This more invasive approach to surgery resulted in greater complication rates and inconsistent outcomes. Today, Dr. Larian solely utilizes the Minimally Invasive Parathyroidectomy approach to curing hyperparathyroidism. As such, after removing the parathyroid tumor, Dr. Larian will perform an intra-operative PTH test to confirm whether or not the patient only had one parathyroid tumor.
Parathyroid hormone is cleared from the blood stream very quickly, if the gland stops producing the hormone within five minutes, half of the hormone in the blood stream disappears. The rapid intra-operative PTH testing depends on this characteristic of PTH, and measures the level of PTH hormone immediately before starting the surgery and 10 minutes after the parathyroid adenoma is removed. If the level comes down by more than 50%, it is confirmation that the surgery has been successful and the other glands are not over-producing PTH and are normal (this test is 97% accurate). By the end of the procedure the patient will have confirmation that the procedure has been successful.
However, a little more then 10% of patients will have more than one hyperactive parathyroid gland. In these cases, pre-operative localization scans may not identify the additional abnormal glands, because the level of activity may not be high enough to be seen on a Sestamibi scan, and/or they may be too small to be seen on ultrasound or CT scan. Therefore, after Dr. Larian removes just the one parathyroid tumor that was identified as abnormal on the localization scans, he still performs the intra-operative PTH test to confirm or deny if the patient has been cured. If the PTH level does not come down by 50%, Dr. Larian knows there is another abnormal gland that needs to be located and removed. Once the additional abnormal gland (or glands) is found and removed the PTH level is tested again to get final confirmation that the surgery has been successful.
Minimally Invasive Parathyroidectomy
Watch the video below to learn even more about how Dr. Larian performs minimally invasive parathyroidectomy to cure his patients from hyperparathyroidism!
Talk To A Parathyroid Expert Today!
If you would like to know more about the benefits of intra-operative PTH testing, or if you are considering minimally invasive parathyroidectomy, schedule a consultation with our parathyroid expert, Dr. Larian, by calling 310.461.0300 today!