Surgical management strategies in patients with primary hyperparathyroidism: which technique in which patients?
OBJECTIVE
This study was planned to investigate the efficacy of either 99mTc-sestamibi scan or ultrasonography in predicting the operative treatment in patients with primary hyperparathyroidism (PHPT).


METHODS
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 99mTc-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 99mTc-sestamibi was 81%, while that of ultrasonography was 42%. 99mTc-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.


CONCLUSIONS
Our findings indicate that bilateral intervention remains a successful management option without prior localization in patients with PHPT especially in an endemic goiter region.
Koyuncu
Ayhan
A
Department of General Surgery, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. akoyuncu@cumhuriyet.edu.tr
Dokmetaş
Hatice Sebila
HS
Aydin
Cengiz
C
Turan
Mustafa
M
Erselcan
Taner
T
Sozeri
Selçuk
S
Sen
Metin
M
D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000601:surgery; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D014463:Ultrasonography
D017256:Technetium Tc 99m Sestamibi