Positive localization studies are necessary before neck explorations for persistent or recurrent HPT. Noninvasive imaging methods should be used first, and Tc 99m sestamibi is the most accurate localizing study. Localization studies should be used complementarily, such that the results obtained individually improve significantly if the studies are combined or concordant. Sestamibi and US may be useful and inexpensive initial imaging studies. SVS, an excellent invasive method, must be used if the rest of the imaging studies are negative or discordant. IOPTH may be useful in some cases but does not replace good surgical experience and interpretation.


1. Levin KE, Gooding GAW, Okerlund M, et al. Localization studies in patients with a persistent or recurrent hyperparathyroidism. Surgery 1987;102:917.

2. Thompson NW. Localization studies in patients with primary hyperparathyroidism. Br J Surg 1988;75:97.

3. Auguste LJ, Attie JN, Schanap D. Initial failure of surgical exploration in patients with primary hyperparathyroidism. Am J Surg 1990;160:333.

4. Clark OH, Wilkes W, Siperstein AE, et al. Diagnosis and management of asymptomatic hyperparathyroidism: Safety, efficacy, and deficiencies in our knowledge. J Bone Miner Res 1991;6:25.

5. Lundgren E, Rastad J, Ridefelt P, et al. Long-term effects of parathyroid operation on serum calcium and parathyroid hormone values in sporadic primary hyperparathyroidism. Surgery 1992:112:1123.

6. Uden P, Chan AK, Duh QY, et al. Primary hyperparathyroidism in younger and older patients: Clinical symptoms and outcome of surgery. World J Surg 1992:16:791.

7. Kjellman M, Sandelin K, Farnebo LO. Primary hyperparathyroidism: Low surgical morbidity supports liberal attitude to operation. Arch Surg 1994:129:237.

8. Sosa JA, Powe NR, Levine MA, et al. Thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: A national survey of endocrine surgeons. J Clin Endocrinol Metab 1998:83:2658.

9. Brennan ME, Norton JA. Reoperation for persistent and recurrent hyperparathyroidism. Ann Surg 1985:120:40.

10. Grant CS, Van Heerden JA, Charboneau EM, et al. Clinical management of persistent and/or recurrent primary hyperparathyroidism. World J Surg 1986:10:555.

11. Carty SE, Norton JA. Management of patients with persistent or recurrent primary hyperparathyroidism. World J Surg 1991:15:716.

12. Jarhült J, Nordeström J, Perbeck L. Reoperation for suspected primary hyperparathyroidism. Br J Surg 1993:80:453.

13. Shen W, Düren M, Morita E, et al. Reoperation for persistent and recurrent primary hyperparathyroidism. Arch Surg 1996:131:861.

14. Wells SA, Debenedetti MK, Doherty GM. Recurrent or persistent hyperparathyroidism. J Bone Miner Res 2002:17:158.

15. Jaskowiak N, Norton JA, Alexander HR, et al. A prospective trial evaluating a standard approach to reoperation for missed parathyroid adenoma. Ann Surg 1996:224:308.

16. Hasse C, Sitter H, Brunne M, et al. Quality of life and patient satisfaction after reoperation for primary hyperparathyroidism: Analysis of long-term results. World J Surg 2002:13:26.

17. Tezelman S, Shen W, Shaver JK, et al. Double parathyroid adenomas: Clinical and biochemical characteristics before and after parathyroidectomy. Ann Surg 1993:218:300.

18. Kebebew E, Arid C, Duh QD, Clark OH. Localization and reoperations results for persistent and recurrent parathyroid carcinoma. Arch Surg 2001:136:878.

19. Wang C-A. The anatomic basis of parathyroid surgery. Ann Surg 1976:183:271.

20. Liechtty RD. Parathyroid anatomy in hyperplasia. Arch Surg 1992:127:813.

21. Henry JF, Denizot A, Audiffret J, France G. Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients. World J Surg 1990:14:303.

22. Fraker DL, Doppman JL, Shwaker TH, et al. Undescended parathyroid: An important etiology for failed operations for primary hyperparathyroidism. World J Surg 1990:14:342.

23. Conn JM, Gongalves MA, Mansour KA, McGarity WC. The mediastinal parathyroid. Am Surg 1991:57:62.

24. Patow CA, Norton JA, Bennan ME. Vocal paralysis and reoperative parathyroidectomy: A prospective study. Ann Surg 1986:203:282.

25. Roe SM, Burns P, Graham LD, et al. Cost effectiveness of preoperative localization studies in primary hyperparathyroidism disease. Ann Surg 1994:219:582.

