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The Pathophysiologic Basis of Nuclear Medicine pp 222–237Cite as

Parathyroid Gland

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Summary

To understand the various scintigraphic patterns of parathyroid disease, it is important to understand parathyroid embryology and anatomy. Although experienced neck surgeons can achieve a high success rate of parathyroidectomy after bilateral neck exploration without prior localizing study [2, 3], a preoperative localization study would decrease operative time and morbidity and is frequently needed for the minimally invasive surgical approach that is currently practiced with increasing frequency. The most commonly used and most cost effective modality for preoperative localization is 99mTc-sestamibi and alternatively 99mTc-Myoview. The technique is being used before the initial surgery but is most clearly indicated for the preoperative evaluation of recurrent or persistent hyperparathyroidism. SPECT and particularly pinhole acquisition are valuable to improve the accuracy of localization. Intraoperative gamma probe localization is increasingly used also along with the minimally invasive surgical approach. The spectrum of parathyroid disease demonstrated with 99mTc-sestamibi scintigraphy includes eutopic disease, ectopic disease, solitary adenoma, double or multiple adenomas, cystic adenoma, lipoadenoma, multiple endocrine neoplasia, hyperfunctioning parathyroid transplant and others. The diagnosis of parathyroid tumors with 99mTc-sestamibi scintigraphy is based on the difference in clearance rates between the thyroid and diseased parathyroid glands, and any condition that interferes with radiotracer clearance will limit the effectiveness of the study. Atypical washout is one of the known entities that can limit the accuracy of these stuidies and it is probably related to the mitochondrial contents of the cells of the abnormal glands. Adding thyroid scan and ultrasonography improves results but is not cost effective enough to be a routine practice.

Subtraction 99mTc-sestamibi, iodine-123 scintigraphy or more recently PET may be helpful in difficult cases.

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  1. Abdelhamid H. Elgazzar
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  1. Department of Nuclear Medicine, Faculty of Medicine Kuwait University Health Sciences Center, PO Box 24923, 13110, Safat, Kuwait

    Abdelhamid H. Elgazzar MD, FCAP (Diplomate, American Board of Pathology Diplomate, American Board of Nuclear Medicine Professor and Chairman) (Diplomate, American Board of Pathology Diplomate, American Board of Nuclear Medicine Professor and Chairman)

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Elgazzar, A.H. (2006). Parathyroid Gland. In: Elgazzar, A.H. (eds) The Pathophysiologic Basis of Nuclear Medicine. Springer, Berlin, Heidelberg . https://doi.org/10.1007/978-3-540-47953-6_8

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