Intrathyroidal parathyroid glands: Small, but mighty (a Napoleon phenomenon)

Mazeh, Haggi; Kouniavsky, Guennadi; Makris, Konstantinos I.; Sippel, Rebecca S.; Dackiw, Alan P.B.; Chen, Herbert; Zeiger, Martha A.

doi:10.1016/j.surg.2012.08.026

Cited by 46 publications

(49 citation statements)

References 20 publications

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“…However, ectopic PT within the thyroid gland can be difficult to recognize, as both are neuroendocrine glands and show similar cytologic features . About 30% of these ectopic nodules are asymptomatic, and clinical and radiologic identification may also be difficult. When misidentified, sampling of intrathyroidal PT is often considered to show potentially atypical thyroid follicular cells, which have been classified in case studies using The Bethesda System for Reporting Thyroid Cytology (TBSRTC) as suspicious for follicular neoplasm (SFN, Bethesda category IV), and even suspicious for papillary carcinoma (Bethesda category V) …”

Section: Introductionmentioning

confidence: 99%

Identification of parathyroid tissue in thyroid fine‐needle aspiration: A combined approach using cytology, immunohistochemical, and molecular methods

Domingo¹,

Ogden²,

Been³

et al. 2017

Diagnostic Cytopathology

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Cytologic features, coupled with IHC, can identify intrathyroidal PT cells in the majority of CytoLyt samples. However, a significant minority (22%) of these FNAs may be misclassified as indeterminate by TBSRTC criteria, and molecular detection of the PT tissue can be helpful to potentially avoid an additional biopsy or diagnostic surgery. Diagn. Cytopathol. 2017;45:526-532. © 2017 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Identification of parathyroid tissue in thyroid fine‐needle aspiration: A combined approach using cytology, immunohistochemical, and molecular methods

Domingo¹,

Ogden²,

Been³

et al. 2017

Diagnostic Cytopathology

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“…P rimary hyperparathyroidism is a common endocrine disease, and more than 80% of patients have solitary adenomas, which cause long-term and excess secretion of parathyroid hormone (PTH) (1,2). Its prevalence increases with old age, and it is more common in women (3).…”

Section: Introductionmentioning

confidence: 99%

Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

Kaya

Tam

Dirikoç

et al. 2016

Arch. Endocrinol. Metab.

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Objective: Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and it may extend hospitalization durations. The purpose of this study is to determine the predictive factors related to the development of hypocalcemia and hungry bone syndrome (HBS) in patients who underwent parathyroidectomy for PHP. Materials and methods: Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD, albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1 st and 4 th days postoperatively, and in the 6 th postoperative month, and their neck ultrasound (US) and bone densitometry data were also recorded. Results: Hypocalcemia was seen in 63 patients (38.4%) on the 1 st day after parathyroidectomy. Ten patients (6.1%) had permanent hypocalcemia in the 6 th month after surgery. Out of the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP, and BUN values were higher in those patients who developed HBS. Furthermore, HBS was more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who underwent thyroidectomy simultaneously with parathyroidectomy. Conclusions: As a result, patients who have the risk factors for development of hypocalcemia and HBS should be monitored more attentively during the perioperative period. Arch Endocrinol Metab.2016;60(5):

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“…According to a previous large series, intrathyroidal PAs account for 1% of all PAs [5]. Cystic intrathyroidal PAs are even rarer, with a few cases described in the literature so far [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Intrathyroidal parathyroid adenoma mimicking thyroid cancer

et al. 2020

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Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia; patients are usually asymptomatic and the cause in 80-85% of cases is a single parathyroid adenoma (PA). Parathyroid adenomas arise from clonal expansion of tumor cells and may be located either posteriorly to the thyroid lobes or in ectopic sites. The incidence of intrathyroidal PAs varies from 1% to 6% and although uncommon, they pose certain diagnostic difficulties which may complicate treatment. The identification of the adenoma requires a combination of clinical evidence, imaging information and cytological findings due to the challenging distinction between thyroid and parathyroid lesions. We present the case of a patient with a large, partially cystic intrathyroidal parathyroid adenoma which was initially identified as a malignant thyroid nodule. We discuss the caveats that present in these rare cases and the important clinical and histological features that aid in the final diagnosis. In the case of our patient the cytological similarities between thyroid malignant cells and parathyroid cells, in combination with the negative sestamibi scan, resulted in a more invasive surgery than that a single parathyroid adenoma would require. Clinicians need to be vigilant in terms of the similarities between parathyroid and thyroid cytology in order to provide optimal patient care in these rare cases.

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Intrathyroidal parathyroid glands: Small, but mighty (a Napoleon phenomenon)

Cited by 46 publications

References 20 publications

Identification of parathyroid tissue in thyroid fine‐needle aspiration: A combined approach using cytology, immunohistochemical, and molecular methods

Identification of parathyroid tissue in thyroid fine‐needle aspiration: A combined approach using cytology, immunohistochemical, and molecular methods

Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

Intrathyroidal parathyroid adenoma mimicking thyroid cancer

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