26. Wyman SM, Robbins LL. The roentgen recognition of parathyroid adenoma. AJR Am J Roentgenol 1954;71:777.

27. Stevens AC, Jackson CE. Localization of parathyroid adenoma by oesophageal cineroentgenography. AJR Am J Roentgenol 1967; 99:223.

28. Samuels BJ, Dowdy AH, Lecky JW. Parathyroid termography. Radiology 1972;104:575.

29. Edis AJ, Evans PC. High-resolution real-time ultrasonography and preoperative localization of parathyroid tumors. N Engl J Med 1979:301:532.

30. Levin K, Clark OH. The reasons of failure in parathyroid surgery. Arch Surg 1989:124:911.

31. Liburty SK, Bartlett DL, Jaskowiak NT, et al. The role of the thyroid resection during reoperation for persistent or recurrent hyperparathyroidism. Surgery 1997;122:1183.

32. Mclntyre RC, Eisenach JH, Pearlman NW, et al. Intrathyroidal parathyroid glands can be a cause of failed cervical exploration for hyperparathyroidism. Am J Surg 1997;174:750.

33. Gooding GAW. Sonography of the thyroid and parathyroid. Radiol Clin North Am 1993 ;31:967.

34. Erdman WA, Breslav NA, Weinreb JC, et al. Noninvasive localization of parathyroid adenomas: A comparison of x-ray, computerized tomography, ultrasound, scintigraphy, and MRI. Magn Reson Imaging 1989:102:917.

35. Kurbskack AJ, Wilson SD, Lawson TL, et al. Prospective comparison of radionuclide, computed tomography, sonographic, and magnetic resonance localization of parathyroid tumors. Surgery 1989:106:639.

36. Miller DL, Doppman JL, Shawker TH, et al. Localization of parathyroid adenomas in patients who have undergone surgery: I. Noninvasive imaging methods. Radiology 1987;162:133.

37. Rodriguez JM, Tezelman S, Siperstein AE, et al. Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg 1994; 129:870.

38. Numerow LM, Morita ET, Clark OH, et al. Persistent/recurrent hyperparathyroidism: A comparison of sestamibi scintigraphy, MRI and ultrasonography. J Magn Res Imaging 1995;5:702.

39. Peeler BB, Martin WH, Sandler MP, Goldstein RE. Sestamibi parathyroid scanning and preoperative localization studies for patients with recurrent/persistent hyperparathyroidism or significant comorbid conditions: Development of an optimal localization. Am Surg 1997;63:37.

40. Thompson JB, Grant CS, Perrier ND, et al. Reoperative parathyroid surgery in the era of sestamibi scanning and intraoperative parathyroid hormone monitoring. Arch Surg 1999:134:699.

41. De Feo ML, Colagrande S, Biagini C, et al. Parathyroid glands: Combination of 99mTc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 2000;214:393.

42. Feingold DL, Alexander HR, Chen CC, et al. Ultrasound and sestamibi scan as the only preoperative imaging test in reoperation for parathyroid adenomas. Surgery 2000; 128:1103.

43. Carlson GL, Farndon GL, Clayton B, Rose PG. Thallium isotope scintigraphy and ultrasonography: Comparative studies of localization techniques in primary hyperparathyroidism. Br J Surg 1990:77:327.

44. Henry JF, Audifret J, Denizot A. Endosonography in the localization of parathyroid tumours: A preliminary study. Surgery 1990:108:1021.

45. Catargi B, Raymond JM, Lafarge-Gense V, et al. Localization of parathyroid tumours using endoscopic ultrasonography in primary hyperparathyroidism. J. Endocrinol Invest 1999;22:688.

46. Gooding GAW, Clark OH. Use of color Doppler imaging in the distinction between thyroid and parathyroid lesions. Am J Surg 1992:164:51.

47. Kohri K, Ishikawa Y, Mitsumasa K, et al. Comparison of imaging methods for localization of parathyroids tumors. Am J Surg 1992:164:140.

48. Auffermann W, Gooding GAW, Okerlund MD, et al. Diagnosis of recurrent hyperparathyroidism: Comparison of MR imaging and the other techniques. AJR Am J Roentgenol 1988; 150:1027.

49. Doherty GM, Doppman JL, Miller DL, et al. Results of a multidiscipli-nary strategy for management of mediastinal parathyroid adenoma as a cause of persistent hyperparathyroidism. Ann Surg 1992:215:101.

50. Mariette C, Pelliser L, Combemale F, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg 1998:383:174.

51. Kem KA, Shawker TH, Jones BL. Intraoperative ultrasound on reoperative parathyroid surgery: An initial evaluation. World J Surg 1986:10:631.

