Intraoperative PTH Monitoring

The use of intraoperative parathyroid hormone (ioPTH) monitoring during parathyroidectomy is a useful adjunct that aids in the decision-making process during surgery to determine whether patients are cured and if surgery should be terminated. This chapter addresses the evolution of the PTH assay to gain a better understanding of this important tool and to improve the proper interpretation of the intraoperative results in order to increase the success of surgery and reduce the recurrence rates. The principal innovations that have occurred in recent years have been the reintroduction of a truly rapid point-of-care assay, a more measured approach to declaring a cure based on intraoperative PTH degradation, and novel uses of the assay to better localize hyperfunctional parathyroid tissue.