With the introduction of Tc-99m MIBI scintigraphy having the purpose to identify and locate the parathyroid adenoma preoperatively, it began the era of focused exploration and minimally invasive parathyroidectomy, the radio-guided surgery, and novel endoscopic techniques (MonchiK 2002). In case of primary hyperparathyroidism, the goal of surgery is to return the patient’s calcium level to normal.
The success of the surgical treatment depends on the localization and identification of the abnormal glands. These procedures may be done as outpatient surgery, even with local anesthesia.
Introduction of intraoperative quick PTH assays opened also new ways of approaches in the management of primary hyperparathyroidism. This assay measures intact PTH levels in the patient’s plasma using an immunochemilumino-metric technique and can be performed during the operation. Therefore, a significant drop in quick PTH level is observed 5-10 min after removal of the abnormal gland. The fall of quick PTH level of about 50% of the preoperative level is considered indicative of successful removal. Under these conditions, the quick PTH assay has a sensitivity and a specificity of 98% and 94%, respectively, and an overall accuracy of 97% in predicting success of surgery Irvin and Carneiro (2000).