Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism

Academic Article

Abstract

  • Background. To date there have been no reports on the feasibility of radioguided parathyroidectomy (RGP) in patients with secondary and tertiary hyperparathyroidism. Methods. Twenty-three consecutive patients with secondary (n = 5) or tertiary hyperparathyroidism (n = 18) underwent RGP. Patients were injected with 10 mCi of technetium 99-sestamibi before surgery. All parathyroid glands were localized during operation with a neoprobe. Results. The mean patient age was 50 ± 3 years. The mean preoperative calcium and intact parathyroid hormone levels were 11.0 ± 0.3 mg/dL and 400 ± 107 pg/mL, respectively. Eighteen patients had 3- or 4-gland hyperplasia, 2 had double adenomas, 2 had forearm graft hyperplasia, 1 had 6-gland disease, and 3 had ectopic glands. All hyperplastic glands had ex vivo counts > 20% of background (mean, 63% ± 6%), making frozen section unnecessary. When compared with 66 historical control subjects who underwent surgery without radioguidance for tertiary hyperparathyroidism, patients undergoing RGP had decreased operative times (96 ± 8 minutes vs 151 ± 15 minutes; P < .001) and lengths of stay (1.3 ± 0.1 days vs 3.7 ± 0.3 days; P < .001). Conclusions. RGP in patients with secondary and tertiary hyperparathyroidism is feasible, may reduce operative time, and permits omission of frozen section. Thus RGP appears to be a useful adjunct in the treatment of secondary and tertiary hyperparathyroidism.
  • Published In

  • Surgery  Journal
  • Digital Object Identifier (doi)

    Author List

  • Nichol PF; Mack E; Bianco J; Hayman A; Starling JR; Chen H; McHenry CR; Prinz RA
  • Start Page

  • 713
  • End Page

  • 717
  • Volume

  • 134
  • Issue

  • 4