The Utility of PTeye in Parathyroidectomy for Recurrent Hyperparathyroidism Due to Intramuscular Parathyroid Autograft Hyperplasia: A Case Report

PTeye is a near-infrared autofluorescence device used intraoperatively to identify parathyroid tissue, typically using thyroid tissue as a reference. In patients with prior total thyroidectomy, the absence of thyroid tissue limits its standard application. Although the use of alternative reference tissues with the PTeye device in thyroidectomized patients has been reported, such data remain limited. Our case differs in that skeletal muscle was used specifically for the detection of recurrent intramuscular parathyroid tissue and may serve as a meaningful reference point for future clinical applications. A patient underwent total thyroidectomy for multinodular goiter and excision of a left lower parathyroid adenoma for primary hyperparathyroidism. The left upper gland was devascularized and autotransplanted into the left sternocleidomastoid muscle. Sixteen years later, recurrent primary hyperparathyroidism developed, and imaging revealed a lesion at the autograft site. During revision surgery, PTeye was used with skeletal muscle as the autofluorescence reference. PTeye accurately identified parathyroid tissue using skeletal muscle as the reference. Successful excision was confirmed by a significant intraoperative parathyroid hormone decline from 125 pg/mL to 35 pg/mL and postoperative histopathology consistent with hyperplasia. This case suggests that PTeye may be effectively used with skeletal muscle as a reference tissue in patients lacking thyroid tissue.

Keywords: Hyperparathyroidism, parathyroidectomy, autofluorescence, probe, PTeye, recurrence