Skip to main content
SpringerLink
Log in

Intraoperative Parathyroid Ultrasound

  • Chapter
  • First Online:
Medical and Surgical Treatment of Parathyroid Diseases

  • 1038 Accesses

Abstract

Localization studies have an important role in the assessment of patients with hyperparathyroidism. After a biochemical diagnosis of hyperparathyroidism is made, the utilization of real-time ultrasonography for precision treatment planning has become increasingly common amongst parathyroid surgeons. Characterization of pathologic parathyroid glands within the context of the surrounding anatomy is essential to plan a surgical approach, and to counsel the patient on treatment options. Preoperative ultrasound may direct the clinician towards or away from immediate surgical intervention. For example, in early or asymptomatic cases of hyperparathyroidism, a non-localizing sestamibi scan may be followed by ultrasound that does not reveal parathyroid pathology. The clinician may recommend additional localization and diagnostic studies, and postpone surgery. In another scenario, concomitant thyroid pathology may be identified on preoperative ultrasound and receive the appropriate evaluation before surgery is planned. The principles of ultrasound apply to the intraoperative setting as well—ultrasound immediately prior to skin incision can enhance surgical strategy. In this chapter we discuss the application of ultrasound technology in the preoperative and intraoperative management of parathyroid disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Orloff LA, editor. Head and neck ultrasonography. San Diego: Plural Publishing, Inc.; 2008. Clinical Review; Level 2; Grade A–B.

    Google Scholar 

  2. Sofferman RA. Ultrasound of the thyroid and parathyroid glands. In: Sofferman RA, Ahuja AT, editor. Springer Science + Business Media; 2012, Clinical Review; Level 2; Grade A–B.

    Google Scholar 

  3. Flint PW, editor. Cummings otolaryngology-head and neck surgery. 2015, Clinical Review; Level 2; Grade A–B.

    Google Scholar 

  4. Milas M, Mensah A, Alghoul M, Berber E, Stephen A, Siperstein A, et al. The impact of office neck ultrasonography on reducing unnecessary thyroid surgery in patients undergoing parathyroidectomy. Thyroid. 2005;15(9):1055–9. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  5. Pelizzo MR, Variolo M, Bernardi C, Izuzquiza M, Piotto A, Grassetto G, et al. Complications in thyroid resurgery: a single institutional experience on 233 patients from a whole series of 4,752 homogeneously treated patients. Endocrine. 2014;47(1):100–6. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  6. Kim MK, Mandel SH, Baloch Z, Livolsi VA, Langer JE, Didonato L, et al. Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol. 2004;130(10):1214–6. Population/Observational Study; Level 3; Grade A–B.

    Article  Google Scholar 

  7. Berger AC, Libutti SK, Bartlett DL, Skarulis MG, Marx SJ, Spiegel AM, et al. Heterogeneous gland size in sporadic multiple gland parathyroid hyperplasia. J Am Coll Surg. 1999;188(4):382–9. Clinical Investigation; Level 2; Grade C.

    Article  CAS  PubMed  Google Scholar 

  8. Doherty GM. Multiple endocrine neoplasia type 1. J Surg Oncol. 2005;89(3):143–50. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  9. Nilubol N, Weinstein L, Simonds WF, Jensen RT, Phan GQ, Hughes MS, et al. Preoperative localizing studies for initial parathyroidectomy in MEN1 syndrome: is there any benefit? World J Surg. 2012;36(6):1368–74. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  10. Alkhalili E, Tasci Y, Aksoy E, Aliyev S, Soundararajan S, Taskin E, et al. The utility of neck ultrasound and sestamibi scans in patients with secondary and tertiary hyperparathyroidism. World J Surg. 2015;39(3):701–5. Clinical Investigation; Level 2; Grade C.

    Article  PubMed  Google Scholar 

  11. Steward DL, Danielson GP, Afman CE, Welge JA. Parathyroid adenoma localization: surgeon-performed ultrasound versus sestamibi. Laryngoscope. 2006;116(8):1380–4. Clinical Investigation; Level 2; Grade C.

