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23103 Parathyroid Hormone, Intraoperative Rapid

Parathyroid Hormone, Intraoperative Rapid
Test Code: IOPTH
Synonyms/Keywords
Parathyroid Surgery Only, IOPTH​
Useful For
Monitoring parathyroid hormone (PTH) levels during surgery for sporadic primary hyperparathyroidism. To assure that all hyper-functioning parathyroid tissue has been adequately excised and the surgical procedure can be concluded.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
No​ Plasma​ EDTA Lavender Top Tube (LTT)​ EDTA Pink Top Tube (PTT)​ 1.0 mL​ 0.7 mL​ 0.4 mL​
Collection Processing Instructions
Baseline sample/samples prior to surgery may be delivered to the lab by pneumatic tube and will be processed as regular specimen. Specimens drawn during surgery must be immediately hand-delivered to Clinical Automated section for rapid processing and quantitation.
Separate plasma from the blood within 15 minutes of arrival of specimens in the lab. Specimen must be free of particulate matter including fibrin which can interfere with the assay. Plasma specimens for PTH should be kept on ice after collection or maintained at refrigerated temperature as if not processed within two hours PTH is not stable at room temperature and disintegrates at room temperature.

It is important to avoid hemolysis during blood collection by filling the EDTA tube completely and avoiding any shaking of the sample.
Specimen Stability Information
Specimen Type Temperature Time
EDTA Plasma Ambient​ 24 hours
​Refrigerate ​48 hours
Rejection Criteria
​Moderately hemolyzed
Grossly lipemic​
Heparinized plasma​
Interference

Heterophilic antibodies in human serum can react with the immunoglobulins included in the assay components causing interference with immunoassay.

For Tosoh AIA immunoassay method performed at Diagnostic and Treatment Center lab, the drug asfotase alfa (Strensiq®), used for the treatment of patients with perinatal/infantile- and juvenile-onset hypophosphatasia (HPP), may cause falsely increased or decreased test results. Test results from patients treated with asfotase alfa should be interpreted with respect to the clinical picture of the patient. Recommend sending test to Marshfield Center lab for analysis by an alternate method.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Diagnostic Treatment Center​ ​Monday through Friday ​Results available within 30 minutes ​Immunoenzymetric Assay/Tosoh
Eau Calire​ ​Monday through Friday ​Results available within 30 minutes ​Rapid Two-site Immunoenzymatic ("sandwich") Assay/DXI Beckman Coulter
Marshfield​ Monday through Sunday​ Results available within 30 minutes Rapid Two-site Immunoenzymatic ("sandwich") Assay/DXI Beckman Coulter
Test Information
This test is required for intraoperative surgeries at Marshfield campus. Intraoperative PTH requests must be scheduled with the Marshfield Labs, minimum one week in advance of the scheduled surgery date. A minimum of two serial samples are required (as two separate orders). It includes BASELINE sample and a POST-OP1 sample. Additional orders can be placed depending upon requirement (You are required to notify the Lab if additional POST-OP specimens are needed).
Reference Range Information
Performing Location Reference Range
All Performing Sites
A drop in PTH levels of 50% or more in POST-OP1 compared to BASELINE specimen.
 
Most commonly accepted Intraoperative PTH monitoring criteria: The ">50 percent drop" criterion and protocol - This protocol utilizes a drop in PTH values of >50 percent from the highest level (either pre-incision or pre-excision) as the criterion to conclude surgery.
Interpretation
Intraoperative PTH monitoring allows a more focused, less invasive approach to parathyroid exploration without requiring direct visualization of every gland. A bilateral neck exploration requires visualization of all parathyroid glands and excision of enlarged gland(s), with preservation of normally functioning ones. The operative success rate of bilateral neck exploration varies with the experience of the surgeon. The success rate is more than 95 percent when performed by high volume, experienced surgeons.

Focused parathyroidectomy guided by intraoperative PTH monitoring minimizes neck dissection, prevents injury or excision of normally functioning glands, identifies multiple gland disease, and, with few exceptions, assures complete excision of all hyper-secreting glands prior to leaving the operating room. In addition, intraoperative PTH measurements accurately predict postoperative calcium levels.

