Supernumerary parathyroid glands in recurrent secondary hyperparathyroidism

Disease recurrence, after initially successful parathyroid surgery, is very common in patients undergoing periodic hemodialysis. The expected diagnosis is hypertrophy of the parathyroid transplant or of the partially resected gland. In addition, repeated operation may be necessary if the surgeon fails to locate multiple ectopic or supernumerary abnormal glands on initial surgery. Parathyroid scintigraphy does not always show the true number of abnormal glands on the first scan, but after removal of the visualized abnormal glands, the remaining parathyroid tissue will presumably become more prominent on sestamibi imaging. Sestamibi parathyroid imaging is recommended as the first-line imaging procedure in patients with recurrent secondary hyperparathyroidism.