Parathyroid Localization With High-Resolution Ultrasound and Technetium Tc 99m Sestamibi

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Abstract
HYPERPARATHYROIDISM results from the enlargement of 1 or a number of parathyroid glands, either because of alterations in growth regulation intrinsic to the gland (primary hyperparathyroidism) or because of the metabolic consequences of physiological abnormalities extrinsic to the gland, such as renal failure (secondary hyperparathyroidism). Treatment of hyperparathyroidism involves surgical removal of abnormally enlarged parathyroid glands with restoration of a sufficient parathyroid mass to render the patient eucalcemic. The classic surgical approach involves bilateral neck exploration, identification of all 4 parathyroid glands, removal of enlarged parathyroid glands, and biopsy of normal glands to confirm identification. Although the surgical approach to primary hyperparathyroidism is usually straightforward, 15% to 20% of patients can have double adenomas or hyperplasia, which is often asymmetrical.1 Ectopic parathyroid glands, supernumerary glands, and previous neck exploration can further complicate surgical treatment.1