How are multiple abnormal glands detected in primary hyperparathyroidism?

Updated: Oct 02, 2018
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Answer

With either sestamibi scanning or ultrasonography, an abnormal parathyroid may be detected preoperatively in 70-80% of cases. However, neither technique is reliable for detecting multiple abnormal glands. [2] Therefore, an additional method is required to confirm that no other abnormal glands are present after excision of the imaged lesion. For this purpose, most centers use the intraoperative parathyroid hormone assay. [2, 24, 25] Because the plasma half-life of parathyroid hormone is only approximately 4 minutes, the level falls quickly after resection of the source. If the level fails to fall after resection of the identified abnormal gland, the procedure is extended to allow for further exploration. However, the intraoperative parathyroid hormone assay is usually available only in centers that perform a high volume of parathyroidectomies.

A few authors have advocated radio-guided parathyroidectomy, detecting the labeled sestamibi in the abnormal gland using a handheld probe. Most centers have abandoned this technique because if the gland labels well with sestamibi, allowing for adequate preoperative imaging, use of the handheld probe intraoperatively is unnecessary in most cases.


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