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  • The Benefits of Local Anesthesia During Minimally Invasive Parathyroid Surgery
    One of the many benefits of minimally invasive parathyroid surgery is that it can be performed under local anesthesia, as opposed to general Read more >
  •  7 Health Problems Caused by High Blood Calcium The Connection Between Heart Palpitations and Parathyroid Disease
    Parathyroid disease may not be the first thing that comes to mind if you’ve been experiencing heart palpitations, but it may be a condition you should consider as a possibility. Read more >
  • All About Ectopic Parathyroid Glands Parathyroid Info: 5 Little-Known Facts
    The thyroid gland is a well-known part of the body, but have you ever heard of the parathyroid? The parathyroid did not get its name because it’s similar to the thyroid gland but because Read more >

Intra-Operative PTH Testing

Our philosophy at the CENTER is to be as thorough and comprehensive as possible. Traditionally, parathyroid surgery was always plagued by not having reliable results because it depended on

  1. 1.   all four glands being found and biopsied
  2. 2.   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 resulted in greater complication rates and inconsistent outcomes. 

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 abnormal gland 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. 

Intra-operative PTH testingMore then 10% of patients will have more than one hyperactive 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 the Sestamibi scan, and they maybe too small to be seen on ultrasound or CT scan. Therefore, when a surgeon decides to remove just the one parathyroid gland that was identified as abnormal on the localization scans, it is important to have a physiologic way to check that there are no other hyperactive parathyroid glands at the time of surgery.  To overcome this problem, once the one gland that is identified as being abnormal is removed, the blood PTH level is tested, if the level does not come down by 50%, it tells the surgeon that there is another abnormal gland that needs to be found and removed.  After the other abnormal gland or glands are found and removed the PTH level is tested again to get final confirmation that the surgery has been successful. 

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 by calling 310.933.4210310.933.4210 today!

Next, learn about local anesthesia parathyroid surgery

Request your consultation with Dr. Larian today.
Call us at 310.933.4210 to schedule an appointment or

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Chief of Head & Neck Surgery at Cedars-Sinai

Assistant Clinical Professor of Surgery at UCLA

By Babak Larian, MD FACS   Privacy Notice © 2013 Babak Larian, MD FACS. All Rights Reserved.    

DISCLAIMER: Content on this website is not intended to serve as medical advice and should not be construed as such. Please see a medical professional in order to obtain specific advice for your medical conditions.
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