Presentation
Hypercalcemia with increased parathyroid hormone level - i.e. primary hyperparathyroidism.
Patient Data
Well-defined mildly lobulated extra thyroidal hypoechoic solid lesion measuring 24.3 x 15.9 x 9.0 mm near the inferior pole of the right thyroid lobe, medial to the common carotid artery. Mild peripheral and internal vascularity were seen.
Given the history of primary hyperparathyroidism, the above findings are likely due to parathyroid adenoma (Sestamibi scan suggested for confirmation).
There is 8.1 x 9.1mm well-defined mildly lobulated heterogeneous hypoechoic solid lesion, taller than wider in the lower pole of the right lobe of the thyroid. A few tiny echogenic foci are seen within it - TR5 lesion (FNAC is suggested).
No significant cervical lymphadenopathy was seen.
Sestamibi scan
Technetium MIBI uptake by the thyroid gland at 20 minutes is reduced. An area of focal increased tracer concentration noted at the level of lower pole of right lobe of thyroid.
Delayed 2 hour image shows adequate washout of tracer from both lobes of thyroid gland; however, there is persistent tracer holdup at the level of lower pole of right lobe of thyroid.
IMPRESSION: Scan features are suggestive of parathyroid adenoma at the level of lower pole of right lobe of thyroid gland.
The FNAC from the right thyroid lobe lesion was done and the report was suspicious for papillary carcinoma (Bethesda category 5).
Case Discussion
Parathyroid adenoma with incidental finding of papillary carcinoma of the thyroid.
Co-authors:
Dr. Mrityunjay kumar Singh, MD (Medicine)
Dr. Ravishwar Narayan, MD (Nuclear medicine).