Abstract
We report two patients with incidentally discovered enlarged parathyroid glands while performing neck ultrasonography (US) for thyroid nodules. The parathyroid masses were seen as hy-poechoic, homogeneous, oval nodules, separated from the thyroid gland. Both patients were completely asymptomatic, although subclinical evidence of hyperparathyroidism (serum PTH and calcium levels in the upper limit of the normal range, increased ionized serum calcium, osteocalcin, urinary calcium and hydroxyproline) was subsequently found in one patient. An enhanced uptake on ses-ta-MIBI scinti scan was concordant with the US finding in the two cases. PTH levels in the wash-out from the US-guided fine needle aspiration biopsy, confirmed the parathyroid origin of the lesions. Cytology and immunocitochemistry were, in our cases, unreliable diagnostic procedures. The extensive use of US imaging in thyroid pathology may increase the finding of US incidentally discovered parathyroid adenomas. The early detection of silent parathyroid pathologic findings may extend the natural history of these masses to a preclinical stage. Further investigations are necessary to evaluate the evolution of parathyroid incidentalomas and therefore their clinical significance.
Similar content being viewed by others
References
Tan G.H., Gharib H. Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann. Intern. Med. 1997, 126:226–231.
Attie J.N., Estrin J., Khafif R.A., Dweck F. Parathyroid adenomas discovered incidentally during explorations of the thyroid. Am. J. Surg. 1967, 114: 538–542.
Katz A.D., Kong LB. Incidental preclinical hyperparathyroidism identified during thyroid operations. Am. Surg. 1992, 58:747–749.
Camaille B.M., Pattou F.N., Oudar C, Lecomte-Houcke M.C., Rocha J.E., Proye C.A. Parathyroid incidentalomas in normocalcemic patients during thyroid surgery. World J. Surg. 1996, 20: 830–834.
Gofrit O.N., Lebensart P.D., Pikarsky A., Lackstein D., Gross D.J., Shiloni E. High resolution ultrasonography: highly sensitive, specific technique for preoperative localization of parathyroid adenoma in the absence of multinodular thyroid disease. World J. Surg. 1997,21:287–291.
Moreau J.F. Parathyroid glands. In: Bruneton J.N. Ultrasonography of the neck. Springer-Verlag, Berlin Heidelberg, 1987, 51–63.
Tikkakoski T., Stenfors L.E., Typpö T., Lohela P., Sarkkinen M.A. Parathyroid adenomas: pre-operative localization with ultrasound combined fine-needle biopsy. J. Laryngol. Otol. 1993, 107: 543–545
Sacks B.A., Pallotta J.A., Cole A., Hurwitz J. Diagnosis of parathyroid adenomas: efficacy of measuring parathormone levels in needle aspirates of cervical masses. Am. J. Roentgenol. 1994, 163: 1223–1226.
Consensus Development Conference Panel. Diagnosis and management of asymptomatic primary hyperparathyroidism: consensus development conference statement. Ann. Intern. Med. 1991, 114:593–597.
Bruneton J.N., Laurent F., Chevallier P., Drouillard J. Imagerie non isotopique des parathyroïdes. In: Bruneton J.N., Padovani B. (Eds.), Imagerie en endocrinologie. Masson, Paris, 1996, 84–94.
Molitch M.E., Rüssel E.J. The pituitary incidentaloma. Ann. Intern. Med. 1990, 112:925–931.
Copeland P.M. The incidentally discovered adrenal mass. Ann. Intern. Med. 1983, 98:940–945.
Al Zaharani A., Levine M.A. Primary hyperparathyroidism. Lancet 1997, 349:1233–1238.
Bardet S., Rohmer V., Murat A., Guillemot C, Mar’echaud R., Chupin M., Lecomte P., Simon D., Delemer B., Schneebelli S., Beutter D., Jacquin V., Peltier P., Charbonnel B. 1311-6 •-lodomethylnorcholesterol scintigraphy: an assessment of its role in the investigation of adrenocortical incidentalomas. Clin. Endocrinol. 1996, 44: 587–596.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pesenti, M., Frasoldati, A., Azzarito, C. et al. Parathyroid incidentaloma discovered during thyroid ultrasound imaging. J Endocrinol Invest 22, 796–799 (1999). https://doi.org/10.1007/BF03343646
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03343646