title: Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism.
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.
authors: Department of Surgery, The University of Wisconsin Medical School, 600 Highland Avenue, Madison, WI 53792, USA.
authors: Peter F
authors: PF
authors: Nichol
authors: Eberhard
authors: E
authors: Mack
authors: Jesus
authors: J
authors: Bianco
authors: Allen
authors: A
authors: Hayman
authors: James R
authors: JR
authors: Starling
authors: Herbert
authors: H
authors: Chen
mesh_terms: D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D025321:Surgery, Computer-Assisted; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi