{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:52:46Z","timestamp":1783745566140,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,8,14]],"date-time":"2018-08-14T00:00:00Z","timestamp":1534204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To review our surgical experience and the impact of intraoperative parathyroid hormone (IOPTH) testing among patients with normocalcemic primary hyperparathyroidism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Case series with chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Academic referral hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subject and Methods<\/jats:title><jats:p>Normocalcemic hyperparathyroidism (NCHPT) patients were identified with normal\u2010range blood ionized calcium and serum elevated parathyroid hormone. Patient demographics, intraoperative findings, IOPTH dynamics, and biochemical outcomes were compared with those of classic primary hyperparathyroidism (PHPT) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 2120 patients who underwent parathyroidectomy, 616 patients met the inclusion criteria: 119 (19.5%) patients had NCHPT, and 497 (80.5%) had classic PHPT. NCHPT patients had higher rates of multigland hyperplasia as compared with classic PHPT (12% vs 4%, <jats:italic>P<\/jats:italic> =. 002) and smaller gland size (<jats:italic>P<\/jats:italic> &lt;. 001). Of 119\u00a0NCHPT patients, 114 (97%) achieved &gt;50% drop in IOPTH intraoperatively, as opposed to 492 (99%) among 497 classic PHPT patients (<jats:italic>P<\/jats:italic> =. 014). IOPTH drop &gt;50% had an equivalent positive predictive value for long\u2010term cure in both groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Surgeons treating NCHPT patients should suspect the presence of multigland disease and have a low threshold for converting to bilateral exploration depending on IOPTH decay dynamics.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599818793879","type":"journal-article","created":{"date-parts":[[2018,8,14]],"date-time":"2018-08-14T08:01:19Z","timestamp":1534233679000},"page":"630-637","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Surgical Management of Normocalcemic Primary Hyperparathyroidism and the Impact of Intraoperative Parathyroid Hormone Testing on Outcome"],"prefix":"10.1002","volume":"159","author":[{"given":"Gina","family":"Trinh","sequence":"first","affiliation":[{"name":"Division of Head and Neck Endocrine Surgery Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Rettig","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Endocrine Surgery Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salem I.","family":"Noureldine","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Endocrine Surgery Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon O.","family":"Russell","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Endocrine Surgery Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishant","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Endocrine Surgery Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aarti","family":"Mathur","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery Department of Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Prescott","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery Department of Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha A.","family":"Zeiger","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery Department of Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph P.","family":"Tufano","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Endocrine Surgery Department of Otolaryngology\u2013Head and Neck Surgery School of Medicine Johns Hopkins University Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1258\/000456305774538283"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2009.05.029"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318208fed9"},{"key":"e_1_2_10_5_1","first-page":"1008","article-title":"Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? 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