Concierge nuclear medicine · London
Parathyroid scan, Tc-99m sestamibi ± SPECT-CT to localise parathyroid adenomas before surgery.
A parathyroid scan uses Tc-99m sestamibi, sometimes with SPECT-CT. It shows which parathyroid gland is overactive. That answers the key question before a keyhole parathyroidectomy. It sits alongside neck ultrasound and 4D-CT.
Key facts
- 01
Definition
A Tc-99m sestamibi scan, sometimes paired with SPECT-CT, to find the overactive parathyroid gland.
- 02
Purpose
Enables focused (minimally invasive) parathyroidectomy.
- 03
Complementary imaging
Complements neck ultrasound and 4D-CT.
- 04
Sensitivity
Sensitivity higher for single adenomas.
- 05
Reporting
Reported by nuclear medicine consultant.
- 06
Role
Standard preoperative planning in hyperparathyroidism.
How it works
From referral to surgical plan — what happens, in order.
A clear diagnostic pathway from endocrinology referral through tracer imaging to the operative plan.
- 01
Endocrinology / endocrine surgery consultation
Referral from an endocrinologist or endocrine surgeon to define the surgical question.
- 02
Confirm biochemical primary hyperparathyroidism
Raised calcium with inappropriately raised PTH — the diagnostic prerequisite.
- 03
IV Tc-99m sestamibi
A small injection of Tc-99m sestamibi radiotracer into a peripheral vein.
- 04
Early and delayed planar imaging
Gamma-camera images at ~15 minutes and again at ~2 hours to exploit differential washout.
- 05
Optional SPECT-CT for localisation
3D SPECT-CT adds anatomical precision — particularly useful for ectopic or deep glands.
- 06
Nuclear medicine report
A consultant nuclear medicine physician reports the study and confirms the localisation.
- 07
Surgical planning
The endocrine surgeon plans a focused or bilateral procedure from the imaging.
What it shows
What a parathyroid scan can localise.
Sestamibi answers a specific question — where is the overactive parathyroid tissue, and how many glands are involved. These are the patterns we see most.
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Solitary parathyroid adenoma
The classic finding — a single hyperfunctioning gland suitable for focused surgery.
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Multi-gland disease
Two or more abnormal glands, changing the operative approach.
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Ectopic parathyroid (mediastinum)
Glands sitting outside the neck — commonly in the anterior mediastinum.
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Retro-oesophageal parathyroid
Deep, behind-the-oesophagus glands that are hard to find at surgery.
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Post-surgical recurrence
Reappearance of disease after prior parathyroidectomy.
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Coincidental thyroid nodule
Thyroid nodules picked up on sestamibi or SPECT-CT that need separate work-up.
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Baseline for repeat imaging
A reference study for future comparison if disease recurs.
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Red flag: multi-gland disease → four-gland exploration
Multi-gland disease shifts management from focused surgery to bilateral neck exploration.
Treatment options
What follows a positive parathyroid scan.
The scan defines the surgical plan — from focused parathyroidectomy to bilateral exploration and long-term follow-up.
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Minimally invasive parathyroidectomy
A focused, small-incision removal of the localised adenoma — the standard for single-gland disease.
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Bilateral neck exploration for multi-gland disease
Formal four-gland exploration when imaging or biochemistry point to multi-gland disease.
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Ectopic gland removal
Targeted removal of ectopic tissue — mediastinal, retro-oesophageal or intrathyroidal.
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Genetic testing for MEN syndromes
MEN 1 and MEN 2A screening where family history or presentation suggests a syndrome.
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Cinacalcet for medical management
A calcimimetic option for patients who are not surgical candidates.
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Endocrine surgery MDT
Multidisciplinary review — endocrinology, endocrine surgery, nuclear medicine and radiology.
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Repeat imaging for post-op recurrence
Re-imaging with sestamibi, SPECT-CT and 4D-CT when hypercalcaemia returns.
