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Radioguided Parathyroidectomy in Patients with Familial Hyperparathyroidism

¹ Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
² Department of Radiology, University of Wisconsin, Madison, WI, USA

Correspondence: Address correspondence and reprint requests to: Herbert Chen, MD FACS. Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA; E-mail: chen{at}surgery.wisc.edu

Background: In patients with sporadic hyperparathyroidism (HPT), radioguided parathyroidectomy (RGP) has been shown to facilitate intraoperative localization of parathyroid glands, reduced operative time, and improve patient outcomes. No studies have focused on the role of RGP in patients with familial HPT.

Methods: Between 3/01 and 6/05, 419 patients underwent RGP. Nineteen had familial HPT, including 12 with Multiple Endocrine Neoplasia (MEN), and 94 had sporadic HPT with parathyroid hyperplasia. All patients were injected with sestamibi pre-operatively and a gamma probe was used intraoperatively. Radiotracer counts were recorded prospectively.

Results: In patients with familial HPT, the gamma probe detected all abnormal parathyroid glands with a mean in vivo radiotracer count of 157 ± 9% above background. Importantly, 5 patients (25%) had ectopic parathyroid glands localized by the probe in the thymus, thyroid and retroesophageal region. All resected hyperplastic parathyroid glands had ex vivo counts > 20%. All patients were cured after surgery with mean calcium and parathyroid hormone levels of 9.4 ± 0.1 mg/dl and 31 ± 7 pg/ml, respectively, and a mean hospital stay of 0.7 ± 0.1 days. In comparing the 2 groups, while patients with familial HPT had lower pre-operative parathyroid hormone levels, the ex vivo radiotracer counts were significantly higher.

Conclusion: RGP in patients with familial HPT is technically feasible and perhaps more sensitive than in patients with sporadic hyperplastic disease. The gamma probe efficiently localized all parathyroid glands including those in ectopic locations, and resulted in high cure rates and short hospital stays. RGP is a viable and useful technique in patients with familial HPT.

Key Words: Parathyroidectomy • Minimally invasive parathyroidectomy • Radioguided parathyroidectomy • MIRP • Multiple endocrine neoplasia

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