Review proposes selective, not routine, use of intraoperative PTH monitoring

A narrative review synthesizing guidelines, imaging studies, and cost-effectiveness analyses from 2020-2026 examined whether intraoperative parathyroid hormone (ioPTH) monitoring is necessary in all cases of sporadic primary hyperparathyroidism. The review reports that focused parathyroidectomy, ioPTH-guided surgery, and bilateral neck exploration all achieve high cure rates, and that ioPTH adds the most value when imaging is discordant or nonlocalizing, biochemistry is atypical, disease is familial or syndromic, or anatomy is unfavorable. The authors state that in a narrowly defined subgroup with sporadic disease, favorable anatomy, and concordant high-fidelity localization, routine ioPTH appears unlikely to alter management, and propose a risk-stratified framework with a low threshold for intraoperative escalation.

Most relevant for: Patients undergoing parathyroidectomy for sporadic primary hyperparathyroidism, particularly those with favorable anatomy and concordant preoperative imaging.

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