52. Aufferman W, Guis M, Tavares NJ, Higgins CB. MR signal intensity of parathyroid adenomas: Correlation with histopathology. AJR Am J Roentgenol 1989;153:873.

53. Higgins CB. Role of magnetic resonance imaging in hyperparathyroidism. Radiol Clin North Am 1993;31:1017.

54. Fayet C, Hoeffel C, Fulla Y, et al. Technetium-99ni sestamibi scintigraphy, magnetic resonance imaging, and venous sampling in persistent and recurrent hyperparathyroidism. Br J Radiol 1998;71:108.

55. Gotway MB, Reddy GP, Webb R, et al. Comparison between MR imaging and "mTc-MIBI scintigraphy in the evaluation of recurrent or persistent hyperparathyroidism. Radiology 2001:218:783.

56. Higgins CB, Aufferman W. MRI imaging of thyroid and parathyroid: A review of current status. AJR Am J Roentgenol 1988:151:1095.

57. Ishibashi M, Nishida H, Hiromatsu Y, et al. Comparison of technetium-99m-MIBI, technetium 99m-tetrofosmin, ultrasound, and MRI for localization of abnormal parathyroid glands. J Nucl Med 1998;39:320.

58. McDermott VG, Fernandez RJM, Meaken TJ, et al. Preoperative MR imaging in hyperparathyroidism: Results and factors affecting parathyroid detection. AJR Am J Roentgenol 1996:166:705.

59. Seelos KC, De Marco R, Clark OH, Higgins CB. Persistent and recurrent hyperparathyroidism assessment with gadopentetate dimeglumine-enhanced MR imaging. Radiology 1990:177:373.

60. Kang YS, Resen K, Clark OH, Higgins CB. Localization of abnormal parathyroid glands of the mediastinum with MR imaging. Radiology 1993:189:137.

61. Fukunaga M, Morita R, Yokenuga Y. Accumulation of 201T1 chloride in a parathyroid adenoma. Clin Nucl Med 1979;4:229.

62. Ferlin G, Borsato N, Camerani M, et al. New perspectives in localizing enlarged parathyroids by technetium-thallium subtraction scan. J Nucl Med 1983:24:438.

63. Young AE, Gaunt JI, Croft DN, et al. Localization of parathyroid adenomas by thallium 201 and technetium 99m. BMJ 1983:286:1384.

64. Chan TY, Serpell IW, Chan O, et al. Misinterpretation of the upper parathyroid adenoma on thallium-201/technetium-99m subtraction scintigraphy. Br J Radiol 1991 ;64:1.

65. Attie JN, Khan A, Rumanck WM, et al. Preoperative localization of parathyroid adenomas. Am J Surg 1988:156:323.

66. Price DC. Radioisotopic evaluation of the thyroid and the parathyroids. Radiol Clin North Am 1993:31:991.

67. Coakley AJ, Kettle AG, Wells CP, et al. 99m-Technetium sestamibi: A new agent for parathyroid imaging. Nucl Med Commun 1989; 10:791.

68. Chiu ML, Kronange JF, Piwnica Worms D. Effect of mitochondrial and plasma membrane potentials on accumulation of hexakis (2-methoxy-isobutylisonitrile) technetium in cultured mouse fibroblasts. J Nucl Med 1990:31:1646.

69. Sandrock D, Merino MJ, Norton JA, et al. Light and electromicro-scopic analyses of parathyroid tumours explain results of T1201 Tc99m parathyroid scintigraphy. Eur J Med 1989;15:410.

70. O'Doherty MJ, Kettle AG, Collins REC, Coakley AJ. Parathyroid imaging with technetium 99m sestamibi: Preoperative localization and tissue uptake studies. J Nucl Med 1992;33:313.

71. Mitchel BK, Cornelius EA, Zoghbi S, et al. Mechanism of technetium 99m sestamibi parathyroid imaging and the possible role of p-glycoprotein. Surgery 1996;120:1039.

72. Pinero A, Rodriguez JM, Martinez-Barba E, et al. Tc-99m sestamibi scintigraphy and cell proliferation in primary hyperparathyroidism: A causal or casual relationship? Surgery 2003;134:41.

73. Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium 99m sestamibi (double-phase study). J Nucl Med 1992:33:1801.

74. Wei JP, Burke GJ, Mansberger AR. Prospective evaluation of the efficiency of technetium 99m sestamibi and iodine 123 radionuclide imaging of abnormal parathyroid glands. Surgery 1992;112:1 111.

75. Wei JP, Burke GJ, Mansberger AD. Prospective imaging of abnormal parathyroid glands in patients with hyperparathyroidism disease using combination Tc99m-pertechnetate and Tc99m sestamibi radionuclide scans. Ann Surg 1994:219:568.

