Background: Recent reports have shown the effectiveness of preoperative parathyroid scintiscanning as an aid to parathyroidectomy. Less attention has been paid to limitations of this approach based on patient characteristics.

Methods: All patients evaluated for primary hyperparathyroidism by an endocrine surgeon from December 1, 1998, through October 31, 1999, were retrospectively reviewed. Data were gathered to determine which patients were candidates for the radioguided approach, the effectiveness of this approach, and the reasons why some patients were not candidates for this approach.

Results: Thirty-three patients were evaluated. Based on history, 4 patients were not candidates for a radioguided approach. Of the remaining 29 patients, 19 had positive sestamibi scans (65.5%) and successful radioguided operations. The 10 patients (34.5%) with negative scans had successful standard parathyroidectomy.

Conclusions: Although radioguided parathyroid surgery is an effective surgical approach, only 57.6% of patients in this series could have a radioguided operation. Standard four-gland exploration will continue to be needed for many patients.