Intraoperative risk management of hyperparathyroidism: Modeling and testing the parathyroid hormone's evolution as a mean reverting stochastic processes

This paper describes and validates a stochastic model (Ornstein-Uhlenbeck process) for parathyroid hormone (PTH) levels. Rapid intraoperative parathyroid hormone assay supports the emergence of a minimally invasive approach to unilateral parathyroid exploration in the surgical treatment of hyperparathyroidism. The model's goal is to verify whether a cure has been attained with excision of abnormal parathyroid tissue, based on intraoperative measurements, sparing the need for a bilateral exploration. The scarcity of PTH observations renders the classical methods of goodness-of-fit tests (GoFT) and cure criteria inadmissible or numerically challenging. The paper suggests a new approach to accomplish these goals given limited data. The GoFT strongly supports the model and consequently the induced cure criterion. This model will clarify the confusion in the literature regarding the required PTH decay representing a high likelihood of cure from hyperparathyroidism.