Complementary nature of radiotracer parathyroid imaging and intraoperativeparathyroid hormone assays in the surgical management of primary hyperparathyroid disease - Case report and review

Purpose: This article illustrates the complementary nature of preoperative radionuclide parathyroid imaging and intraoperative rapid parathyroid hormo ne (PTH) assays in primary hyperparathyroid disease. The authors review the literature on these procedures and compare this protocol and its cost-effe ctiveness with those of the classic four-gland exploration. Materials and Methods: Preoperative parathyroid imaging with Tc-99m MIBI an d intraoperative rapid PTH assays were performed at the time of neck explor ation. Results: One of two parathyroid adenomas seen on radionuclide images would have been missed if the authors had relied solely on the initial decrease i n PTH assay value to a normal level. Conclusions: Tc-99m MIBI imaging and intraoperative rapid PTH assays are co mplementary; when used together, they lessen the likelihood that abnormal p arathyroid glands will be overlooked. This experience and that of others su ggest these combined procedures are cost-effective.