Surgical Management Strategies in Patients with Primary Hyperparathyroidism: Which Technique in Which Patients?

• Published in: Medical principles and practice Vol. 14; no. 3; pp. 194 - 198
• Main Authors: Koyuncu, Ayhan, Dökmetaş, Hatice Sebila, Aydın, Cengiz, Turan, Mustafa, Erselcan, Taner, Sözeri, Selçuk, Şen, Metin
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland 01.05.2005
• Subjects: Female; Humans; Hypercalcemia - surgery; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - surgery; Male; Middle Aged; Original Paper; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - surgery; Parathyroidectomy - methods; Predictive Value of Tests; Preoperative Care - methods; Radionuclide Imaging; Technetium Tc 99m Sestamibi; Treatment Outcome; Ultrasonography; Hypercalcemia; Sestamibi scintigraphy; Primary hyperparathyroidism; Bilateral neck exploration; Surgery; Unilateral neck exploration
• ISSN: 1011-7571; 1423-0151
• DOI: 10.1159/000084639

Objective: This study was planned to investigate the efficacy of either 99m Tc-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 99m Tc-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 99m Tc-sestamibi was 81%, while that of ultrasonography was 42%. 99m Tc-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.