Radio-Guided Surgery and Intraoperative iPTH Determination in the Treatment of Primary Hyperparathyroidism

Since the main cause of PHPT is solitary adenoma, Tibblin et al. (1982) described the possibility of performing a unilateral neck exploration. Up till that time, the greatest limitation for this technique was the lack of precision in preoperative localization protocols. Nowadays, thanks to 99mTc-methoxy-isobutyl-isonitrile (MIBI) scintigraphy (Fig 1) and high resolution ultrasonography, unilateral neck exploration is successfully applied. 99m-Tc-MIBI imaging has been widely acknowledged as a basic test for preoperative localization and planning of the operation, being the test of choice in patients with persistent or recurrent PHPT, suspect of ectopic adenomas or in those who have been submitted to thyroidectomy or to other previous neck operations (Papathanassiou et al., 2008).