Thallium-Technetium Subtraction Scintigraphy of Enlarged Parathyroid Glands after Calcitonin Stimulation of Parathyroid Hormone Secretion

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Abstract
To improve the sensitivity of thallium-technetium subtraction scintigraphy for preoperative localization procedure of enlarged parathyroid glands in primary hyperparathyroidism, we administered calcitonin intramuscularly 4 hours before the scintigraphy in 14 consecutive patients. Injection of calcitonin reduced plasma levels of ionized calcium from 1.47 ± 0.10 mmol/l to 1.41 ± 0.09 mmol/l (p < 0.01). Concomitantly, serum levels of intact parathyroid hormone increased from 6.4 ± 2.5 pmol/l to 7.9 ± 2.6 pmol/l (p < 0.001). The scintigram after calcitonin injection visualized 11 adenomas (sensitivity 78%) compared to only 9 (sensitivity 64%) in conventional scintigrams. In addition, 5 of the adenomas were more distinctly imaged in the scintigram after calcitonin injection, whereas in only one patient was the conventional scintigram better. Thus, the calcitonin injection improved the scintigram in 7 cases and was inferior in only one case (p = 0.031). We conclude that stimulation of parathyroid hormone secretion with calcitonin results in a better preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism.