Diagnostic Fine-Needle Aspiration Biopsy of an Intrathyroidal Parathyroid Gland and Subsequent Eucalcemia in a Patient with Primary Hyperparathyroidism |
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| Affiliation: | 1. Division of Endocrinology, Diabetes, and Metabolism, Ohio State University, Columbus, Ohio;2. Geisinger Health System, Department of Otolaryngology-Head and Neck Surgery, Danville, Pennsylvania.;1. Patras University School of Medicine, Patras, Greece;2. Aiginiteio University Hospital, Athens University School of Medicine, Athens, Greece;3. Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece;4. Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, London, UK;5. First Department of Cardiology, Athens University School of Medicine, Athens, Greece;1. Department of Oral and Maxillofacial Surgery, Ewha Womans University, Seoul, Republic of Korea;2. Clinical Trial Center, Ewha Womans University, Seoul, Republic of Korea;3. Department of Oral and Maxillofacial Surgery, Yonsei University, Seoul, Republic of Korea |
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| Abstract: | ObjectiveTo present the clinical course of a patient with persistent primary hyperparathyroidism (PHPT) whose intrathyroidal parathyroid gland was diagnosed by ultrasound-guided fine-needle aspiration biopsy (FNAB).MethodsWe describe the clinical course and laboratory, radiographic, and microscopic findings of a patient with persistent PHPT due to an intrathyroidal cystic parathyroid gland and review the relevant literature.ResultsA 74-year-old man with PHPT (presenting serum calcium concentration, 16.2 mg/dL; intact parathyroid hormone [PTH] concentration, 341 pg/mL) had surgical excision of the right superior, right inferior, and left inferior parathyroid glands, but the left superior parathyroid gland remained unidentified. Microscopic examination revealed parathyroid hyperplasia. Technetium Tc 99m sestamibi single-photon emission computed tomography imaging showed uptake in 2 foci, 1 on each side of midline in the neck. Reoperation with attention to the left neck failed to locate another parathyroid gland. Neck ultrasonography demonstrated a complex nodule within the right lower lobe of the thyroid. Results from FNAB of the solid component were consistent with parathyroid cells, and cystic fluid PTH concentration was greater than 1800 pg/mL. Nine months later, neck ultrasonography showed a hypoechoic area located posterior to the inferior pole of the right thyroid. The patient remained eucalcemic 16 months postprocedure.ConclusionAutoinfarction of the parathyroid gland and aspiration of cystic fluid may explain resolution of hypercalcemia. Although PHPT due to functioning parathyroid cysts is rare, and PHPT due to cystic parathyroid hyperplasia has been described, this is the first case report of a patient with persistent PHPT due to a functional parathyroid cyst whose diagnosis by FNAB was followed by eucalcemia. (Endocr Pract. 2008;14:80-86) |
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