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Endocrine Surgery

(301) Evaluating the Accuracy of Pre-Operative Localizing Imaging Modalities in Thyroiditis Patients Undergoing Parathyroidectomy

Saturday, October 17, 2026

Presenting Author(s)

SC

Smrithi Chidambaram, MD

Resident Physician
Allegheny Health Network Medical Education Consortium Program, Division of Otolaryngology-Head and Neck Surgery
Pittsburgh, Pennsylvania, United States

Co-Author(s)

SH

Samantha Huebner, BS

Medical Student
Drexel University College of Medicine, United States
JL

Jenna Li, MS

Statistician
Allegheny Health Network Research Institute, United States
MG

Matt Goodwin, PhD

Senior BI Developer
Allegheny Health Network Research Institute, United States
WS

Warren Swegal, MD

Physician
Allegheny Health Network-Division of Otolaryngology-Head and Neck Surgery, United States

Senior Author(s)

SM

Shelly J. McQuone, MD

Physician, Division Chair
Allegheny Health Network, Division of Otolaryngology-Head and Neck Surgery
Sewickley, Pennsylvania, United States

Introduction: Technetium-99m sestamibi and 4D-CT scans aid in pre-operative localization of abnormal parathyroid glands. Given that sestamibi is a nonspecific tracer absorbed by mitochondrial rich tissue, underlying inflammatory thyroid disease (thyroiditis) may impact accuracy of localization.

Methods: This is retrospective cohort study of adult patients who underwent parathyroidectomy for primary hyperparathyroidism at a single institution from January 2017- March 2024. Patient demographics, pre-operative sestamibi and parathyroid 4D-CT results (categorized as right, left, or bilateral adenomas), concomitant diagnosis of thyroiditis (specifically hypothyroidism), and final pathology/location of adenoma were abstracted. Differences in demographics and sestamibi/CT positive prediction proportions between those with and without thyroiditis were calculated using Chi Square and Fisher’s Exact tests.

Results: The study cohort consisted of 353 patients who underwent parathyroidectomy from 2017-2024. Most patients were female (77%), White (84%), not Hispanic or Latino (94%), and euthyroid (78%), with no significant differences in demographics between the thyroiditis/euthyroid groups (p>0.05). All patients had a sestamibi scan and 60.3% (n=214) had a 4D-CT. Sestamibi scans correctly localized adenomas in 270/353 (76%) cases and CT scans did so in 184/214 (86%) cases. In the euthyroid vs thyroiditis groups, sestamibi and CT scans correctly localized adenomas in 76.4% and 76.6% of cases (p=1). CT scans had a higher correct localization proportion in the thyroiditis (47/48 cases, 98%) vs the euthyroid (137/166, 83%) group (p=0.004).

Conclusions: While the accuracy of sestamibi imaging for localizing parathyroid adenomas was similar in patients with and without thyroiditis, 4D-CTs had a higher percentage of correctly localizing adenomas within the thyroiditis group. Given pre-operative scans for parathyroidectomy can vary across providers and institutions, assessing the relationship between thyroid pathology and imaging results can help better inform operative planning and patient counseling.