Does a sestamibi scan also detect problems in the thymus?

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Posted on Mon, 4 Aug 2014 in Thyroid Problem and Hormonal Problems
Question: Does a sestamibi scan also detect problems in the thymus? Do they show overactive parathyroid if all 4 are overactive?
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Answered by Dr. Binu Parameswaran Pillai 29 minutes later
Brief Answer:
Hi

Detailed Answer:
Hello,
Good day.
SESTAMIBI scan detects the parathyroid mitochondrial activity. In MEN syndromes, often parathyroid tissue is seen in Thymus too. For this reason , experienced surgeons explore the thymus as well when they do surgery for parathyroidetomy in MEN syndromes.

I have seen atleast 3 cases of ectopic parathyroid adenomas in thymus, (in non MEN hyperparathyroidism ). The chances of SESTAMIBI picking these lesions is based on many factors. If the lesion is not rich in mitochondria, it will not take up enough MIBI and may not show up in the scan. Thats why text books recommend a good surgical exploration and not to rely on SESTAMIBI too much in cases of hyperparathyroidism.

10-20% cases of hyperparathyroidism may not be picked up on SESTAMIBI and an experienced surgeon's hand is superior often to find out the lesion during surgical exploration.

To answer your question, SESTAMIBI picks overactive parathyroid tissue in thymus too ( but as i mentioned earlier, they may miss as well). SESTAMIBI can pick up all four glands in if they are overactive. But in many cases, overactivity starts first in one or two glands in MEN syndromes and only they may be pointed out in scan. If you remove just those glands and leave the rest in situ, there is high ikelyhood of the remaining glands becoming overactiive in due course.

The way surgeons and endocrnologists deal a simple hyperparathyroidism is different from hyperparathyroidism due to MEN syndromes.

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1418 Questions

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