Citation Information :
Scheidt M, Hubbs D, Kabaker A, De Jong S. Completely Intrathyroidal Parathyroid Adenoma in a Patient with a Previously Failed Cervical Exploration. World J Endoc Surg 2020; 12 (3):136-139.
Aim: This case report highlights the importance of preoperative imaging and the clinical considerations a surgeon must have intraoperatively while searching for an ectopic parathyroid adenoma.
Background: Primary hyperparathyroidism is a disorder of autonomous function of either one or multiple parathyroid glands. Definitive treatment requires resection of the autonomous gland. Resection at the initial operation is important as reoperative patients are at a higher risk of having complications. Ectopic locations of parathyroid glands are common with a reported incidence of 6–22%. Due to the greater embryonic migration distance of the inferior parathyroid glands, they have greater anatomic variation compared to the superior glands and are often more difficult to identify. True intrathyroidal parathyroid adenomas are a rare subset of ectopic parathyroids that must be considered when a parathyroid adenoma cannot be identified.
Case: A rare case of a completely intrathyroidal parathyroid adenoma in a patient with a previously failed cervical neck exploration.
Conclusion: This case demonstrates that in the setting of inconclusive imaging, one\'s clinical acumen, and anatomical and embryologic knowledge must be utilized in a systematic approach to identifying parathyroid adenomas. After other ectopic locations are excluded, a thyroid lobectomy should be considered to treat a completely intrathyroidal parathyroid adenoma.
Clinical significance: Anatomical variation should always be accounted for when faced with a missing parathyroid gland.
Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands. Surgery 1984;95(1):14–21.
Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol 2007;188(6):1706–1715. DOI: 10.2214/AJR.06.0938.
Solorzano CC, Carneiro-Pla D. Minimizing cost and maximizing success in the preoperative localization strategy for primary hyperparathyroidism. Surg Clin North Am 2014;94(3):587–605. DOI: 10.1016/j.suc.2014.02.006.
Wang C. The anatomic basis of parathyroid surgery. Ann Surg 1976;183(3):271–275. DOI: 10.1097/00000658-197603000-00010.
Carter WB, Carter DL, Cohn HE. Cause and current management of reoperative hyperparathyroidism. Am Surg 1993;59(2):120–124.
Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2006;191(3):418–423. DOI: 10.1016/j.amjsurg.2005.10.049.
Roy M, Mazeh H, Chen H, et al. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg 2013;37(1):102–106. DOI: 10.1007/s00268-012-1773-z.
Bahar G, Feinmesser R, Joshua B, et al. Hyperfunctioning intrathyroid parathyroid gland: a potential cause of failure in parathyroidectomy. Surgery 2006;139(6):821–826. DOI: 10.1016/j.surg.2005.11.009.
Feliciano DV. Parathyroid pathology in an intrathyroidal position. Am J Surg 1992;164(5):496–500. DOI: 10.1016/s0002-9610(05)81188-2.
Goodman A, Politz D, Lopez J, et al. Intrathyroid parathyroid adenoma: incidence and location--the case against thyroid lobectomy. Otolaryngol Head Neck Surg 2011;144(6):867–871. DOI: 10.1177/0194599811400366.
McIntyre Jr RC, Eisenach JH, Pearlman NW, et al. Intrathyroidal parathyroid glands can be a cause of failed cervical exploration for hyperparathyroidism. Am J Surg 1997;174(6):750–754. DOI: 10.1016/s0002-9610(97)00190-6.
Proye C, Bizard JP, Carnaille B, et al. Hyperparathyroidism and intrathyroid parathyroid gland. 43 cases. Ann Chir 1994;48(6):501–506.
Wang C. Hyperfunctioning intrathyroid parathyroid gland: a potential cause of failure in parathyroid surgery. J R Soc Med 1981;74(1):49–52. DOI: 10.1177/014107688107400109.
Agarwal G, Prasad KK, Kar DK, et al. Indian primary hyperparathyroidism patients with parathyroid carcinoma do not differ in clinicoinvestigative characteristics from those with benign parathyroid pathology. World J Surg 2006;30(5):732–742. DOI: 10.1007/s00268-005-0366-5.
Erovic BM, Harris L, Jamali M, et al. Biomarkers of parathyroid carcinoma. Endocr Pathol 2012;23(4):221–231. DOI: 10.1007/s12022-012-9222-y.
Fitko R, Roth SI, Hines JR, et al. Parathyromatosis in hyperparathyroidism. Hum Pathol 1990;21(2):234–237. DOI: 10.1016/0046-8177(90)90136-s.
Kim J, Horowitz G, Hong M, et al. The dangers of parathyroid biopsy. J Otolaryngol Head Neck Surg 2017;46(1):4–7. DOI: 10.1186/s40463-016-0178-7.
Cheung K, Wang TS, Farrokhyar F, et al. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol 2012;19(2):577–583. DOI: 10.1245/s10434-011-1870-5.
Dasgupta DJ, Navalkissoor S, Ganatra R, et al. The role of single-photon emission computed tomography/computed tomography in localizing parathyroid adenoma. Nucl Med Commun 2013;34(7):621–626. DOI: 10.1097/MNM.0b013e3283617d5b.
Yordanova A, Mahjoob S, Lingohr P, et al. Diagnostic accuracy of [(99m)Tc]Tc-Sestamibi in the assessment of thyroid nodules. Oncotarget 2017;8(55):94681–94691. DOI: 10.18632/oncotarget.21866.