Effectiveness of the Gamma Probe in Childhood Parathyroidectomy: Retrospective Study

Cureus. 2020 Jan 11;12(1):e6629. doi: 10.7759/cureus.6629.

Abstract

Background There are few reports about parathyroidectomy due to secondary hyperparathyroidism in patients with end-stage renal failure in the literature. We aimed to evaluate the surgical treatment methods and the results of patients who were operated for secondary hyperparathyroidism with end-stage renal disease in our center. Method Sixteen patients with the diagnosis of secondary hyperparathyroidism were treated surgically in our center. Demographical data, laboratory findings, and imagining methods were all examined. The effect of the Technetium 99m methoxyisobutylisonitrile (Tc-99m-MIBI) probe sensitive to gamma rays detection was also evaluated to locate and identify all the parathyroid glands during the operation. Results Eleven of the patients underwent intravenous (IV) Tc-99m MIBI preoperatively and a gamma probe was detected during surgery. The gamma probe was not used in five patients. Four parathyroid glands were removed in eight (72.7%) out of 11 patients with gamma probes and three parathyroid glands were found in three patients. Total parathyroidectomy and parathyroid autoimplantation were made to eight patients who had removed four glands, subtotal parathyroidectomy was done for the other patients. On a comparison of laboratory findings before and after the surgery, there was a significant relationship between the decrease of serum parathyroid hormone and calcium levels (p<0.05). Conclusion Total parathyroidectomy and parathyroid autoimplantation is the most efficient and safe mode of management for secondary parathyroidism patients. During the surgery, using a probe sensitive to gamma rays detection may also help the surgeon. Thus, unnecessary dissections to prevent the presence of atypical parathyroid glands are prevented.

Keywords: end-stage renal disease; gamma probe detection; secondary hyperparathyroidism; tc-99m-mibi.