Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation

Abstract

Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A 99mtechnetium (99mTc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the procedure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL. Neck ultrasonography and 99mTc sestamibi scan detected a 5-cm parathyroid neoplasm in the left lower lobe of the patient's thyroid; left parathyroidectomy was performed. This case indicated that thyroid ultrasonographers and pathologists need to be experienced enough to differentiate a parathyroid neoplasm from a thyroid nodule; 99mTc sestamibi scan, serum calcium, and iPTH levels can help to establish the diagnosis of parathyroid neoplasm.

The coexistence of primary hyperparathyroidism and thyroid nodules: should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted?

“…In this specific case, the US-guided fine-needle aspiration biopsy could help to distinguish a thyroid nodule from a parathyroid adenoma, although the reliability of the cytology to identify the parathyroid cells is still controversial (41)(42)(43). Concerning this, the FNA-PTH assay seems to be more accurate (20,42).…”

Denosumab-related osteonecrosis of the jaw: A literature review

“…However, accessory investigations, such as neck ultrasonography or fine needle biopsy of the parathyroids, may leave some doubts, since parathyroid adenoma/hyperplasia might be misdiagnosed as a colloid goiter or follicular neoplasm of the thyroid gland, as was the case in our patient. 7 The relationship between pregnancy and brown tumor progression has not been well documented in the literature, as brown tumors are extremely rare in pregnant women. Several researchers emphasize the increased demand for vitamin D3 (resulting in suboptimal circulating 25-hydroxyvitamin D) and calcium (total calcium increases while ionized calcium remains stable) as well as PTH-related protein secretion by the placenta, decidua and mammary glands.…”

“…The most common cause is a parathyroid adenoma (80-85%), although it can be difficult to distinguish between a normal and an abnormal gland, with multigland hyperplasia (15%) and carcinoma (1-2%) developing afterwards. 1,[3][4][5][6][7][8][9] Parathyroidectomy is the treatment of choice for symptomatic and progressive PHPT. [9][10][11] Multifocal brown tumors are a rare complication of hyperparathyroidism.…”

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study

“…Both ultrasound and MIBI were performed to locate the ectopic SHPT nodules [6,28,29]. Ultrasound examination was performed with real-time color Doppler using a 10.0/3.5 MHz transducer to identify the ectopic SHPT nodule (Aplio 500, Toshiba, Japan, Figure 1(A)).…”