title: Radioguided parathyroidectomy for tertiary hyperparathyroidism.
abstract: BACKGROUND
  Tertiary hyperparathyroidism (3HPT) is defined as the persistent hyperproduction of parathyroid hormone and resulting hypercalcemia after renal transplantation. Here, we examine the utility of radioguided parathyroidectomy (RGP) in patients with 3HPT.
  
  
  METHODS
  We reviewed a prospective surgery database containing 80 3HPT patients who underwent RGP from January 2001-July 2014 at our institution. We evaluated patient demographics, operative management, radioguided neoprobe utilization, and operative outcomes. Data are reported as mean ± standard error of the mean.
  
  
  RESULTS
  The mean age of the patients was 52 ± 1 y, and 46% were male. A total of 69 patients had hyperplasia and received subtotal parathyroidectomy, whereas 5 patients had double adenomas and 6 patients had single adenomas. The average calcium level among 3HPT patients was 10.8 ± 0.1 mg/dL preoperatively and 8.7 ± 0.1 mg/dL postoperatively. In vivo radioguided counts normalized to background counts averaged 145 ± 4%, whereas ex vivo counts normalized to background counts averaged 69 ± 5%. All but one ex vivo count was >20%. Ectopically located glands were successfully localized in 38 patients using the gamma probe. Ex vivo percentage did not correlate with parathyroid gland weight, preoperative parathyroid hormone, or preoperative calcium. Our radioguided approach achieved normocalcemia in 96% of 3HPT patients undergoing RGP; two patients developed recurrent disease.
  
  
  CONCLUSIONS
  In this series, all enlarged parathyroid glands were localized and resected using the gamma probe. Thus, RGP reliably localizes adenomatous, hyperplastic, and ectopically located glands in patients with 3HPT, resulting in high cure rate after resection.
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Yash R
authors.initials: YR
authors.lastname: Somnay
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Eric
authors.initials: E
authors.lastname: Weinlander
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Amal
authors.initials: A
authors.lastname: Alfhefdi
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: David
authors.initials: D
authors.lastname: Schneider
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin. Electronic address: chen@surgery.wisc.edu.
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
mesh_terms: D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: Gamma probe; Radioguided parathyroidectomy; Technetium (99mTc) sestamibi; Tertiary hyperparathyroidism