title: Thyroid-related factors that influence preoperative localization of parathyroid adenomas.
abstract: OBJECTIVE
  To evaluate the effect that thyroid-related factors have on the preoperative localization of parathyroid adenomas.
  
  
  METHODS
  This retrospective study included adult patients who were referred for further evaluation of primary hyperparathyroidism between December 2005 and October 2009 at a teaching and research hospital in Turkey. High-frequency ultrasonography and sestamibi scintigraphy (MIBI) were performed in all patients. Surgical procedure involved focal or bilateral exploration on the basis of concordant or discordant imaging studies. Selection of patients for minimally invasive parathyroidectomy was made based on the presence or absence of a single parathyroid adenoma detected by both ultrasonography and MIBI scan. Patients with negative or discordant imaging studies and a concomitant thyroid nodule underwent bilateral neck exploration.
  
  
  RESULTS
  Two hundred and forty-eight patients with primary hyperparathyroidism who underwent parathyroidectomy were included in the study. Parathyroid gland abnormalities were successfully detected preoperatively by ultrasonography in 231 patients and by MIBI scan in 152 patients. When used together, ultrasonography and MIBI scan were unsuccessful in detecting an abnormality in 11 cases. MIBI scan visualized a lesion in 6 cases that remained undiagnosed by ultrasonography. Fifty-six of 85 patients with lesions detected by ultrasonography, but not by MIBI scan, had thyroid nodules. The frequency of thyroid nodules was higher in the 96 patients in whom a MIBI scan could visualize a parathyroid lesion than in the 152 patients in whom MIBI scan was successful (P = .004). No difference was observed regarding ipsilateral thyroid lobe involvement or nodule volume. Parathyroid adenomas were significantly smaller in patients with negative MIBI scans (P<.001).
  
  
  CONCLUSIONS
  Our results suggest that ultrasonography is more sensitive than MIBI scan in the detection of parathyroid adenomas, particularly in the presence of small parathyroid adenomas or other thyroid related-factors.
authors: Endocrinology and Metabolism Clinic, Ministry of Health, Ankara, Turkey. isik_serhat@yahoo.com
authors: Serhat
authors: S
authors: Isik
authors: Gulhan
authors: G
authors: Akbaba
authors: Dilek
authors: D
authors: Berker
authors: Yasemin Ates
authors: YA
authors: Tutuncu
authors: Ufuk
authors: U
authors: Ozuguz
authors: Yusuf
authors: Y
authors: Aydin
authors: Irfan
authors: I
authors: Peksoy
authors: Serdar
authors: S
authors: Guler
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000601:surgery; D013507:Endocrine Surgical Procedures; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000209:etiology; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D013961:Thyroid Gland / Q000502:physiology*; D016606:Thyroid Nodule / Q000150:complications; D015899:Tomography, Emission-Computed, Single-Photon; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi