Radio-guided parathyroidectomy in patients with primary hyperparathyroidism and concomitant multinodular goiter

We investigated possible instances where the standard bilateral neck exploration for parathyroid adenoma may be omitted in primary hyperparathyroidism (pHPT) if preoperative diagnostics for the location have been performed.

Ten patients underwent surgical treatment for pHPT and multinodular goiter between October 2006 and October 2008. Identification of the parathyroid adenomas' location with cervical ultrasound and (99m)technetium-sestamibi nuclear scanning ((99m)Tc-MIBI) was not possible in any of these patients. An extirpation of the parathyroid adenomas was performed with intraoperative use of the (99m)Tc-MIBI-guided probe technique. The median follow-up time was 17.5 months (range 2-30).

Ten patients underwent an elective operation for solitary (n = 9) or dual (n = 1) parathyroid adenomas and concomitant thyroid disease. Definitive proof of the parathyroid adenomas was achieved in all of the patients without further neck exploration. The adenomas were 1.3 cm (range 1-2) in diameter. Calcium and parathyroid hormonal levels were reduced on the first postoperative day (P = 0.003). There were no postoperative complications. All patients were free from recurrence.

The intraoperative probe technique is feasible in patients with pHPT and limited diagnostics for the location of parathyroid adenomas with concomitant goiter. This diagnostic technique identified the parathyroid adenoma in all cases, and thus rendered a bilateral neck exploration obsolete.