Ultrasound as a Localization Technique in Hyperparathyroidism
High-resolution ultrasound (US) of the thyroid, parathyroid, and soft tissues of the neck should always be performed prior to parathyroidectomy. US performed by experienced sonographers has similar sensitivity to Sestamibi (MIBI) scan in localizing eutopic parathyroid adenomas. US is the least expensive localization study. The results of US and other localization studies are highly dependent on the quality of imaging. When the surgeon can rely on accurate and clear US results to localize the parathyroid gland, he or she can proceed with parathyroidectomy solely guided by the US results and intraoperative PTH. When the parathyroid gland is not clearly identified or the images are equivocal, an additional study such as MIBI or 4DCT can be obtained. The choice of which additional localization study to obtain will depend on local expertise, surgeon’s comfort level with such study, and experience. US followed by 4DCT or US followed by MIBI appear to be the most cost-effective localization strategies.
KeywordsUltrasound Parathyroid Surgeon-performed Localization Cost-effective Convenient Thyroid
Ultrasound in transverse view confirming a parathyroid adenoma above the esophagus in a patient with agenesis of the left lobe of the thyroid (MP4 2,261 kb)
Transverse view of the typical ultrasound appearance of an inferior left parathyroid adenoma (MP4 5,042 kb)
Longitudinal view of an inferior parathyroid in the thyro-thymic ligament showing the typical arc of vascularity (MP4 2,582 kb)
Transverse ultrasound view of a superior parathyroid located in the paraesophageal location. The scanning starts at the upper thyroid poles and proceeds inferiorly toward the clavicle. This type of parathyroid is often missed on exploration because the surgeon does not look posteriorly enough (MP4 12,334 kb)
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