Thyroid Suppression in Patients With Primary Hyperparathyroidism: Does It Improve the Pre-Surgical Scintigraphy Localisation?

Gómez-Ramírez, Joaquín; Posada, María Cristina; Rodrı́guez, Ana; Bravo, José Miguel; Domínguez, Luis; Martín-Pérez, M; Larrañaga, Eduardo

doi:10.1016/j.cireng.2011.06.004

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…All patients were hypothyroid, with L-thyroxine substitution therapy at the time of MIBI scintigraphy. The administration of L-thyroxine to suppress the thyroid was claimed by some authors to improve the sensitivity of parathyroid scintigraphy in primary hyperparathyroidism [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Absent 99mTc-MIBI Uptake in the Thyroid Gland during Early Phase of Parathyroid Scintigraphy in Patients with Primary and Secondary Hyperparathyroidism

Jovanovska¹,

Stoilovska²,

Mileva³

et al. 2018

Open Access Maced J Med Sci

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BACKGROUND:Thyroid uptake of technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) during parathyroid scintigraphy can be affected by various conditions.AIM:To evaluate the frequency of absent 99mTc-MIBI uptake by the thyroid gland in the early phase of dual-phase parathyroid scintigraphy.METHODS:The early planar images of dual phase Tc99m MIBI parathyroid scintigraphy from 217 patients performed between 2014 and 2017 were retrospectively analysed. Patients were divided into two groups. The first group included 147 patients with primary hyperparathyroidism and the second group included 70 patients with chronic renal failure. Patient records, laboratory and ultrasonographic data were analysed in all patients. Descriptive statistic was used for data analysis.RESULTS:Out of all patients in the first group, 18 patients (12.24%) showed absent thyroid uptake. Thyroidectomy was performed in 44.4% of these patients, and the rest of them had some thyroid disease. Only one patient had no thyroid or another chronic disease. In the second group, 8 patients (11.42%) presented with absent thyroid uptake of MIBI. Among them, 5 patients had no history of thyroid disease and had been on hemodialysis programme, and 3 patients had hypothyroidism.CONCLUSION:Absent 99mTc-MIBI uptake in the thyroid during the early phase of parathyroid scintigraphy is most frequently related to thyroid disease. A small proportion of patients with chronic renal failure can present with absent 99mTc-MIBI uptake in the thyroid as well. The mechanism for this alteration is still unclear and needs further investigation.

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Section: Discussionmentioning

confidence: 99%

Absent 99mTc-MIBI Uptake in the Thyroid Gland during Early Phase of Parathyroid Scintigraphy in Patients with Primary and Secondary Hyperparathyroidism

Jovanovska¹,

Stoilovska²,

Mileva³

et al. 2018

Open Access Maced J Med Sci

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Does levothyroxine administration impact parathyroid localization?

Ayers

Tobin

Sippel

et al. 2015

Journal of Surgical Research

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Background Proper localization is crucial in performing minimally invasive parathyroidectomy for primary hyperparathyroidism (PHPT). Ultrasonography (US) and Tc-99m sestamibi (MIBI) scintigraphy are common methods used for localization. As the appearance and activity of the thyroid gland may impact parathyroid localization, the purpose of this study was to determine how exogenous use of the thyroid hormone, levothyroxine (LT), affects parathyroid localization. Methods Adult patients with non-familial PHPT who underwent initial parathyroidectomy from 2000 to 2014 were retrospectively identified. Levothyroxine (+LT) and non-levothyroxine (-LT) patients were matched 1:3 based on age, gender, goiter status, and preoperative parathyroid hormone levels. Subgroup analysis was performed on patients previously treated with radioactive iodine and patients undergoing single adenoma resection. Results Of the 1,737 patients that met inclusion criteria, 286 were on LT at the time of their parathyroid localization scan. Use of LT not did impact the percentage of correct MIBI localization scans when compared to −LT patients (p=0.83). Interestingly, use of LT significantly hindered localization by US in comparison to the −LT group (48.4 vs 62.2%, p<0.01). When examining only patients where a single upper gland was removed, the +LT group was less likely to have a correct US compared to the −LT group (50 vs. 72.8%, p<0.01). However, there was no difference in US accuracy for patients who only had a single lower gland removed (p=0.51). Conclusions Exogenous levothyroxine is associated with impaired parathyroid localization with US but not MIBI. Surgeons should be aware of localization efficiency for this subset of patients in the era of personalized medicine and cost effectiveness.

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Thyroid Suppression in Patients With Primary Hyperparathyroidism: Does It Improve the Pre-Surgical Scintigraphy Localisation?

Cited by 2 publications

References 8 publications

Absent 99mTc-MIBI Uptake in the Thyroid Gland during Early Phase of Parathyroid Scintigraphy in Patients with Primary and Secondary Hyperparathyroidism

Absent 99mTc-MIBI Uptake in the Thyroid Gland during Early Phase of Parathyroid Scintigraphy in Patients with Primary and Secondary Hyperparathyroidism

Does levothyroxine administration impact parathyroid localization?

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