Radioguided Parathyroidectomy is Successful in 98.7% of Selected Patients.

OBJECTIVE To examine an individualized approach to patients with primary hyperparathyroidism (PHPT) in an effort to identify factors that would differentiate patients who can be treated with radioguided parathyroidectomy (RP) from those that require more extensive parathyroid exploration (PE) using intraoperative parathyroid hormone (IOPTH) measurement and to compare rates of recurrent and persistent hypercalcemia. METHODS A total of 100 patients were retrospectively studied. Patients with positive single photon emission computed tomography (SPECT) scans underwent surgeon-performed sonography (SPS) followed by RP. Patients with negative or equivocal SPECT scans underwent PE utilizing SPS as a guide and IOPTH. The success rate, recurrence and persistence rates, and rate of bilateral exploration were compared. RESULTS Seventy-five percent of patients with PHPT had a positive SPECT scan and underwent RP, whereas 25% of patients had a negative SPECT scan and underwent PE with IOPTH utilizing SPS as a guide. Persistent hypercalcemia was noted in 1 patient (1.3%) and recurrent hypercalcemia in 2 patients (2.6%) in the RP group, whereas no persistent hypercalcemia was noted in the group undergoing PE utilizing SPS and IOPTH. Overall, 89% of patients were cured with unilateral surgery. CONCLUSION Patients with positive SPECT scans may undergo RP with an expected cure rate of 98.7%. Patients with negative SPECT scans should undergo SPS followed by PE using IOPTH and can expect a cure rate near 100%. Properly selected patients may undergo RP, with low rates of persistent (1.3%) and recurrent (2.6%) hypercalcemia.