Intrathyroidal parathyroid adenomas: Scoping review on clinical presentation, preoperative localization, and surgical treatment

Gowrishankar, Shravan V; Bidaye, Rohan; Das, Tilak; Majcher, Veronika; Fish, Brian; Casey, Ruth; Masterson, Liam

doi:10.1002/hed.27287

Cited by 6 publications

(3 citation statements)

References 109 publications

(331 reference statements)

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“…In about 6%-16% of cases, one or more parathyroid adenomas are in an ectopic position [17]. Intrathyroidal parathyroid adenoma is one of the possible ectopic variants, with an incidence of 0.7% to 6% between the ectopic parathyroid variants [18].…”

Section: Discussionmentioning

confidence: 99%

Ectopic Intrathyroidal Parathyroid Adenoma Presenting With Osteoporotic Fractures in a Young Man: A Case Report

Cosme,

Nobre,

Travessa

et al. 2023

Cureus

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Primary hyperparathyroidism (PHPT) can be associated with osteoporosis (OP) and fractures. We present a case of a 49-year-old male referred to our osteoporosis outpatient clinic due to a right femur osteoporotic fracture. At the age of 38, a right plantar nodular lesion was excised, and its histology was compatible with a deep dermis nodule formed by mononuclear and giant osteoclast-like cells. He has reported osteoporotic fractures since age 39 and renal colic episodes since age 45. His father had lipomas and renal colic episodes, and his paternal grandmother had lipomas. The laboratory evaluation was compatible with PHPT. A cervical ultrasound showed a 10mm single solid nodule in the left thyroid lobe, strongly hypoechogenic, with microcalcifications. Its cytology showed parathyroid tissue without atypia. Parathyroid scintigraphy had no uptake. A dual-energy X-ray absorptiometry scan showed a femoral neck Z-score of -4.3. He started alendronate/cholecalciferol (70mg/5600IU) weekly. He was submitted to a left hemithyroidectomy. Its histology showed an intrathyroidal parathyroid adenoma. Ectopic parathyroid adenomas are rare, of which 0.7%-6% are intrathyroidal. The excised foot lesion could be a brown tumour. Furthermore, calcium metabolism evaluation at that time might have allowed a PHPT diagnosis and its morbidity prevention. Osteoporotic fractures in young men must alert to secondary OP.

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Section: Discussionmentioning

confidence: 99%

Ectopic Intrathyroidal Parathyroid Adenoma Presenting With Osteoporotic Fractures in a Young Man: A Case Report

Cosme,

Nobre,

Travessa

et al. 2023

Cureus

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“…Radiological imaging, including neck ultrasound, computed tomography, and technetium sestamibi scan, are helpful in localization. Still, a definitive diagnosis typically needs histological examination through fineneedle aspiration or surgical biopsy (11,12).…”

Section: Clinical Features and Diagnosismentioning

confidence: 99%

An updated mini-review on parathyroid cancer

Pour

Khayyat

2023

J Parathyr Dis

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Parathyroid cancer is a rare malignancy originating from the parathyroid glands, which regulate calcium levels in the body. This review article aims to provide a comprehensive overview of parathyroid cancer, including its epidemiology, etiology, clinical presentation, diagnostic methods, treatment options, and prognosis. The article also highlights recent advancements in research and potential future directions for improving the management of this challenging disease.

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“…Inter-observer differences have been reported with concern to Tc-99m-based scintigraphy, but, generally, ultrasound is regarded as the most commonly recognised subject of pitfalls [25]. A higher rate of localisation failure was also described in ectopic intra-thyroid parathyroid adenomas [26]. Also, a lower PTH value at baseline is correlated with a negative finding at 99m-Tc scintigraphy; thus, in these cases a combination of several modalities is required from the start [27].…”

Section: Imaging Pitfalls In Phpmentioning

confidence: 99%

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Carsote,

Stanciu,

Popa

et al. 2023

Medicina

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Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95–99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation.

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Intrathyroidal parathyroid adenomas: Scoping review on clinical presentation, preoperative localization, and surgical treatment

Cited by 6 publications

References 109 publications

Ectopic Intrathyroidal Parathyroid Adenoma Presenting With Osteoporotic Fractures in a Young Man: A Case Report

Ectopic Intrathyroidal Parathyroid Adenoma Presenting With Osteoporotic Fractures in a Young Man: A Case Report

An updated mini-review on parathyroid cancer

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

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