King Faisal Specialist Hospital Research Center, Saudi Arabia
Amal Alhefdhi has completed her MBBS from King Saud University, MS at University of Wisconsin-Madison, and EdD at Edgewood College. She has the Arab and Saudi board in general surgery. She completed her fellowship in breast and endocrine surgery at university Wisconsin-Madison, USA. She is a breast and endocrine surgeon at King Faisal hospital & research center, Riyadh, KSA. He has published more than 20 papers in reputed journals.
Surgery is the only curative treatment for PHPT. Minimally invasive parathyroidectomy is now commonly performed, the successful removal of hypersecreting parathyroid glands is indicated by a decrease in intraoperative parathyroid hormone (IoPTH) levels by >50% within 15 min. However, the use of IoPTH testing in patients with mild PHPT whose PTH levels are within the normal range and that of a subsequent final set of IoPTH levels after all four glands are visualized remain questionable. The aim of this work was to optimize the surgical treatment of PHPT, focusing on the role of IoPTH testing in mild disease, the role of IoPTH after four-parathyroid gland exploration, and persistent and recurrent disease after surgery. A retrospective analysis was performed on the data from a prospectively collected database of more than 1,000 patients who received parathyroidectomy for PHPT at a single institution from 2001 to 2013 by two experienced endocrine surgeons. IoPTH testing plays an important role in the operative management in 14% of patients with mild hyperparathyroidism. Importantly, a 50% decline in IoPTH levels within 15 min of parathyroidectomy is 96.5% reliable in predicting a cure in patients with PTH levels within the normal range. Moreover, when experienced surgeons visualize all four parathyroid glands, drawing a subsequent final set of IoPTH levels serves a limited role and rarely changes the operative course. Recurrent and persistent PHPT occur more frequently in patients with double adenoma (DA), which suggests that DA in some cases may represent asymmetric or asynchronous hyperplasia.