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Surgery for patients with primary hyperparathyroidism and negative sestamibi scintigraphy--a feasibility study

Thier, Mark LU ; Nordenström, Erik LU ; Bergenfelz, Anders LU and Westerdahl, Johan LU (2009) In Langenbeck's Archives of Surgery 394(5). p.4-881
Abstract

BACKGROUND: We report the surgical treatment of a consecutive series of scan negative patients with the intention of unilateral parathyroid exploration with the aid of intraoperative quick PTH (qPTH).

MATERIALS AND METHODS: The study included 35 consecutive sestamibi scan negative patients (27 women, eight men) with sporadic pHPT subjected to first time surgery. Median age was 70 years and median preoperative calcium level 2.8 mmol/L.

RESULTS: Thirty-three patients had a histological diagnosis of a parathyroid adenoma (median weight 0.48 g [range 0.12 g-2.5 g]). Nineteen patients were explored bilaterally and 16 patients (46%) were operated unilaterally. The median operation time was 40 min in the unilateral group and 95 min... (More)

BACKGROUND: We report the surgical treatment of a consecutive series of scan negative patients with the intention of unilateral parathyroid exploration with the aid of intraoperative quick PTH (qPTH).

MATERIALS AND METHODS: The study included 35 consecutive sestamibi scan negative patients (27 women, eight men) with sporadic pHPT subjected to first time surgery. Median age was 70 years and median preoperative calcium level 2.8 mmol/L.

RESULTS: Thirty-three patients had a histological diagnosis of a parathyroid adenoma (median weight 0.48 g [range 0.12 g-2.5 g]). Nineteen patients were explored bilaterally and 16 patients (46%) were operated unilaterally. The median operation time was 40 min in the unilateral group and 95 min in the bilateral group (p < 0.001). Three patients were treated for postoperative hypocalcemia after bilateral exploration versus none in the unilateral group (p = 0.23). With a minimum of 12 months of follow-up, 33 patients (94.3%) were cured. One case of recurrent HPT presented after bilateral exploration with visualization of four glands. One case of persistent HPT was observed after unilateral exploration. qPTH was predictive of operative failure in both patients.

CONCLUSION: Forty-six percent of the patients in our study could be operated unilaterally with a total cure rate of 94%. Patients in the unilateral group had a significant shorter operation time and a lower incidence of postoperative hypocalcemia. In conclusion our investigation shows that limited parathyroid exploration can safely be performed on patients with negative sestamibi scintigraphy by the aid of qPTH.

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Contribution to journal
publication status
published
keywords
Adenoma, Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Humans, Hyperparathyroidism, Primary, Male, Middle Aged, Parathyroid Glands, Parathyroid Neoplasms, Parathyroidectomy, Radiopharmaceuticals, Technetium Tc 99m Sestamibi
in
Langenbeck's Archives of Surgery
volume
394
issue
5
pages
4 pages
publisher
Springer
external identifiers
  • Scopus:68649099651
ISSN
1435-2451
DOI
10.1007/s00423-009-0524-6
language
English
LU publication?
yes
id
02146bb0-1ea4-4b92-8900-a9ce59865213
date added to LUP
2016-04-27 16:08:27
date last changed
2016-10-13 05:07:05
@misc{02146bb0-1ea4-4b92-8900-a9ce59865213,
  abstract     = {<p>BACKGROUND: We report the surgical treatment of a consecutive series of scan negative patients with the intention of unilateral parathyroid exploration with the aid of intraoperative quick PTH (qPTH).</p><p>MATERIALS AND METHODS: The study included 35 consecutive sestamibi scan negative patients (27 women, eight men) with sporadic pHPT subjected to first time surgery. Median age was 70 years and median preoperative calcium level 2.8 mmol/L.</p><p>RESULTS: Thirty-three patients had a histological diagnosis of a parathyroid adenoma (median weight 0.48 g [range 0.12 g-2.5 g]). Nineteen patients were explored bilaterally and 16 patients (46%) were operated unilaterally. The median operation time was 40 min in the unilateral group and 95 min in the bilateral group (p &lt; 0.001). Three patients were treated for postoperative hypocalcemia after bilateral exploration versus none in the unilateral group (p = 0.23). With a minimum of 12 months of follow-up, 33 patients (94.3%) were cured. One case of recurrent HPT presented after bilateral exploration with visualization of four glands. One case of persistent HPT was observed after unilateral exploration. qPTH was predictive of operative failure in both patients.</p><p>CONCLUSION: Forty-six percent of the patients in our study could be operated unilaterally with a total cure rate of 94%. Patients in the unilateral group had a significant shorter operation time and a lower incidence of postoperative hypocalcemia. In conclusion our investigation shows that limited parathyroid exploration can safely be performed on patients with negative sestamibi scintigraphy by the aid of qPTH.</p>},
  author       = {Thier, Mark and Nordenström, Erik and Bergenfelz, Anders and Westerdahl, Johan},
  issn         = {1435-2451},
  keyword      = {Adenoma,Adult,Aged,Aged, 80 and over,Feasibility Studies,Female,Humans,Hyperparathyroidism, Primary,Male,Middle Aged,Parathyroid Glands,Parathyroid Neoplasms,Parathyroidectomy,Radiopharmaceuticals,Technetium Tc 99m Sestamibi},
  language     = {eng},
  number       = {5},
  pages        = {4--881},
  publisher    = {ARRAY(0x8841fe8)},
  series       = {Langenbeck's Archives of Surgery},
  title        = {Surgery for patients with primary hyperparathyroidism and negative sestamibi scintigraphy--a feasibility study},
  url          = {http://dx.doi.org/10.1007/s00423-009-0524-6},
  volume       = {394},
  year         = {2009},
}