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The Parathyroid Glands00:59

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
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Stepwise Approach for Parathyroid Localisation in Primary Hyperparathyroidism.

Vijay Korwar1, Fernando Yuen Chang2, Ella Teasdale2

  • 1Department of Transplant and Endocrine Surgery, General Surgery North Bristol NHS Trust, Southmead Hospital, Brunel Building, Level 3, Gate 38, Room 2, Westbury-on-Trym, Bristol, BS10 5NB, UK. vkorwar@gmail.com.

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Ultrasound is a highly sensitive first-line imaging tool for primary hyperparathyroidism (PHPT) localization, guiding selective parathyroidectomy. Other imaging like sestamibi and SPECT CT are reserved for complex cases.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Radiology

Background:

  • Primary hyperparathyroidism (PHPT) is common in surgical practice.
  • Localization studies have shifted treatment from bilateral neck exploration to selective parathyroidectomy.
  • Ultrasound is the first-line imaging, but its sensitivity is operator-dependent.

Purpose of the Study:

  • To evaluate the sensitivity and accuracy of pre-operative imaging modalities for localizing abnormal parathyroid glands in PHPT patients.
  • To compare ultrasound (US), 99mTc-sestamibi, and SPECT CT in identifying hyperfunctioning parathyroid glands.

Main Methods:

  • 250 consecutive PHPT patients undergoing parathyroidectomy were studied.
  • Pre-operative imaging included neck ultrasound (n=249), 99mTc-sestamibi (n=237), and SPECT CT (n=198).
  • Sensitivity, positive predictive value (PPV), and accuracy were calculated against surgical and pathology findings.

Main Results:

  • Ultrasound showed 80.80% sensitivity, 92.35% PPV, and 75.73% accuracy.
  • Sestamibi had 71.82% sensitivity, 94.61% PPV, and 69.00% accuracy.
  • SPECT CT demonstrated 70.21% sensitivity, 97.78% PPV, and 69.11% accuracy. Overall success rate was 94.8%.

Conclusions:

  • Ultrasound by an experienced sonographer is highly sensitive for localizing abnormal parathyroid glands in PHPT.
  • Ultrasound can be the primary and sole imaging investigation for most patients.
  • Sestamibi, SPECT CT, and other tests are best reserved for cases with negative US, failed primary surgery, or recurrence.