Hyperparathyroidism by Ann E. Kearns & Robert A. Wermers

Author:Ann E. Kearns & Robert A. Wermers
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Management

The patient underwent parathyroid subtraction imaging with single-photon emission computed tomography (SPECT) views. The images showed uptake in area of the right thyroid bed, which are shown to be more anterior in the pretracheal area on SPECT (Figs. 11.1 and 11.2). A neck ultrasound showed multiple nodules in the neck (Fig. 11.3). There were a 9-mm nodule in the right thyroid bed and a 1.3-cm nodule inferior to the left lobe of the thyroid, both corresponding to the abnormalities seen on the parathyroid scan. There were three nodules within the left thyroid gland (the right lobe was surgically absent) with the largest measuring 1.8 cm. There were two nodules felt to be enlarged lymph nodes located pretracheal within the subcutaneous tissue, the measuring 1.2 cm and 0.7 cm. There was also a small superficial “lymph node” superficial to the left lobe of the thyroid gland measuring 5 mm. The largest thyroid nodule and one of the large lymph nodes underwent fine needle aspiration biopsy. The thyroid nodule biopsy was nondiagnostic, and the pretracheal nodule was neoplastic with a reported differential of parathyroid versus follicular versus medullary. A vocal cord assessment was normal. Neck exploration was recommended for removal of the multiple implants and a completion thyroidectomy because of the nondiagnostic biopsy and history of external radiation.

Fig. 11.1Parathyroid subtraction imaging showing uptake in the pretracheal region

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