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Preoperative Identification of Multiglandular Disease in Patients with Primary Hyperparathyroidism
Michele L. Lombardo, Jack M. Monchik
Brown University Department of Surgery, Providence, RI

Objective. Non-familial primary hyperparathyroidism (NPHPT) usually involves a single parathyroid gland, and minimally invasive parathyroid exploration is often the procedure of choice. Multiglandular disease (MGD) accounts for a small but significant subpopulation of these patients. We reviewed preoperative ultrasound (US) and technetium-99m sestamibi scan (STS) to assess their role in identifying MGD.
Design. A retrospective chart review.
Setting. Academic medical center.
Patients. Five hundred and seventy-two patients underwent parathyroid exploration for NPHPT between January 2001 to November 2006. All patients had preoperative localization by US and STS.
Main Outcome Measures. US and STS results were compared in the patients who were intraoperatively identified to have MGD.
Results. MGD was identified in 46 patients with PHPT (8.0%). Preoperative US and STS showed no localization in five patients (10.8%). MGD was recognized by US in one patient (2.2%) and by STS in four patients (8.7%). Two patients had multifocal localization by both modalities (4.3%). Localization to single sites on opposite sides of the neck by STS and US was seen in four patients (8.7%).
Conclusions. Preoperative STS and US identified MGD in approximately 25 percent of patients. The finding of multifocal disease by US and STS or disparate localization should prompt bilateral exploration.


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