PREOPERATIVE
LOCALIZATION STUDIES FOR PERSISTENT / RECURRENT PRIMARY HYPERPARATHYROIDISM
(PHPT)
Preoperative
localization is mandatory before reoperation for recurrent / persistent PHPT.
I.Repeat
sestamibi scintigraphy is necessary. When required, the scan should include
single photon emission computed tomography (SPECT), subtraction etc.
II.Repeat
ultrasonography may reveal pathological (enlarged) parathyroid glands and is
strongly recommended.
III.Ultrasound-guided
fine-needle aspiration with parathormone (PTH) measurement in the aspirate is
recommended when an abnormality of uncertain nature is identified on
ultrasonography
IV.Computed
tomography (preferentially 4-D CT) and magnetic resonance imaging (MRI) should
be considered when sestamibi scintigraphy and ultrasonography are inconclusive
V.Venous
sampling for PTH measurement is rarely indicated today to locate the laterality
of the hyperfunctioning gland and to indicate whether it is in the neck or the mediastinum
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