Hyperparathyroidism but a negative sestamibi scan: a clinical dilemma

The outcomes of patients with biochemically confirmed hyperparathyroidism but a negative Tc-99 Sestamibi scan are unclear. We examined the outcomes and quality of life of patients having surgery and those who had medical therapy.

Patients having a diagnosis of hyperparathyroidism with confirmed elevated calcium and parathormone levels, yet negative sestamibi scans were identified. The RAND SF-36 Health Survey was administered via mail to these patients. The patient's charts were then reviewed to verify treatments and to determine outcomes.

Ninety-five patients fitting the criteria were identified. Twenty patients completed all aspects of the study. Ten of the respondents had undergone parathyroidectomy, and 10 had not. The surgical patients scored more favorably in all 8 of the measured parameters than patients treated medically. The differences in 3 domains, physical functioning, pain, and social functioning, were statistically significant.

Our findings suggest that surgical therapy confers a better quality of life and is superior to medical therapy in the treatment of primary hyperparathyroidism, even in patients having a negative sestamibi scan.