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Case Report
Parathyroidectomy guided by intraoperative parathyroid hormone monitoring in a case of parathyroid hyperplasia
1 Post Graduate Intern, Thumbay Labs, Gulf Medical University, Ajman, United Arab Emirates
2 Assistant Professor and Specialist Pathology, Gulf Medical University, Ajman, United Arab Emirates
3 Anatomic Pathology Specialist and Lecturer, Thumbay Labs, Gulf Medical University, Ajman, United Arab Emirates
Address correspondence to:
Lena Abdu Baset Labania
Gulf Medical University, Ajman,
United Arab Emirates
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Article ID: 101139Z01MH2020
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Hussain MN, Labania LAB, Hassanein EHI, Bylappa SK. Parathyroidectomy guided by intraoperative parathyroid hormone monitoring in a case of parathyroid hyperplasia. Int J Case Rep Images 2020;11:101139Z01MH2020.ABSTRACT
Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disorder of the parathyroid glands, characterized by excessive production of parathyroid hormone by one or more of the parathyroid glands, causing hypercalcemia. The cause is usually an abnormal group of cells forming a benign parathyroid adenoma, hyperplasia, or, rarely, a carcinoma. Primary hyperparathyroidism is typically diagnosed by routine serum chemistry analysis showing hypercalcemia, hypophosphatemia, and elevated parathyroid hormone (PTH) level.
Case Report: A case report of a 54-year-old female who presented with pain, swelling, and itching in the front of the neck for few months. Laboratory investigations revealed sustained hypercalcemia and gradually elevating PTH level. Computed tomography (CT) scan showed multiple hypo-enhancing thyroid nodules in both lobes. Ultrasonography (USG) showed an enlarged thyroid gland with multiple variable-sized cystic to spongiform nodules suggesting multinodular colloid goiter. Total thyroidectomy with right superior parathyroidectomy was done. Intraoperative PTH level monitoring showed markedly decreased level. Microscopically, fat tissue was present throughout the sections, no compressed tissue at the periphery, few chief and oxyphil (oncocytic) cells were seen.
Conclusion: These findings were most consistent with parathyroid hyperplasia. However, PTH level decreased immediately after surgery for >50% (Miami or “>50% intraoperative PTH drop” criterion). It can be either due to parathyroid adenoma or single gland hyperplasia. Thus, it could be challenging to distinguish between parathyroid adenoma and hyperplasia. Correct diagnosis is achieved only after correlating the pathologic findings with the clinical setting and biochemical results and it is advised for long-term follow-up with PTH level in cases of hyperplasia.
Keywords: Adenoma, Hypercalcemia, Hyperparathyroidism, Hyperplasia, Parathyroid hormone
SUPPORTING INFORMATION
Author Contributions
Maryam Nasir Hussain - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Lena Abdu Baset Labania - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Eman Hassan Ibrahim Hassanein - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Sunil Kumar Bylappa - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Maryam Nasir Hussain et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
