Radioguided reoperative parathyroidectomy for persistent primary hyperparathyroidism.

We report a case of reoperative radioguided parathyroidectomy in a patient with primary hyperparathyroidism. A 58-year-old man presented to our center with persistent hypercalcemia and hyperparathyroidism after 2 previous parathyroid explorations at an outside facility. Despite the use of preoperative and intraoperative localization, identification of the hyperfunctioning gland was unsuccessful during the initial operations. Because of the continued presence of symptoms, the patient was referred to our center for reoperation. Repeat Tc-99m sestamibi parathyroid scan showed an inferior right parathyroid adenoma. With the intraoperative guidance of a hand-held gamma probe, an enlarged parathyroid gland was localized on the spine behind the esophagus on the right, and successfully removed. Intraoperative parathyroid hormone testing confirmed a surgical cure. The use of radioguidance and intraoperative parathyroid hormone testing were essential to the successful resection. The patient remained disease-free at follow-up.