Near-patient parathyroid hormone immunoassay for intraoperative monitoring in parathyroid surgery

Appropriate parathyroidectomy by skilled surgeons is the procedure of choice to treat hyperparathyroidism, The operation requires the surgeon to find and remove the correct amount of abnormal parathyroid tissue. The number and location of parathyroid glands are quite variable, although four glands are found in the majority of the population. Locating parathyroid tissue is particularly difficult in re-operative cases due to the disturbed tissue plane and the increased likelihood that the diseased gland or glands may be in an ectopic site (thymus, mediastinum), Currently, there are commercial parathyroid hormone (PTH) measurement kits available, but use of such kits significantly increases the cost of surgery. We developed a rapid PTH assay by using in-house antibodies. In this article, we report our cumulative laboratory experience in the development of a rapid PTH assay for intraoperative monitoring and further evaluate its surgical value, We hope our experience can be used by others to develop their own "in-house" rapid assay and particularly by industry to develop cost effective rapid PTH assays. Presently, the cost of commercial kits prevents their widespread use.