title: Improving the yield of preoperative parathyroid localization: technetium Tc 99m-sestamibi imaging after thyroid suppression.
abstract: BACKGROUND
  Preoperative localization is essential for successful directed, minimally invasive or reoperative parathyroidectomy. Standard technetium Tc 99m-sestamibi imaging is the most sensitive modality for localization. We reviewed our experience with (99m)Tc-sestamibi imaging and specifically investigated the effect of thyroid suppression on repeat imaging of patients who had initially nonlocalizing scans.
  
  
  METHODS
  . The records of patients who underwent (99m)Tc-sestamibi imaging during evaluation for primary hyperparathyroidism were reviewed. A subset of patients with initially nonlocalizing scans underwent thyroid suppression with either thyroxin or liothyronine and then had their scans repeated.
  
  
  RESULTS
  Ninety-nine patients with primary hyperparathyroidism underwent (99m)Tc-sestamibi imaging followed by parathyroidectomy (initial operation, 78; reoperation, 21). Successful parathyroid localization was obtained on standard imaging in 67 patients. Fourteen of 32 patients who had nonlocalizing (99m)Tc-sestamibi imaging studies underwent an additional scan after thyroid suppression. In 10 of 14 patients (71%), repeat (99m)Tc-sestamibi imaging after thyroid suppression successfully localized abnormal parathyroid tissue.
  
  
  CONCLUSIONS
  Thyroid suppression may improve the yield of (99m)Tc-sestamibi imaging in patients with hyperparathyroidism who have an initially nonlocalizing study. This diagnostic strategy may be helpful in patients motivated to undergo a directed, minimally invasive operation, as well as in the evaluation of patients for reoperative parathyroidectomy.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Royal
authors.forename: Ebrahim S
authors.initials: ES
authors.lastname: Delpassand
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Shapiro
authors.forename: Herbert A
authors.initials: HA
authors.lastname: Fritsche
authors.forename: Rena
authors.initials: R
authors.lastname: Vassilopoulou-Sellin
authors.forename: Steven I
authors.initials: SI
authors.lastname: Sherman
authors.forename: Robert F
authors.initials: RF
authors.lastname: Gagel
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
mesh_terms: D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D009532:Nickel; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D013974:Thyroxine / Q000008:administration & dosage; D014025:Titanium; D015899:Tomography, Emission-Computed, Single-Photon; D014284:Triiodothyronine / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D014284:Triiodothyronine; C040654:titanium nickelide; D009532:Nickel; D017256:Technetium Tc 99m Sestamibi; D014025:Titanium; D013974:Thyroxine