Incidence and location of ectopic abnormal parathyroid glands

Am J Surg. 2006 Mar;191(3):418-23. doi: 10.1016/j.amjsurg.2005.10.049.

Abstract

Background: Ectopic parathyroid glands are a cause for failed parathyroid exploration.

Methods: Patients with hyperparathyroidism and ectopic parathyroid glands were identified from a parathyroid database. Laboratory data, gland weights, and surgical outcomes were obtained. The locations of the ectopic glands were correlated with results of technetium-99m-sestamibi imaging.

Results: Of 231 patients operated on for hyperparathyroidism, 37 (16%) had ectopic parathyroid glands. Ectopic inferior glands (N = 23 [62%]) were intrathymic, n = 7 (30%); anterosuperior mediastinal, n = 5 (22%); intrathyroidal, n = 5 (22%); within the thyrothymic ligament, n = 4 (17%); and submandibular, n = 2 (9%). Ectopic superior glands (N = 14 [38%]) were in the tracheoesophageal groove, n = 6 (43%); retroesophageal, n = 3 (22%); posterosuperior mediastinal, n = 2 (14%); intrathyroidal, n = 1 (7%); in the carotid sheath, n = 1 (7%); and paraesophageal, n = 1 (7%). Sestamibi scans were true-positive in 81%, identifying 13 of 16 retrosternal glands, and false-negative in 19%.

Conclusions: A 16% incidence of ectopic parathyroid glands and a 100% positive predictive value of sestamibi scintigraphy underscore the importance of sestamibi imaging in patients with primary hyperparathyroidism.

MeSH terms

  • Choristoma / diagnostic imaging*
  • Choristoma / epidemiology*
  • Choristoma / surgery
  • Female
  • Humans
  • Hyperparathyroidism* / surgery
  • Incidence
  • Male
  • Middle Aged
  • Parathyroid Glands*
  • Preoperative Care
  • Radionuclide Imaging
  • Radiopharmaceuticals*
  • Sensitivity and Specificity
  • Statistics, Nonparametric
  • Technetium Tc 99m Sestamibi*
  • United States / epidemiology

Substances

  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi