Recommendations after non-localizing sestamibi and ultrasound scans in primary hyperparathyroid disease: order more scans or explore surgically?

Nicholas E Hoda, Paul Phillips, Naveed Ahmed
Journal of the Mississippi State Medical Association 2013, 54 (2): 36-41

BACKGROUND: Treatment for primary hyperparathyroidism (PHPT) is surgical excision. Sestamibi and ultrasound scans, used to locate hyperfunctioning glands, can fail to do so. When both preoperative studies are non-localizing, options include 1) referral to a surgeon for a bilateral neck examination or 2) additional preoperative imaging.

STUDY DESIGN: Retrospective review of patients who underwent a parathyroidectomy from January 2010 to December 2011 at the University of Mississippi Medical Center (UMMC) was conducted. Only patients with negative or inconclusive findings on both sestamibi and ultrasound scans were included. The subsequent courses of action and the operative and postoperative outcomes were retrospectively reviewed.

RESULTS: Negative or inconclusive preoperative findings were present in 3 of 26 patients (12%). Additional imaging studies were ordered for 1 patient, which also produced nonlocalizing findings. All three patients underwent bilateral neck examination (BNE) with intraoperative PTH assay. A parathyroid adenoma was found in each case but was found in an ectopic location or in the presence of a multinodular goiter. Surgery yielded appropriate PTH levels for all 3 patients and each patient was eucalcemic at follow-up.

CONCLUSIONS: Non-localizing preoperative scans may result from ectopic parathyroid adenoma or presence of a multinodular goiter in PHPT. When presented with negative preoperative studies, we propose that the patient be scheduled for bilateral neck examination with intraoperative PTH assay rather than for additional preoperative studies. The surgeon's level of experience with four gland exploration and a thorough understanding of normal and aberrant positioning of parathyroid glands are imperative for patient safety and treatment, especially when localization studies have failed.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.