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Open access

Deep Dutta, Chitra Selvan, Manoj Kumar, Saumik Datta, Ram Narayan Das, Sujoy Ghosh, Satinath Mukhopadhyay and Subhankar Chowdhury

Summary

Parathyroid cysts are rare (0.8–3.41% of all parathyroid lesions) and usually arise secondary to cystic degeneration of parathyroid adenomas. Intrathyroidal parathyroid cysts are extremely rare with only three cases reported till date. We present a 24-year-old female with clinical and biochemical features of primary hyperparathyroidism (PHPT; Ca2 +: 12.1 mg/dl; intact parathyroid hormone (iPTH): 1283 pg/ml) and poor radiotracer uptake with minimal residual uptake in the left thyroid lobe at 2 and 4 h on Tc99m sestamibi imaging. Neck ultrasonography (USG) revealed 0.6×1 cm parathyroid posterior left lobe of thyroid along with 22×18 mm simple thyroid cyst. USG-guided fine-needle aspiration (FNA) and needle tip iPTH estimation (FNA-iPTH) from parathyroid lesion was inconclusive (114 pg/ml), necessitating FNA of thyroid cyst, which revealed high iPTH (3480 pg/ml) from the aspirate. The patient underwent a left hemithyroidectomy. A >50% drop in serum iPTH 20 min after left hemithyroidectomy (29.4 pg/ml) along with histopathology suggestive of intrathyroidal cystic parathyroid adenoma (cystic lesion lined by chief cell variant parathyroid cells without any nuclear atypia, capsular or vascular invasion surrounded by normal thyroid follicles) confirmed that the parathyroid cyst was responsible for PHPT. This report highlights the importance of FNA-iPTH in localizing and differentiating a functional parathyroid lesion from nonfunctional tissue in PHPT.

Learning points

  • Fine-needle aspiration from suspected parathyroid lesion and needle tip iPTH (FNA-iPTH) estimation from the saline washing has an important role in localizing primary hyperparathyroidism (PHPT).
  • FNA-iPTH estimation may help in differentiating functional from nonfunctional parathyroid lesion responsible for PHPT.
  • iPTH estimation from aspirate of an intrathyroid cyst is helpful in differentiating intrathyroidal parathyroid cyst from thyroid cyst.

Open access

Sachiko-Tsukamoto Kawashima, Takeshi Usui, Yohei Ueda, Maiko-Kakita Kobayashi, Mika Tsuiki, Kanako Tanase-Nakao, Kazutaka Nanba, Tetsuya Tagami, Mitsuhide Naruse, Yoshiki Watanabe, Ryo Asato, Sumiko Kato and Akira Shimatsu

Background Parathyroid cysts causing primary hyperparathyroidism are uncommon (1) (2) . Parathyroid cystic adenomas are often misdiagnosed as thyroid cysts, even in the case of elevated parathyroid hormone (PTH) levels, and especially with

Open access

Alejandro García-Castaño, Leire Madariaga, Sharona Azriel, Gustavo Pérez de Nanclares, Idoia Martínez de LaPiscina, Rosa Martínez, Inés Urrutia, Aníbal Aguayo, Sonia Gaztambide and Luis Castaño

calcium excretion and inappropriately normal or mildly elevated parathyroid hormone (PTH) concentrations. This disorder is caused by heterozygous loss-of-function mutations in the CASR gene (OMIM +601199) encoding the human calcium-sensing receptor (CaSR

Open access

Marta Araujo Castro, Ainhoa Abad López, Luz Martín Fragueiro and Nuria Palacios García

the lesion, the intraoperative PTH dropped from 752 to 70 pg/mL. Prophylactic administration of calcium and calcitriol was initiated, and the calcemia reached a nadir of 8.3 mg/dL at 24 h of surgery. There were no difficulties for the management of

Open access

K Nadarasa, M Bailey, H Chahal, O Raja, R Bhat, C Gayle, A B Grossman and M R Druce

, polydipsia, constipation and lethargy. On examination, a 3 cm mass was palpable in the right side of her neck. Biochemistry showed a corrected calcium level of 3.4 mmol/l (normal range, 2.15–2.65) and a PTH level of 53 pmol/l (normal range, 1.6–6.9). Both an

Open access

Benjamin Kwan, Bernard Champion, Steven Boyages, Craig F Munns, Roderick Clifton-Bligh, Catherine Luxford and Bronwyn Crawford

inappropriately normal PTH. To date, more than 70 mutations have been reported in association with ADH1 ( 1 ). Treatment with activated vitamin D analogues and calcium should be reserved for symptomatic patients, due to the risk of hypercalciuria and severe

Open access

Kirun Gunganah, Ashley Grossman and Maralyn Druce

drugs, gallstones, corticosteroids, excess alcohol and hypertriglyceridaemia were excluded. However, she was noted to have an elevated calcium level, which was thought to be the cause of her pancreatitis. As her parathyroid hormone (PTH) level was

Open access

Peter Novodvorsky, Ziad Hussein, Muhammad Fahad Arshad, Ahmed Iqbal, Malee Fernando, Alia Munir and Sabapathy P Balasubramanian

Background Primary hyperparathyroidism (PHPT) is characterised by excess parathyroid hormone (PTH) secretion arising mostly from one or more autonomously functioning parathyroid adenomas (up to 85%), parathyroid hyperplasia (<15%), and in 1

Open access

Aisling McCarthy, Sophie Howarth, Serena Khoo, Julia Hale, Sue Oddy, David Halsall, Brian Fish, Sashi Mariathasan, Katrina Andrews, Samson O Oyibo, Manjula Samyraju, Katarzyna Gajewska-Knapik, Soo-Mi Park, Diana Wood, Carla Moran and Ruth T Casey

Background Primary hyperparathyroidism is characterised by hypercalcaemia in the context of a raised or inappropriately normal PTH. It is important to note that the physiological changes of pregnancy can mask its diagnosis, as hypoalbuminaemia

Open access

Jingjing Jiang, Mei Zhang, Ronghua He, Meiping Shen and Wei Liu

.5–7.5). PTH (1–84) was 576 pg/ml (normal, 10–69), and osteocalcin 63.8 μg/l (normal, 11–43). Thyroid-stimulating hormone was 1.9 mIU/l (normal, 0.3–4.2), free thyroxine was 13.6 pmol/l (normal, 12.0–22), free triiodothyronine was 3.7 pmol/l (normal, 3