title: Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism.
abstract: 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.
authors.affiliation: Endocrine Surgery Unit, Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain. jgomezramirez@hotmail.com
authors.forename: Joaquin
authors.initials: J
authors.lastname: Gómez-Ramírez
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Sancho-Insenser
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Pereira
authors.forename: Jaime
authors.initials: J
authors.lastname: Jimeno
authors.forename: Assumpta
authors.initials: A
authors.lastname: Munné
authors.forename: Antonio
authors.initials: A
authors.lastname: Sitges-Serra
mesh_terms: 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
chemical_list: D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi