Unilateral surgery for primary hyperparathyroidism on the basis of technetium Tc 99m sestamibi and iodine 123 subtraction scanning.

Open Access
Publisher Website
Google Scholar
Abstract
PRIMARY hyperparathyroidism (PHP) is a long-standing, surgically correctable disease with the third highest incidence of all endocrine disorders after diabetes mellitus and hyperthyroidism.1 The average annual incidence of PHP is 28 per 100,000 population and rises to 188 cases per 100,000 population among women older than 60 years.2 Conventional surgical teaching states that during first-time exploration for PHP, both sides of the neck must be opened to identify the 4 parathyroid glands. Grossly enlarged glands (estimated weight >50 mg) should be removed, and normal-appearing glands be left untouched. With this approach, multiple parathyroid gland disease (MGD), due either to hyperplasia or to multiple adenomas, is found in 10% to 15% of patients.3,4 Most cases of MGD are sporadic, while a small number are associated with multiple endocrine neoplasia or non–multiple endocrine neoplasia familial hyperparathyroidism.4