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Purpose: To determine the utility of radioguided parathyroidectomy for treatment of patients with secondary hyperparathyroidism.
Methods: Between August 2003 and October 2011, 50 patients underwent parathyroidectomyfor secondary hyperparathyroidism related to chronic renal failure. Of these, 25 cases with secondaryhyperparathyroidism underwent total parathyroidectomy with autotransplantation {group I). The other 25 casesunderwent total radioguided parathyroidectomy with autotransplantation (group II). All changes were comparedbetween the two groups, including clinical manifestations, parathyroid hormone (1TH), serum calcium, pathologyand complications. We studied the radioactive counts in different tissues, including the parathryoid glands, normalthyroid tissue, fat tissue and lymph nodes. We also compared methods to locate the parathryoid glands, includingultrasound, sestamibi scans and localization during the operation.
Results: The clinical symptoms of all patientsimproved after treatment. Postoperative levels of PTH and calcium in group II were lower than those in group I(P=0.012), and were lower than the preoperative PTH and calcium levels (P<0.001). We were able to locate theparathyroid glands more precisely in group II than in group I. In vivo and ex vivo counts of the hyperplasticparathyroid glands were higher than those of thyroid tissue and fat tissue (P <0.001). Ex vivo counts ofhyperplastic parathryoid glands with negative sestamibi scans were greater than 20％ of background counts (P<0.001). In vivo counts of hyperplastic parathryoid glands with negative sestamibi scans were greater thanbackground counts (P<0.001).
Conclusion: In patients with secondary hyperparathyroidisim, radioguided surgery isa sensitive adjunct for the intraoperative localization of parathyroid glands. Radioactive counts are different amonghyperplastic parathyroid glands, thyroid glands and fat tissue. Radioguided techniques are effective in patientswith negative sestamibi scans who undergo parathyroidectomy to treat renal hyperparathyroidism.