    Article  PubMed  Google Scholar 

  12. Yeh MW, Barraclough BM, Sidhu SB, Sywak MS, Barraclough BH, Delbridge LW. Two hundred consecutive parathyroid ultrasound studies by a single clinician: the impact of experience. Endocr Pract. 2006;12(3):257–63. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  13. Iacobone M, Citton M, Pagura G, Viel G, Nitti D. Increased and safer detection of nonrecurrent inferior laryngeal nerve after preoperative ultrasonography. Laryngoscope. 2015, Clinical Investigation; Level 2; Grade C.

    Google Scholar 

  14. Policeni BA, Smoker WR, Reede DL. Anatomy and embryology of the thyroid and parathyroid glands. Semin Ultrasound CT MR. 2012;33(2):104–14. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  15. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19(2):577–83. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  16. Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol. 2007;188(6):1706–15. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  17. Smith RB, Evasovich M, Girod DA, Jorgensen JB, Lydiatt WM, Pagedar NA, et al. Ultrasound for localization in primary hyperparathyroidism. Otolaryngology. 2013;149(3):366–71. Clinical Investigation; Level 2; Grade C.

    Google Scholar 

  18. Sung JY. Parathyroid ultrasonography: the evolving role of the radiologist. Ultrasonography. 2015, Clinical Review; Level 2; Grade A–B.

    Google Scholar 

  19. Lane MJ, Desser TS, Weigel RJ, Jeffrey Jr RB. Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas. AJR Am J Roentgenol. 1998;171(3):819–23. Clinical Investigation; Level 2; Grade B–C.

    Article  CAS  PubMed  Google Scholar 

  20. Kwak JY, Kim EK, Moon HJ, Kim MJ, Ahn SS, Son EJ, et al. Parathyroid incidentalomas detected on routine ultrasound-directed fine-needle aspiration biopsy in patients referred for thyroid nodules and the role of parathyroid hormone analysis in the samples. Thyroid. 2009;19(7):743–8. Clinical Review; Level 2; Grade A–B.

    CAS  PubMed  Google Scholar 

  21. Owens CL, Rekhtman N, Sokoll L, Ali SZ. Parathyroid hormone assay in fine-needle aspirate is useful in differentiating inadvertently sampled parathyroid tissue from thyroid lesions. Diagn Cytopathol. 2008;36(4):227–31. Clinical Investigation; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  22. Clayman GL, Gonzalez HE, El-Naggar A, Vassilopoulou-Sellin R. Parathyroid carcinoma: evaluation and interdisciplinary management. Cancer. 2004;100(5):900–5. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  23. Fyfe ST, Hoover LA, Zuckerbraun L, Goodman MD. Parathyroid carcinoma: clinical presentation and treatment. Am J Otolaryngol. 1990;11(4):268–73. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  24. American Institute of Ultrasound in Medicine, American College of Radiology, Society for Pediatric Research, Society of Radiologists in Ultrasound. AIUM practice guideline for the performance of a thyroid and parathyroid ultrasound examination. J Ultrasound Med. 2013;32(7):1319–29. Clinical Review; Level 2; Grade A–B.

    Article  Google Scholar 

  25. Gurney TA, Orloff LA. Otolaryngologist-head and neck surgeon-performed ultrasonography for parathyroid adenoma localization. Laryngoscope. 2008;118(2):243–6. Clinical Investigation; Level 2; Grade C.

    Article  PubMed  Google Scholar 

  26. Hessman O, Stalberg P, Sundin A, Garske U, Rudberg C, Eriksson LG, et al. High success rate of parathyroid reoperation may be achieved with improved localization diagnosis. World J Surg. 2008;32(5):774–81. discussion 82-3, Clinical Investigation; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  27. Solorzano CC, Carneiro-Pla DM, Irvin 3rd GL. Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg. 2006;202(1):18–24. Clinical Investigation; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  28. Van Husen R, Kim LT. Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg. 2004;28(11):1122–6. Clinical Investigation; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  29. Miller B. SPUS Facilitates MIP. World J Surg. 2008;32(5):772–3. Clinical Review; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  30. Candell L, Campbell MJ, Shen WT, Gosnell JE, Clark OH, Duh QY. Ultrasound-guided methylene blue dye injection for parathyroid localization in the reoperative neck. World J Surg. 2014;38(1):88–91. Clinical Investigation; Level 2; Grade B–C.

