Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism.

Abstract

To date there have been no reports on the feasibility of radioguided parathyroidectomy (RGP) in patients with secondary and tertiary hyperparathyroidism. Twenty-three consecutive patients with secondary (n=5) or tertiary hyperparathyroidism (n=18) underwent RGP. Patients were injected with 10 mCi of technetium 99-sestamibi before surgery. All parathyroid glands were localized during operation with a neoprobe. The mean patient age was 50+/-3 years. The mean preoperative calcium and intact parathyroid hormone levels were 11.0+/-0.3 mg/dL and 400+/-107 pg/mL, respectively. Eighteen patients had 3- or 4-gland hyperplasia, 2 had double adenomas, 2 had forearm graft hyperplasia, 1 had 6-gland disease, and 3 had ectopic glands. All hyperplastic glands had ex vivo counts >20% of background (mean, 63%+/-6%), making frozen section unnecessary. When compared with 66 historical control subjects who underwent surgery without radioguidance for tertiary hyperparathyroidism, patients undergoing RGP had decreased operative times (96+/-8 minutes vs 151+/-15 minutes; P<.001) and lengths of stay (1.3+/-0.1 days vs 3.7+/-0.3 days; P<.001). RGP in patients with secondary and tertiary hyperparathyroidism is feasible, may reduce operative time, and permits omission of frozen section. Thus RGP appears to be a useful adjunct in the treatment of secondary and tertiary hyperparathyroidism.