title: Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology.
abstract: OBJECTIVE
  Patients with concomitant thyroid pathology are usually excluded from minimally invasive radioguided parathyroidectomy (MIRP). We assessed the value in these patients of the gamma probe, alone or in combination with other techniques, in MIRP and unilateral or bilateral approaches. We evaluated its performance in association with intraoperative determination of intact parathyroid hormone (ioPTHi) and preoperative (99m)Tc-MIBI dual phase scintigraphy.
  
  
  METHODS
  Included in the study were 87 patients with a diagnosis of primary hyperparathyroidism who underwent radioguided surgery. They were divided into two groups depending on the presence of concomitant thyroid pathology (TP group, 33 patients) or absence of concomitant thyroid pathology (NTP group, 54 patients).
  
  
  RESULTS
  In the TP group, ioPTHi achieved the highest accuracy (90.9%), followed by the gamma probe (81.8%) and scintigraphy (69.7%). In the NTP group, the probe (94.4%) performed better than ioPTH and scintigraphy (both 85.2%). In the TP group, scintigraphy in combination with the gamma probe had a success rate of 90.9%, and 94% in combination with ioPTHi. The three techniques are applied together had a success rate of 97%. For all patients undergoing MIRP, the probe alone worked well, irrespective of the presence or absence of concomitant thyroid pathology.
  
  
  CONCLUSIONS
  Patients with concomitant thyroid pathology should not be a priori excluded from a MIRP, as long as other adjuvant techniques (scintigraphy or ioPTHi) are used in conjunction with the gamma probe. In these patients, the probe can also be helpful in unilateral or bilateral surgery.
authors.affiliation: Department of Nuclear Medicine, University Hospital of Valladolid, Valladolid, Spain. palomagtalavera@gmail.com
authors.forename: Paloma
authors.initials: P
authors.lastname: García-Talavera
authors.forename: Carmen
authors.initials: C
authors.lastname: González
authors.forename: José Ramón
authors.initials: JR
authors.lastname: García-Talavera
authors.forename: Esther
authors.initials: E
authors.lastname: Martín
authors.forename: Mariano
authors.initials: M
authors.lastname: Martín
authors.forename: Alberto
authors.initials: A
authors.lastname: Gómez
mesh_terms: D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013959:Thyroid Diseases / Q000150:complications* / Q000453:epidemiology*
chemical_list: D010281:Parathyroid Hormone