{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:20:38Z","timestamp":1787862038549,"version":"build-2784847793"},"reference-count":62,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether routine intraoperative parathyroid hormone (ioPTH) monitoring is necessary in all cases of sporadic primary hyperparathyroidism (pHPT) in the era of advanced preoperative localization and to propose a conservative, risk\u2010stratified operative framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>PubMed, Scopus, and Embase were searched for English\u2010language publications from January 2020 through January 2026, supplemented by key guidelines, consensus statements, and high\u2010impact reviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Review Methods<\/jats:title>\n                    <jats:p>\n                      This narrative review synthesizes contemporary guidelines, imaging performance studies (ultrasound, sestamibi\u2010based techniques, four\u2010dimensional computed tomography [4D\u2010CT], and\n                      <jats:sup>18<\/jats:sup>\n                      F\u2010fluorocholine positron emission tomography [FCH\u2010PET]), observational cohorts comparing operative strategies, and decision\u2010analytic and cost\u2010effectiveness analyses. Evidence was prioritized by clinical relevance and methodological quality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Focused parathyroidectomy, ioPTH\u2010guided surgery, and bilateral neck exploration all achieve high cure rates when appropriately applied. The incremental value of ioPTH is greatest in settings of elevated residual uncertainty, including discordant or nonlocalizing imaging, atypical biochemical profiles (including normocalcemic or discordant calcium\u2013PTH presentations), familial or syndromic disease, reoperative necks, and unfavorable anatomy. In a narrowly defined subgroup with sporadic disease, favorable anatomy, and concordant high\u2010fidelity localization\u2014particularly high\u2010quality, surgeon\u2010reviewed or surgeon\u2010performed ultrasound combined with 4D\u2010CT\u2014the likelihood that routine ioPTH alters management appears low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Practice<\/jats:title>\n                    <jats:p>Selective omission of ioPTH may be reasonable in carefully selected patients within a conservative, risk\u2010stratified framework, with a low threshold for intraoperative escalation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70409","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:40:50Z","timestamp":1787859650000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative PTH Monitoring in Primary Hyperparathyroidism: A Risk\u2010Stratified Approach"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0651-6994","authenticated-orcid":false,"given":"Sholem","family":"Hack","sequence":"first","affiliation":[{"name":"City St. George's University London School of Medicine, Program Delivered by University of Nicosia at the Chaim Sheba Medical Center Ramat Gan Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Z","family":"Allen","sequence":"additional","affiliation":[{"name":"Division of Endocrine Head &amp; Neck Surgery, Department of Otolaryngology\u2013Head &amp; Neck Surgery Emory University Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Remer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head &amp; Neck Surgery Sheba Medical Center Ramat Gan Israel"},{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel\u2010Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eran E","family":"Alon","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head &amp; Neck Surgery Sheba Medical Center Ramat Gan Israel"},{"name":"Gray Faculty of Medical &amp; Health Sciences, Tel\u2010Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianna L","family":"Rosamilia","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery McGovern Medical School at the University of Texas Health Science Center Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugur Nur","family":"Basmaci","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery McGovern Medical School at the University of Texas Health Science Center Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron J","family":"Karni","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery McGovern Medical School at the University of Texas Health Science Center Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"201","volume-title":"A Case\u2010Based Guide to Clinical Endocrinology","author":"Helbing A","year":"2024"},{"issue":"10","key":"e_1_2_8_3_1","article-title":"Minimally invasive parathyroidectomy guided by intraoperative parathyroid hormone monitoring (IOPTH) and preoperative imaging versus bilateral neck exploration for primary hyperparathyroidism in adults","volume":"2020","author":"Ahmadieh H","year":"2020","journal-title":"Cochrane Database Syst 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