Clinical Usefulness of an Intraoperative “Quick Parathyroid Hormone” Measurement in Primary Hyperparathyroidism Management

Hypercalcemia was detected in an elderly female presenting with psychological symptoms. Primary hyperparathyroidism was diagnosed according to laboratory results. Normal serum calcium (Ca) levels were restored following hydration and the administration of furosemide and zoledronic acid. However, parathyroidectomy was required. Because of poor health, minimally invasive parathyroidectomy was the preferred method, requiring adenoma localization. Neck ultrasonography (USG) revealed a suspicious mass in the inferoposterior region of the right thyroid lobe that can be a parathyroid adenoma. Scintigraphic imaging could not be performed to confirm the USG findings because of poor health. Intraoperative parathyroid hormone assay (quick PTH) was scheduled. During the operation, following the removal of the mass revealed on USG findings, PTH levels decreased from 579 to 50.8 pg/mL. On follow-up, serum Ca, phosphate, and PTH levels remained in the normal range, and cognitive impairment gradually improved.