Parathyroid Adenomas and Hyperplasia

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Abstract
Dual radionuclide imaging of the neck (99mTc pertechnetate and 201Tl thallous chloride) was performed in 22 patients with chemical evidence of hyperparathyroidism (elevated blood Ca and parathormone [PTH] levels). Of these, 19 of 22 had localization of a 201Tl excess area on radiothallium-radiotechnetium subtraction images. In 13 patients who have had operative confirmation at this writing, the dual radionuclide imaging was positive in 12 (12/13 = 92.3%). One patient had 2 parathyroid adenomas, both of which were seen on the images; thus, overall detection was 13 out of 14 or 92.8%. The parathyroid adenomas visualized weighed from 0.06 to 3.0 g; the 1 not detected weighed 0.25 g. In 3 patients with parathyroid hyperplasia secondary to renal disease, the subtraction imaging detected 8 of 12 glands (66.7%). The forearm bone mineral content and bone density were determined in 8 patients with parathyroid adenomas; results were abnormally low in 5 of these 8. One of the 3 patients with secondary hyperparathyroidism had an abnormally low radial bone mass. The combination of dual radionuclide imaging and radial bone mass determination may present a useful approach in both localizing abnormal parathyroid tissue and in examining its functional consequences.