Unilateral Surgery for Primary Hyperparathyroidism on the Basis of Technetium Tc 99m Sestamibi and Iodine 123 Subtraction Scanning

摘要: Hypothesis Parathyroid scanning, based on simultaneous recording of technetium Tc 99m sestamibi and iodine 123 images, is able to identify patients with multiple parathyroid gland disease a safe imaging technique for unilateral surgery. Design Scintigraphic criteria eligibility surgery were prospectively tested against findings conventional bilateral Setting Patients referred an endocrine surgeon in university hospital. Seventy consecutive primary hyperparathyroidism had dual-isotope scanning before Forty-one scan compatible surgery, single focus high intensity seen the anterior lateral views. The remaining 29 1 or more ineligibility: (1) pointing disease, (2) no well-identified focus, (3) contralateral thyroid nodule requiring surgical management, (4) family history disease. Main Outcome Measures Number enlarged glands at inspection calcemia follow-up. Results None 41 patients, well-defined image, showed evidence involvement. Each adenoma was resected from precise site predicted by subtraction scan. Nine (13%) All 9 ineligible preoperative image findings. Conclusions Unilateral can be safely offered 60% hyperparathyroidism, basis Tc-sestamibi I scanning. This may reduce length operation, anesthesia requirements, hospital stay, risks hypoparathyroidism injury recurrent laryngeal nerve.