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Excerpt

We would like to thanks the authors for their interest and kind comments regarding our study.1 We would also like to congratulate them on their experience and expertise with cervical ultrasound for the preoperative localization of parathyroid adenomas. One of the goals of our study was to illustrate that the majority of patients with a negative sestamibi scan still had a single parathyroid adenoma as the etiology of their primary hyperparathyroidism, and that additional localization studies can potentially find the adenoma. In the authors’ experience, the additional of cervical ultrasound has led to their ability to find additional single adenomas over sestamibi alone. We totally agree with the authors that additional studies including ultrasound are beneficial. However, although the authors have demonstrated expertise with ultrasound, the accuracy of this technique is operator dependent. Thus, not all surgeons may have access to highly experienced ultrasonographer as they do. Therefore, the ideal additional imaging study may vary amongst different institutions. …