Using Technetium- 99mmethoxyisobutylisonitrile ( 99mTc-sestaMIBI) for the diagnosis of parathyroid adenoma could be an easy and standard technique, with early and 2 hours delayed images ( 1, 2). parathyroid nodules and could be useful for determining the differential diagnosis between malignant vs. Establishing an appropriate acquisition protocol is mandatory for making the correct differential diagnosis between thyroid vs. Personalised nuclear diagnosis imaging is, undoubtedly, part of precision medicine approach, and based on concrete data, representing a clear example of evidenced based medicine, by understanding the cellular uptake mechanisms. In conclusion, using a 99mTc-sestaMIBI personalized protocol, related to the radiotracer cellular uptake mechanisms: 1 hour scan (supplementary image, corresponding to the maximum uptake pattern of 99mTc-sestaMIBI for cancer cells) and 2 hours scan (for parathyroid washout evaluation) may avoid unnecessary extensive thyroid surgery. The intense uptake persists in both delayed scans suggesting no malignant phenotype and which was confirmed after surgery by benign histology. Due to the suspicion of malignancy for this nodule, we performed an additional scan (1 hour before the classical 2 hours parathyroid delayed scan). Scans described an early intense 99mTc-sestaMIBI uptake with no 99mTc-pertechnetate uptake in the left thyroid lobe larger nodule. hot nodules, and eventually, for guiding the choice of a subsequent Fine-Needle Aspiration Biopsy (FNAB). parathyroid localization, between cold vs. Functional nuclear imaging was performed for accurate differential diagnosis between thyroid vs. Cervical ultrasound illustrated a multinodular aspect of the thyroid with solid nodules and cystic-component nodules the larger one represented a multinodular complex with necrosis areas in the left thyroid lobe, ACR TI-RADS score 4 (moderately suspicious).

A 62 years old woman was diagnosed with multinodular toxic goiter and primary hyperparathyroidism/left parathyroid adenoma by hormonal assessment, ultrasound and nuclear thyroid/parathyroid scans.

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