76. Hindis E., Melliere D, Simon D, Perlemuter L, et al. Primary hyperparathyroidism: Is technetium 99m sestamibi/iodine subtraction scanning the best procedure to locate enlarged glands before surgery? J Clin Endocrinol Metab 1995:80:302.

77. Chen CC, Skarulis MC, Fraker DL, et al. Technetium-99m sestamibi imaging before reoperation for primary hyperparathyroidism. J Nucl Med 1995:36:2186.

78. Jeanguillaume C, Hindie E, Meignan-Debray S, et al. Tc-99m sestamibi and 1-123 detection of a parathyroid adenoma in the presence of cold thyroid nodule. Clin Nucl Med 1997;22:258.

79. Sfakianakis GN, Irvin GL III, Foss J, et al. Efficient parathyroidectomy guided by SPECT-MIBI and hormonal measurements. J Nucl Med 1996;88:798.

80. Neumann DR, Esselstyn CB, Kim EY, et al. Primary experience with double-phase SPECT using Tc-99m sestamibi in patients with hyperparathyroidism. Clin Nucl Med 1997;22:217.

81. Chen CC, Holder LE, Scovill WA, et al. Comparison of parathyroid imaging with technetium-99m-pertechnetate/sestamibi subtraction, double-phase technetium-99m sestamibi and technetium-99m sestamibi SPECT. J Nucl Med 1997;38:834.

82. Teigen EL, Kilgore EJ, Cowan RJ, et al. Technetium-99m sestamibi SPECT localization of mediastinal parathyroid adenomas. J Nucl Med 1996:37:1535.

83. Irvin GL, Molinari AS, Figueroa C, et al. Improved success rate in reoperative parathyroidectomy with intraoperative PTH assay. Ann Surg 1999:229:874.

84. Pattou F, Huglo D, Proye C. Radionuclide scanning in parathyroid diseases. Br J Surg 1998;85:1605.

85. Pinero A, Rodriguez JM, Ortiz S, et al. Influence of thyroid pathology on the results of parathyroid gammagraphy with Tc99m sestamibi. Clin Endocrinol 2000;53:655.

86. Koss WGM, Brown MR, Balfour JF. A false-positive localization of parathyroid adenoma with technetium Tc99m sestamibi scan secondary to a thyroid follicular carcinoma. Arch Surg 1996; 131:216.

87. Nakahara H, Noguchi S, Murakami N, et al. Technetium-99m sestamibi scintigraphy compared with thallium-201 in evaluation of thyroid tumours. J Nucl Med 1996;37:901.

88. Balon HR, Fink-Bennet D, Staffer SS. Technetium-99m sestamibi uptake by recurrent Hiirthle cell carcinoma of the thyroid. J Nucl Med 1992;33:1393.

89. Scott AM, Kostakoglu L, O'Brien JP, et al. Comparison of technetium-99m-MIBI and thallium-201-chloride uptake in primary thyroid lymphoma. J Nucl Med 1992:33:1396.

90. Aigner RM, Fueger GF, Nicoletti R. Parathyroid scintigraphy: Comparison of technetium-99m methoxyisobutylisonitrile and technetium-99m-tetrophosmin studies. Eur J Nucl Med 1996;23:693.

91. Pattou F, Oudar C, Huglo D, et al. Localization of abnormal parathyroid glands with jugular sampling for parathyroid hormone, and subtraction scanning with sestamibi or tetrophosmin. Aust N Z J Surg 1998;68:108.

92. Ishibashi M, Nishida H, Strauss W, et al. Localization of parathyroid glands using technetium-99m-tetrofosmin imaging. J Nucl Med 1997; 38:706.

93. Pattou F, Huglo D, Proye C. Radionuclide scanning in parathyroid disease. Br J Surg 1998;85:1605.

94. Giordano A, Meduri G, Rubini G, et al. Italian multicenter study on 99m-Tc-tetrophosmin in parathyroid scintigraphy: Results in 133 subjects. Eur J Nucl Med 1998;25:9.

95. Aigner RM, Fueger GF, Wolf G. Parathyroid scintigraphy: First experiences with technetium(III)-99m-Q12. Eur J Nucl Med 1997; 24:326.

96. Arslan N, Rydzewski B. Detection of a recurrent parathyroid carcinoma with FDG positron emission tomography. Clin Nucl Med 2002;27:221.

97. Neumann DR, Esselstyn CB, Maclntyre WJ, et al. Regional body FDG-PET in postoperative recurrent hyperparathyroidism. J Comput Assist Tomogr 1997;21:25.

