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Surg Clin North Am. 2014 Jun;94(3):587-605. doi: 10.1016/j.suc.2014.02.006. Epub 2014 Mar 29.

Minimizing cost and maximizing success in the preoperative localization strategy for primary hyperparathyroidism.

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  • 1Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, 597 PRB, 2220 Pierce Avenue, Nashville, TN 37232, USA. Electronic address:
  • 2Division of Oncologic and Endocrine Surgery, Medical University of South Carolina, 25 Courtenay Drive, 7008, Charleston, SC 29414, USA.


Ultrasonography of the thyroid, parathyroid, and soft tissues of the neck should always be performed before parathyroidectomy. The most cost-effective localization strategies seem to be ultrasonography followed by four-dimensional computed tomography (4DCT) or ultrasonography followed by sestamibi ± 4DCT. These localization strategies are highly dependent on the quality of imaging. Surgeons should critically evaluate the imaging and operative data at their own institution to determine the best preoperative localization strategy before parathyroidectomy. Surgeons should communicate with the referring physicians about the best localization algorithms in the local area and become the decision maker as to when to obtain them.


Cost-effectiveness; Four-dimensional computed tomography; Hyperparathyroidism; Localization; Parathyroidectomy; Sestamibi scan; Ultrasonography

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