• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (9)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Otolaryngology/ Head & Neck Surgery  • Radiologic Imaging  • Surgery  • Surgical Interventions  • Endocrine Surgery  • Ultrasonography  • Endocrine Diseases  • Thyroid/ Parathyroid Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Rodney K. Chan, MD; Daniel T. Ruan, MD; Atul A. Gawande, MD, MPH; Francis D. Moore Jr, MD

Arch Surg. 2008;143(4):335-337.

Hypothesis  Patients with primary hyperparathyroidism and negative preoperative localization imaging have a different outcome than patients with positive imaging.

Design  Prospective single-surgeon case series.

Setting  Referral center.

Patients  Forty-two patients with primary hyperparathyroidism, indications for surgery, and both cervical ultrasonographic results and technetium Tc 99m sestamibi nuclear images that were nonlocalizing over a 5- year span.

Main Outcome Measures  Extent of surgery required to produce cure; operative findings.

Results  Of 430 patients undergoing surgery for primary hyperparathyroidism, 351 underwent both ultrasonographic and sestamibi imaging. Among 351 patients, the imaging results of 42 patients did not show an adenoma, and these patients underwent cervical exploratory surgery. Of 42 patients, 41 were cured at a mean follow-up of 90 days; 1 patient underwent surgical reexploration and was cured by removal of a mediastinal adenoma. To achieve initial cure, 12 of 42 patients (28.6%) required partial thyroidectomy, 9 (21.4%) required partial thymectomy, 17 (40.5%) required paratracheal dissection to access or devascularize an obscure adenoma. Pathologic examination disclosed single adenoma in 26 of 42 patients (61.9%), parathyroid hyperplasia in 14 (33.3%), and double adenoma in 2 (4.8%).

Conclusions  Patients whose preoperative localization studies fail to localize solitary adenoma commonly require extensive surgery to cure hyperparathyroidism. Lack of localization may be a reasonable criterion on which to base referral of the patient to a high-volume medical center.

Author Affiliations: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Surgical Treatment of Mediastinal Parathyroid Adenoma: Rationale for Intraoperative Parathyroid Hormone Monitoring
Sagan and Gozdziuk
Ann. Thorac. Surg. 2010;89:1750-1755.
ABSTRACT | FULL TEXT  

Are Additional Localization Studies and Referral Indicated for Patients With Primary Hyperparathyroidism Who Have Negative Sestamibi Scan Results?
Elaraj et al.
Arch Surg 2010;145:578-581.
ABSTRACT | FULL TEXT