98. Cook GJ, Wong JC, Smelie WJ, et al. ["CJMethionine positron emission tomography for patients with persistent or recurrent hyperparathyroidism after surgery. Eur J Endocrinol 1998:139:195.

99. Marcocci C, Mazzeo S, Bruno-Bossio G, et al. Preoperative localization of suspicious parathyroid adenomas by PTU assay in the needle aspiration. Eur J Endocrinol 1998;139:72.

100. Tikkakosky T, Stenfors LE, Typpo T, et al. Parathyroid adenomas: Preoperative localization with ultrasound combined with fine-needle biopsy. J Laryngol Otol 1989;62:981.

101. Karstrup S, Glenthoj A, Hainau B, et al. Ultrasound-guided, histological, fine-needle biopsy from suspect parathyroid tumours: Success rate and reliability of histological diagnosis. Br J Radiol 1989;62:981.

102. McFarlane MP, Fraker DL, Shawker TH, et al. Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism. Surgery 1994;116:959.

103. Miller DL. Preoperative localization and interventional treatment of parathyroid tumours. When and how? World J Surg 1991; 15:706.

104. Mclntyre RC, Kumpe DA, Liechty D. Reexploration and angiographic ablation for hyperparathyroidism. Arch Surg 1994; 129:499.

105. Miller DL. Endocrine angiography and venous sampling. Radiol Clin North Am 1993:31:1051.

106. Nilsson BE, Tissell LE, Janson S, et al. Parathyroid localization by catheterization of large cervical and mediastinal veins to determine serum concentrations of intact parathyroid hormone. World Surg 1994:18:605.

107. Sugg SL, Fraker DL, Alexander R, et al. Prospective evaluation of selective venous sampling for parathyroid hormone concentrations in patients undergoing reoperations for primary hyperparathyroidism. Surgery 1993:114:1004.

108. Billingsley KG, Fraker DL, Doppman JL, et al. Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism. Surgery 1994; 116:982.

109. Jones JJ, Brunaud L, Dowd CF, et al. Accuracy of selective venous sampling for intact parathyroid hormone in difficult patients with recurrent or persistent hyperparathyroidism. Surgery 2002; 132:944.

110. Casanova D, Safati E, De Francisco A, et al. Secondary hyperparathyroidism: Diagnosis of site of recurrence. World J Surg 1991; 15:546.

111. Demeter JG, De Jong SA, Lawrence AM, Paloyan E. Recurrent hyperparathyroidism due to parathyroid autografts: Incidence, presentation, and management. Am Surg 1993:59:178.

112. Fong-Fu C, Chiang Hsuan L, Hue-Yon C, et al. Persistent and recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Ann Surg 2002;235:99.

113. Alexander HR, Chen CC, Shawker T, et al. Role of preoperative localization manoeuvers including intraoperative PTH assay determination for patients with persistent or recurrent hyperparathyroidism. J Bone Miner Res 2002;17:133.

114. Norman JG, Jaffray CE, Chheda H. The false-positive parathyroid sestamibi: A real or perceived problem and a case for radio-guided parathyroidectomy. Ann Surg 2000;231:31.

115. Huang GU, Wu HS, Tsai SC, et al. Recurrent hyperfunctioning parathyroid gland demonstrated radionuclide imaging and an intraoperative gamma probe. Clin Nucl Med 2000;25:348.

116. Geissler B, Grober S, Zugel N, Lindemann F. [Radio-guided parathyroidectomy: Successful intraoperative parathyroid localization diagnosis with 99mTc sestamibi in primary and recurrent hyperparathyroidism.] Chirurg 2001;72:1179.

117. Navarra G, Feggi L, Ascanelli S, et al. Role of radio-guided surgery in recurrent secondary hyperparathyroidism. Nephron 2001;88:36.

118. Proye CA, Goropoulos A, Franz C, et al. Usefulness and limits of quick intraoperative measurements of intact (1-84) parathyroid hormone in the surgical management of hyperparathyroidism: Sequential measurements in patients with multiglandular disease. Surgery 1991:110:1035.

119. Irvin GL III, Prudhomme BS, Deriso GT, et al. A new approach to parathyroidectomy. Ann Surg 1994;219:574.

120. Irvin GL III, Dembrow VD, Prudhomme DL. Clinical usefulness of an intraoperative "quick parathyroid hormone" assay. Surgery 1993;114:1019.

121. Irvin GL, Molinari AS, Figueroa C, Carneiro DM. Improved success rate in reoperative parathyroidectomy with intraoperative PTH assay. Ann Surg 1999:226:874.

10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook

Post a comment