Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism.
BACKGROUND
Primary hyperparathyroidism with coexisting thyroid nodular disease (TND) has been considered a contraindication for selective parathyroidectomy because the low sensitivity of preoperative localization studies, especially 99(m)Tc-sestamibi scanning (MIBI) and ultrasound. The aim of this study was to assess the impact of concomitant TND in the preoperative image studies.


METHODS
A total of 236 consecutive patients who had parathyroidectomy for sporadic hyperparathyroidism and the preoperative localization study that was done with MIBI were reviewed. Patients were divided into three groups: those who did not have any thyroid disease, those who had concomitant TND not necessary to resect, and those in whom thyroid resection due to TND was necessary at the time of parathyroidectomy.


RESULTS
MIBI showed a sensitivity of 78.5% in patients without concomitant TND, 73% in patients with TND but not thyroidectomy needed, and 54.5% in the cases that thyroid resection was necessary. When MIBI and ultrasound were both suspicious for an adenoma, the sensitivity was not influenced by the TND.


CONCLUSIONS
In patients with coexisting thyroid disease but not thyroidectomy needed, MIBI scintigraphy contributes to the detection of a solitary adenoma. When thyroid resection is required, MIBI imaging is often negative.
Gómez-Ramírez
Joaquin
J
Endocrine Surgery Unit, Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain. jgomezramirez@hotmail.com
Sancho-Insenser
Juan Jose
JJ
Pereira
Jose Antonio
JA
Jimeno
Jaime
J
Munné
Assumpta
A
Sitges-Serra
Antonio
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods; D011300:Preoperative Care; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D016606:Thyroid Nodule / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods; D018608:Ultrasonography, Doppler; D055815:Young Adult
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi