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| =Other diagnostic studies= | | =Other diagnostic studies= |
| ==Intraoperative parathyroid hormone (IOPTH)==
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| *Measurement of intraoperative parathyroid hormone (IOPTH) by using a modified sensitive assay (immunoradiometric assay) is beneficial for long term surgical outcomes.Post-surgical success is defined as postoperative normocalcemia.
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| *Patients with hyperparathyroidism due to lesion in a single gland shows a rapid decline of intact parathyroid hormone. The levels of intact parathyroid hormone reached to indetectable levels within hours of resection.<ref name="pmid3194839">{{cite journal| author=Nussbaum SR, Thompson AR, Hutcheson KA, Gaz RD, Wang CA| title=Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism. | journal=Surgery | year= 1988 | volume= 104 | issue= 6 | pages= 1121-7 | pmid=3194839 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3194839 }} </ref>
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| *After resection of parathyroid adenoma, intact parathyroid hormone levels decrease by 85% is observed in first 15 minutes. This fall in parathyroid hormone levels is due to short half-life of parathyroid hormone.<ref name="pmid8145618">{{cite journal| author=Bergenfelz A, Isaksson A, Ahrén B| title=Intraoperative monitoring of intact PTH during surgery for primary hyperparathyroidism. | journal=Langenbecks Arch Chir | year= 1994 | volume= 379 | issue= 1 | pages= 50-3 | pmid=8145618 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8145618 }} </ref>
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| *The fall in parathyroid hormone level is significantly more after resection of parathyroid adenoma than after resection of parathyroid hyperplasia.
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| *A fall in level of parathyroid hormone 15 minutes after resection of hyper-functioning parathyroid glands may help differentiating sigle gland disease from multi gland disease.<ref>{{cite journal |last1=Irvin III |first1=George L. |last2=Dembrow |first2=Victor D. |last3=Prudhomme |first3=David L. |date= December 1993 |title=Clinical usefulness of an intraoperative “quick parathyroid hormone” assay |url=http://www.surgjournal.com/article/0039-6060(93)90317-7/abstract |journal=Surgery |volume=114 |issue=6 |pages=1019 - 1023 |doi= |access-date= }}</ref><ref name="pmid9718013">{{cite journal| author=Bergenfelz A, Isaksson A, Lindblom P, Westerdahl J, Tibblin S| title=Measurement of parathyroid hormone in patients with primary hyperparathyroidism undergoing first and reoperative surgery. | journal=Br J Surg | year= 1998 | volume= 85 | issue= 8 | pages= 1129-32 | pmid=9718013 | doi=10.1046/j.1365-2168.1998.00824.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9718013 }} </ref>
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| *IOPTH monitoring has a predictive accuracy of 97%. <ref name="pmid8957480">{{cite journal| author=Boggs JE, Irvin GL, Molinari AS, Deriso GT| title=Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy. | journal=Surgery | year= 1996 | volume= 120 | issue= 6 | pages= 954-8 | pmid=8957480 | doi=10.1016/S0039-6060(96)80040-7 | pmc= | url=http://ac.els-cdn.com/S0039606096800407/1-s2.0-S0039606096800407-main.pdf?_tid=99caa004-930c-11e7-92b8-00000aab0f01&acdnat=1504706978_12ba7c16e03bb28c66dc1c17a05074c4}} </ref>
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| ===Technique for intraoperative parathyroid hormone (IOPTH) monitoring===
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| *When the enlarged parathyroid gland is first visualized intraoperatively, the baseline sample should be obtained.<ref name="pmid11822958">{{cite journal| author=Westerdahl J, Lindblom P, Bergenfelz A| title=Measurement of intraoperative parathyroid hormone predicts long-term operative success. | journal=Arch Surg | year= 2002 | volume= 137 | issue= 2 | pages= 186-90 | pmid=11822958 | doi=10.1001/archsurg.137.2.186 | pmc= | url=http://jamanetwork.com/journals/jamasurgery/fullarticle/212128 }} </ref>
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| *The baseline samples should never be obtained before induction of anesthesia. It is due to the fact that an increase in parathyroid hormone level may be observed after general anesthesia.
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| *After excision of enlarged gland, 2nd and 3rd samples are collected at 5 and 10 minutes respectively.
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| *Several criteria are used for predicting post-operative normocalcemia including:
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| **A decline in parathyroid hormone levels of ≥60% from baseline value at 15 minutes.
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| **A decline in parathyroid hormone levels of ≥50% from baseline value at 10 minutes.
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| ==Super Selective Venous Sampling== | | ==Super Selective Venous Sampling== |
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