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Structured endocrine follow-up
Long-term calcium, PTH and vitamin D follow-up under endocrinology.
Our vetted London network
A small panel of clinics, we picked them.
Nuclear medicine partners across central London with sestamibi and SPECT-CT capability, joint-reporting arrangements and direct endocrine-surgery pathways.
Selection criteria
How we choose every clinic in our network.
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Consultant nuclear medicine physicians reporting every study
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Dual-phase Tc-99m sestamibi with SPECT-CT capability on site
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Joint reporting with head-and-neck radiology where available
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Direct onward pathway to a specialist endocrine surgeon
Red flags
When something needs urgent surgical input.
The features and complications that warrant urgent endocrine-surgery, ENT or genetics involvement.
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Persistent hypercalcaemia post-op
Calcium that fails to normalise after surgery — needs urgent biochemical and surgical review.
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Recurrent primary hyperparathyroidism
Return of hypercalcaemia months or years after initial cure.
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MEN 1 / 2A
Multiple Endocrine Neoplasia syndromes — screen family and consider genetic testing.
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Parathyroid carcinoma
A rare but important differential in very high calcium and PTH values.
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Ectopic mediastinal gland
Glands in the chest may need thoracic input for removal.
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Post-op hypocalcaemia (hungry-bone)
Sudden calcium drop after surgery — requires prompt replacement.
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Vocal cord palsy (recurrent laryngeal nerve)
Hoarseness after surgery warrants ENT assessment.
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Suspected parathyromatosis
Scattered functioning parathyroid tissue after prior surgery — a complex re-operative problem.
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Concurrent thyroid malignancy
Any suspicious thyroid nodule found alongside needs its own investigation.
Reading your report
A parathyroid scan report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your surgeon, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and biochemistry
Your details, referring clinician, calcium/PTH values and the clinical question.
- 02 Technique
Tracer, dose and imaging phases
Tc-99m sestamibi dose, early and delayed planar imaging, and whether SPECT-CT was performed.
- 03 Findings
Location, laterality and gland number
Where the abnormal tracer uptake is, which side, and whether one or more glands are involved.
- 04 Impression
The conclusion: read this first
Localised adenoma, multi-gland disease, ectopic or negative study — with the concrete surgical implication.
Clinical sources
Who informs this guide.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about parathyroid scans.
Quick answers on how the scan works, what SPECT-CT adds, safety, negative scans and who reports.
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What is a parathyroid scan?
A nuclear medicine scan using Tc-99m sestamibi — sometimes with SPECT-CT — to find overactive parathyroid glands before surgery for primary hyperparathyroidism.
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Why do I need one before surgery?
It localises the abnormal gland so the endocrine surgeon can perform a minimally invasive, focused parathyroidectomy rather than a full four-gland exploration.
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What does SPECT-CT add?
SPECT-CT gives a 3D map fused with anatomical CT — particularly useful for ectopic glands, deep retro-oesophageal glands or when planar imaging is equivocal.
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Is a parathyroid scan safe?
The radiation dose is low and comparable to other diagnostic nuclear medicine studies. The tracer is well tolerated. It is not used in pregnancy without specific indication.
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What if the scan is negative?
A negative sestamibi doesn’t rule out primary hyperparathyroidism. Neck ultrasound and 4D-CT are complementary, and bilateral neck exploration by an experienced endocrine surgeon remains an option.
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Who reports the scan?
A consultant nuclear medicine physician, often in conjunction with head-and-neck radiology, with the report going to your endocrinologist or endocrine surgeon.
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In practice, in London
The honest picture around parathyroid scan in London
With parathyroid scan, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. On the NHS, parathyroid scan typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.
A typical private booking for parathyroid scan in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For parathyroid scan specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Where a good concierge earns its keep is in the matching. There are dozens of consultants in London who see parathyroid scan — but not all of them are the right fit for every case. We narrow it down based on subspecialty, insurer coverage, the specific question being asked, and whether continuity into treatment matters. The right first appointment saves you from repeating yourself later.