Radioguided parathyroidectomy in patients with secondary hyperparathyroidism due to chronic renal failure.

OBJECTIVE: The aim of the study was to determine the effectiveness of radioguided parathyroidectomy in patients with secondary hyperparathyroidism (sHPT) due to chronic renal failure (CRF).

METHODS: Between August 2003 and October 2011, CRF patients undergoing parathyroidectomy for sHPT received conventional parathyroidectomy with preoperative ultrasound localization or radioguided surgery. For radioguided surgery, 370 MBq of (99m)Tc-sestamibi was injected intravenously 1.5-2 h before surgery, and a gamma probe was used intraoperatively to identify the parathyroid glands by radioactivity count.

RESULTS: Twenty-five patients underwent conventional parathyroidectomy and 25 underwent radioguided parathyroidectomy. The median patient age was 55 years (range, 37-75 years). In the conventional surgery group, the parathyroid glands were removed in 18 patients, and seven patients experienced recurrence as determined by intact parathyroid hormone (iPTH) levels. One patient in the radioguided surgery group experienced recurrence due to ectopic parathyroid tissue in the mediastinum. The operative time of radioguided surgery was shorter than that of conventional surgery [median (interquartile range), 100.0 (84.0-118.0) vs. 114.0 (103.0-134.0) min, respectively; P=0.015]. On postoperative day 1, iPTH and serum calcium levels were significantly lower in the radioguided surgery group than in the conventional surgery group [median (interquartile range), iPTH: 3 (3-20) vs. 53 (11-230) ng/l; P=0.006, calcium: 1.72 (1.63-1.85) vs. 2.06 (1.92-2.12) mmol/l; P<0.001]. Radioactivity counts of parathyroid glands were significantly higher than in thyroid tissue, lymph nodes, and fat (all, P<0.001).

CONCLUSION: Radioguided localization of the parathyroid glands improves the success rate of surgery in patients with CRF undergoing parathyroidectomy for sHPT.