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Does levothyroxine administration impact parathyroid localization?

Rachell R Ayers1, Kirby Tobin2, Rebecca S Sippel1

  • 1Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.

The Journal of Surgical Research
|April 29, 2015
PubMed
Summary

Levothyroxine (LT) use impairs ultrasonography (US) for parathyroid localization in primary hyperparathyroidism but does not affect Tc-99m sestamibi (MIBI) scans. Surgeons should consider this when planning minimally invasive parathyroidectomy.

Keywords:
LevothyroxinePreoperative localizationPrimary hyperparathyroidismSestamibi scintigraphyUltrasound

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Medical Imaging

Background:

  • Minimally invasive parathyroidectomy for primary hyperparathyroidism relies on accurate preoperative localization.
  • Common localization methods include ultrasonography (US) and Tc-99m sestamibi (MIBI) scintigraphy.
  • Thyroid gland characteristics can influence parathyroid localization accuracy.

Purpose of the Study:

  • To investigate the effect of exogenous thyroid hormone, levothyroxine (LT), on parathyroid localization.
  • To compare the efficacy of US and MIBI scintigraphy in patients on LT versus those not on LT.

Main Methods:

  • Retrospective analysis of adult patients with primary hyperparathyroidism undergoing initial parathyroidectomy (2000-2014).
  • Patients were categorized as on levothyroxine (LT) or not (-LT) and matched for age, gender, goiter, and PTH levels.
  • Subgroup analyses included patients treated with radioactive iodine and those with single adenoma resections.

Main Results:

  • Levothyroxine use did not significantly impact MIBI scintigraphy localization accuracy (P = 0.83).
  • LT use significantly hindered ultrasonography (US) localization accuracy (48.4% vs. 62.2%, P < 0.01).
  • This US impairment was noted for single upper gland resections but not single lower gland resections.

Conclusions:

  • Exogenous levothyroxine (LT) is associated with reduced accuracy in parathyroid localization using ultrasonography (US).
  • MIBI scintigraphy accuracy remains unaffected by LT use.
  • Awareness of LT's impact on US localization is crucial for personalized and cost-effective surgical planning.