Surgical management strategies in patients with primary hyperparathyroidism: which technique in which patients?

Abstract

OBJECTIVE:

This study was planned to investigate the efficacy of either 99mTc-sestamibi scan or ultrasonography in predicting the operative treatment in patients with primary hyperparathyroidism (PHPT).

SUBJECTS AND METHOD:

Thirty patients (25 female, 5 male; mean age: 53 years) being operated for symptomatic primary PHPT were included in this study. Ultrasonography was used in 29 patients while 99mTc-sestamibi scintigraphy was done in 28 patients to localize the hyperfunctioning gland(s). Standard bilateral neck exploration was done in 6 patients. Although unilateral intervention had been planned for 24 patients, bilateral intervention was performed in 9 of them.

RESULTS:

Sensitivity of 99mTc-sestamibi was 81%, while that of ultrasonography was 42%. 99mTc-sestamibi localization method led to misleading results in 10/28 (35.7%) patients. False-positive localization and accompanying thyroid pathologies played an important role in determining transition from unilateral to bilateral intervention.

CONCLUSION:

Our findings indicate that bilateral intervention remains a successful management option without prior localization in patients with PHPT especially in an endemic goiter region.

• Authors: Ayhan Koyuncu, Hatice Sebila Dokmetaş, Cengiz Aydin, Mustafa Turan, Taner Erselcan, Selçuk Sozeri, Metin Sen
• Journal: Medical principles and practice : international journal of the Kuwait University, Health Science Centre (Med Princ Pract) 2005 May-Jun Vol. 14 Issue 3 Pg. 194-8 ISSN: 1011-7571 [Print] Switzerland
• PMID: 15863995 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Technetium Tc 99m Sestamibi

Topics

• Female
• Humans
• Hypercalcemia (surgery)
• Hyperparathyroidism (diagnostic imaging, surgery)
• Male
• Middle Aged
• Parathyroid Glands (diagnostic imaging, surgery)
• Parathyroidectomy (methods)
• Predictive Value of Tests
• Preoperative Care (methods)
• Radionuclide Imaging
• Technetium Tc 99m Sestamibi
• Treatment Outcome
• Ultrasonography