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.
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