to bilateral intervention. Conclusion: Our fi ndings indicate that bilateral intervention remains a successful management option without prior localization in patients with PHPT especially in an endemic goiter region. Abstract Objective: This study was planned to investigate the effi cacy of either 99m Tc-sestamibi scan or ultrasonography in predicting the operative treatment in patients with primary hyperparathyroidism (PHPT). Subjects and Method: Thirty patients (25 female, 5 male; mean age:

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... 3 years) being operated for symptomatic primary PHPT were included in this study. Ultrasonography was used in 29 patients while 99m Tc-sestamibi scintigraphy was done in 28 patients to localize the hyperfunctioning gland(s). Standard bilateral neck exploration was done in 6 patients. Although unilateral intervention had been planned for 24 patients, bilateral intervention was performed in 9 of them. Results: Sensitivity of 99m Tc-sestamibi was 81%, while that of ultrasonography was 42%. 99m Tc-sestamibi localization method led to misleading results in 10/28 (35.7%) patients. False-positive localization and accompanying thyroid pathologies played an important role in determining transition from unilateral