The National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Intraoperative Parathyroid Hormone

Abstract

The National Academy of Clinical Biochemistry developed clinical practice guidelines for the use of intraoperative parathyroid hormone (PTH) at the point-of-care (and in the central laboratory) based on a systematic review of the literature. Parathyroid hormone plays an adjunct role as a functional measure in parathyroid surgery to confirm the adequacy of parathyroid gland resection. Although controlled trials are few, based on evidence for improved patient/health, operational, and economic outcomes, intraoperative PTH is recommended for routine use in patients undergoing initial or reoperative surgery for primary hyperparathyroidism, particularly in directed or limited surgical approaches. No recommendation was made for or against use in patients with secondary/tertiary hyperparathyroidism, familial disease (multiple endocrine neoplasia 1), or parathyroid cancer. Use of rapid parathyroid hormone for diagnostic localization is recommended for use in the interventional radiology suite, but no recommendation was made for use in the operating suite. Recent studies suggest an additional role for preoperative localization using ultrasound-guided biopsies and for tissue identification intraoperatively. There was no evidence to recommend a specific assay or location for PTH testing on site or in the central laboratory. Timing of samples and criteria for interpretation of results are more established for primary hyperparathyroidism than other parathyroid diseases. Although additional refinement and studies may be needed, the National Academy of Clinical Biochemistry guidelines for intraoperative PTH have useful information for the surgical and clinical laboratory communities and are reflected in current clinical practice as illustrated by a case presentation.