Sestamibi dual-phase planar parathyroid scintigraphy reliably and cost-effectively identifies hyperfunctioning parathyroid tissue, but it lacks the anatomic sensitivity necessary for increasingly technical procedures.
It is currently the consensus among most endocrinologists that screening should be performed in all patients with an incidental adrenal mass to exclude an occult, asymptomatic hyperfunctioning adrenal mass.
1,4,5) It is believed that in patients with toxic nodular goiters, the radioiodine uptake is restricted primarily to the hyperfunctioning autonomous areas within the gland as opposed to uniform distribution of radioiodine uptake in Graves' disease, hence conferring a relative protection against hypothyroidism.
Chen's research, published in Surgery in 2005, determined that intraoperative parathyroid hormone measurement improves cure rates in patients undergoing minimally invasive parathyroidectomies because it allows surgeons to recognize and address additional hyperfunctioning parathyroids during surgery that were missed by preoperative imaging.
Intact (1-84) parathyroid hormone (PTH) has a short half-life and can be monitored during surgery to confirm the removal of all hyperfunctioning parathyroid tissue, but exact criteria for timing of sample collection and number of samples that best indicate a surgical cure are still to be perfected (1).