Parathyroid Exploration for Primary Hyperparathyroidism

Fig. 11.1

Algorithm for surgical treatment in patients with/without contraindication to imaging studies other than ultrasound (see text). BNE, bilateral neck exploration; CT, computed tomography; ioPTH, intraoperative parathyroid hormone; MIBI, ^99mTc-sestamibi; MIP, minimally invasive procedure; MRI, magnetic resonance imaging; US, ultrasonography

When there is contraindication to imaging studies other than ultrasound (e.g. in pregnancy), surgical treatment is appropriate: if ultrasound is positive MIP is the treatment of choice (and ioPTH could be an option); if ultrasound is negative bilateral MIP or BNE are the treatments of choice.

When there are no contraindications to imaging studies, ^99mTc-sestamibi and ultrasound are indicated. If they are concordant a MIP is the treatment of choice and ioPTH is optional. If imaging studies are discordant or negative, CT or MRI can be considered: if these are positive MIP is the treatment of choice (possibly with ioPTH); if they are negative, bilateral MIP or BNE are the treatments of choice (possibly with ioPTH).

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