Improving the yield of preoperative parathyroid localization: Technetium Tc 99m-sestamibi imaging after thyroid suppression

• Published in: Surgery Vol. 132; no. 6; pp. 968 - 975
• Main Authors: Royal, Richard E., Delpassand, Ebrahim S., Shapiro, Suzanne E., Fritsche, Herbert A., Vassilopoulou-Sellin, Rena, Sherman, Steven I., Gagel, Robert F., Evans, Douglas B., Lee, Jeffrey E.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.12.2002
• Subjects: Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - surgery; Nickel; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - surgery; Preoperative Care; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Sestamibi; Thyroxine - administration & dosage; Titanium; Tomography, Emission-Computed, Single-Photon; Triiodothyronine - administration & dosage
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1067/msy.2002.128609

Background. Preoperative localization is essential for successful directed, minimally invasive or reoperative parathyroidectomy. Standard technetium Tc 99m-sestamibi imaging is the most sensitive modality for localization. We reviewed our experience with 99mTc-sestamibi imaging and specifically investigated the effect of thyroid suppression on repeat imaging of patients who had initially nonlocalizing scans. Methods. The records of patients who underwent 99mTc-sestamibi imaging during evaluation for primary hyperparathyroidism were reviewed. A subset of patients with initially nonlocalizing scans underwent thyroid suppression with either thyroxin or liothyronine and then had their scans repeated. Results. Ninety-nine patients with primary hyperparathyroidism underwent 99mTc-sestamibi imaging followed by parathyroidectomy (initial operation, 78; reoperation, 21). Successful parathyroid localization was obtained on standard imaging in 67 patients. Fourteen of 32 patients who had nonlocalizing 99mTc-sestamibi imaging studies underwent an additional scan after thyroid suppression. In 10 of 14 patients (71%), repeat 99mTc-sestamibi imaging after thyroid suppression successfully localized abnormal parathyroid tissue. Conclusions. Thyroid suppression may improve the yield of 99mTc-sestamibi imaging in patients with hyperparathyroidism who have an initially nonlocalizing study. This diagnostic strategy may be helpful in patients motivated to undergo a directed, minimally invasive operation, as well as in the evaluation of patients for reoperative parathyroidectomy. (Surgery 2002;132:968-75.)