Intraoperative PTH monitoring takes advantage of the short half-life (three to five minutes) of PTH and utilizes a rapid immuno-assay technique that allows measurements while the patient is still in the operating room. The assay can be completed with a turnaround time of 8 to 20 minutes. Intraoperative rapid PTH assays measure the circulating amount of hormone at the time and from the location where the sample is obtained. Accuracy of intraoperative PTH monitoring is dependent upon the surgeon's knowledge and familiarity with PTH dynamics.
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
83970​
Synonyms/Keywords
Parathyroid Surgery Only, IOPTH​
Ordering Applications
Ordering Application Description
​Centricity ​Parathyroid Surgery Only, IOPTH
​Cerner None​
​COM ​Parathyroid Surgery Only,IOPTH
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
No​ Plasma​ EDTA Lavender Top Tube (LTT)​ EDTA Pink Top Tube (PTT)​ 1.0 mL​ 0.7 mL​ 0.4 mL​
Collection Processing
Baseline sample/samples prior to surgery may be delivered to the lab by pneumatic tube and will be processed as regular specimen. Specimens drawn during surgery must be immediately hand-delivered to Clinical Automated section for rapid processing and quantitation.
Separate plasma from the blood within 15 minutes of arrival of specimens in the lab. Specimen must be free of particulate matter including fibrin which can interfere with the assay. Plasma specimens for PTH should be kept on ice after collection or maintained at refrigerated temperature as if not processed within two hours PTH is not stable at room temperature and disintegrates at room temperature.

It is important to avoid hemolysis during blood collection by filling the EDTA tube completely and avoiding any shaking of the sample.
Specimen Stability Information
Specimen Type Temperature Time
EDTA Plasma Ambient​ 24 hours
​Refrigerate ​48 hours
Rejection Criteria
​Moderately hemolyzed
Grossly lipemic​
Heparinized plasma​
Interference

Heterophilic antibodies in human serum can react with the immunoglobulins included in the assay components causing interference with immunoassay.

For Tosoh AIA immunoassay method performed at Diagnostic and Treatment Center lab, the drug asfotase alfa (Strensiq®), used for the treatment of patients with perinatal/infantile- and juvenile-onset hypophosphatasia (HPP), may cause falsely increased or decreased test results. Test results from patients treated with asfotase alfa should be interpreted with respect to the clinical picture of the patient. Recommend sending test to Marshfield Center lab for analysis by an alternate method.

Useful For
Monitoring parathyroid hormone (PTH) levels during surgery for sporadic primary hyperparathyroidism. To assure that all hyper-functioning parathyroid tissue has been adequately excised and the surgical procedure can be concluded.
Reference Range Information
Performing Location Reference Range
All Performing Sites
A drop in PTH levels of 50% or more in POST-OP1 compared to BASELINE specimen.
 
Most commonly accepted Intraoperative PTH monitoring criteria: The ">50 percent drop" criterion and protocol - This protocol utilizes a drop in PTH values of >50 percent from the highest level (either pre-incision or pre-excision) as the criterion to conclude surgery.
Interpretation
Intraoperative PTH monitoring allows a more focused, less invasive approach to parathyroid exploration without requiring direct visualization of every gland. A bilateral neck exploration requires visualization of all parathyroid glands and excision of enlarged gland(s), with preservation of normally functioning ones. The operative success rate of bilateral neck exploration varies with the experience of the surgeon. The success rate is more than 95 percent when performed by high volume, experienced surgeons.

Focused parathyroidectomy guided by intraoperative PTH monitoring minimizes neck dissection, prevents injury or excision of normally functioning glands, identifies multiple gland disease, and, with few exceptions, assures complete excision of all hyper-secreting glands prior to leaving the operating room. In addition, intraoperative PTH measurements accurately predict postoperative calcium levels.

Intraoperative PTH monitoring takes advantage of the short half-life (three to five minutes) of PTH and utilizes a rapid immuno-assay technique that allows measurements while the patient is still in the operating room. The assay can be completed with a turnaround time of 8 to 20 minutes. Intraoperative rapid PTH assays measure the circulating amount of hormone at the time and from the location where the sample is obtained. Accuracy of intraoperative PTH monitoring is dependent upon the surgeon's knowledge and familiarity with PTH dynamics.
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Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Diagnostic Treatment Center​ ​Monday through Friday ​Results available within 30 minutes ​Immunoenzymetric Assay/Tosoh
Eau Calire​ ​Monday through Friday ​Results available within 30 minutes ​Rapid Two-site Immunoenzymatic ("sandwich") Assay/DXI Beckman Coulter
Marshfield​ Monday through Sunday​ Results available within 30 minutes Rapid Two-site Immunoenzymatic ("sandwich") Assay/DXI Beckman Coulter
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
83970​
For most current information refer to the Marshfield Laboratory online reference manual.