A 58-year-old man presented with hypercalcemia caused by primary hyperparathyroidism (PTH: 290 ng/l). Imaging was performed for allocation of parathyroid adenoma. Ultrasonography (US) showed multinodular goiter with a large (4.5-cm diameter), hypoechoic, inhomogeneous, unsharp nodule caudally in the right lobe, representing potential criteria of malignancy. Caudodorsally, a small (1.5-cm diameter) hypoechoic lesion was detected with no further malignant signs whereby the differentiation toward the thyroid was sonomorphologically vague, leaving a marginal thyroid nodule or an enlarged parathyroid gland as potential differential diagnoses.
99mTc-pertechnetate scintigraphy proved both nodules to be hypofunctional (Fig.
99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy (Fig.
1b) and single-photon emission computed tomography (SPECT; not shown) demonstrated a great area of reduced uptake in the right caudal part but a slight spot caudodorsally, which showed no correlation on
Thyroid Cancer Goiter Thyroid Nodule Primary Hyperparathyroidism Parathyroid Adenoma
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The authors declare that they have no conflict of interest.
Supplementary material 1 (WMV 5114 kb). Supplement 1: Magnetic sensor-navigated 99mTc-MIBI SPECT/US of right thyroid lobe, sagittal sweep from lateral to medial. The hypoechoic, MIBI-positive parathyroid adenoma caudodorsally is marked with a yellow arrow
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