Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation
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±èÈ£¼ö(Kim Ho-Su) - Gyeongsang National University School of Medicine Department of Internal Medicine
ÃÖºÀȸ(Choi Bong-Hoi) - Gyeongsang National University School of Medicine Department of Nuclear Medicine
¹ÚÁ¤¶û(Park Jung-Rang) - Gyeongsang National University School of Medicine Department of Internal Medicine
ÇÔÁ¾·Ä(Hahm Jong-Ryeal) - Gyeongsang National University School of Medicine Department of Internal Medicine
Á¤Á¤È(Jung Jung-Hwa) - Gyeongsang National University School of Medicine Department of Internal Medicine
±è¼ö°æ(Kim Soo-Kyoung) - Gyeongsang National University School of Medicine Department of Internal Medicine
±è¼º¼ö(Kim Sung-Su) - Gyeongsang National University School of Medicine Department of Internal Medicine
±è°æ¿µ(Kim Kyong-Young) - Gyeongsang National University School of Medicine Department of Internal Medicine
Á¤¼øÀÏ(Chung Soon-Il) - Gyeongsang National University School of Medicine Department of Internal Medicine
Á¤Å½Ä(Jung Tae-Sik) - Gyeongsang National University School of Medicine Department of Internal Medicine
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.
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Parathyroid neoplasms, Thyroid nodule, Thyroid ultrasonography
KMID :
0356620130280030231
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À¯È¿¼º°á°ú(Recomendation)
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.