    Article  PubMed  Google Scholar 

  31. Ryan WR, Orloff LA. Intraoperative tumor localizaiton with surgeon-performed ultrasound-guided needle dye injection. Laryngoscope. 2011;121(8):1651–5. Clinical Investigation; Level 2; Grade B–C.

    Article  PubMed  Google Scholar 

  32. Tamiya H, Miyakawa M, Takeshita A, Miura D, Takeuchi Y. Ultrasonographic evaluation of parathyroid hyperplasia in multiple endocrine neoplasia type 1: positive correlation between parathyroid volume and circulating parathyroid hormone concentration. J Bone Miner Metabolism. 2014, Population/Observational Study; Level 3; Grade A–B.

    Google Scholar 

  33. Buderi SI, Saleh HZ, Theologou T, Shackcloth M. Endobronchial ultrasound-guided biopsy to diagnose large posterior mediastinal parathyroid adenoma prior to video-assisted thoracoscopic resection. BMJ Case Rep. 2014;2014, Clinical Investigation; Level 2; Grade B–C.

    Google Scholar 

  34. Vu DH, Erickson RA. Endoscopic ultrasound-guided fine-needle aspiration with aspirate assay to diagnose suspected mediastinal parathyroid adenomas. Endocr Pract. 2010;16(3):437–40. Clinical Review; Level 3; Grade A–B.

    Article  PubMed  Google Scholar 

  35. Yasufuku K, Nakajima T, Fujiwara T, Yoshino I, Keshavjee S. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal masses of unknown etiology. Ann Thorac Surg. 2011;91(3):831–6. Clinical Review; Level 3; Grade A–B.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA

    Ryan J. Li (Assistant Professor)

  2. Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, 875 Blake Wilbur Drive, CC-2225, Stanford, CA, 94305-5826, USA

    Lisa A. Orloff M.D., F.A.C.S.

Authors
  1. Ryan J. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa A. Orloff M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa A. Orloff M.D., F.A.C.S. .

Editor information

Editors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Brendan C. Stack, Jr.

  2. Department of Geniatrics and Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Donald L. Bodenner

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Simple sweep in transverse plane following right common carotid artery inferiorly to where it meets right subclavian artery at bifurcation from innominate artery (WMV 4914 kb)

Sagittal-view power Doppler demonstrating increased and polar vascularity of parathyroid adenoma (middle arrow) in relation to thyroid (superior to adenoma, left arrow) and lymph node (inferior to adenoma, right arrow), in a patient with coexisting Hashimoto’s thyroiditis and central compartment lymphadenopathy (WMV 2575 kb)

Transverse view in same patient as Video 23.2, showing increased and polar vascularity of parathyroid adenoma compared to hypovascularity of lymph node (parathyroid = upper arrow, lymph node = lower arrow) (WMV 4240 kb)

Sagittal-view power Doppler demonstrating polar vascularity of small right inferior parathyroid adenoma (WMV 1146 kb)

Ultrasound sweep from inferior to superior and back in transverse plane to visualize a parathyroid adenoma in the context of regional anatomy (large left inferior parathyroid adenoma deep/posterior to a relatively small left thyroid lobe) (WMV 8625 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Li, R.J., Orloff, L.A. (2017). Intraoperative Parathyroid Ultrasound. In: Stack, Jr., B., Bodenner, D. (eds) Medical and Surgical Treatment of Parathyroid Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-26794-4_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26794-4_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26792-0

  • Online ISBN: 978-3-319-26794-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation