Background
Methods
Results
Patients
Characteristic | Patient | |||||||
---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | ||
Gender | F | F | F | F | M | F | F | |
Age, years | 56 | 34 | 57 | 54 | 52 | 50 | 49 | |
Reason | Thyroid nodule follow-up. | Bone pain (mainly right upper limb) for half a year. | Thyroid nodule follow-up. | Thyroid nodule follow-up. | Thyroid and parathyroid nodule during annual examination | Thyroid nodule follow-up. | Thyroid nodule follow-up. | |
History | No history of radiation exposure | ·Lobectomy history (Left lobe-thyroid adenoma).·Brown tumor.·No history of radiation exposure | No history of radiation exposure | No history of radiation exposure | No history of radiation exposure | No history of radiation exposure | No history of radiation exposure | |
Preoperative biochemistry | ||||||||
Calcium, mg/dL | 2.65 | 3.63 | 2.66 | 3.01 | 2.75 | 2.51 | 2.98 | |
Phosphate, mg/dL | 1.15 | 0.98 | 1.34 | 0.87 | – | 0.95 | 0.75 | |
Parathyroid hormone, pg/mL | 189.9 | 769.2 | 57.99 | 164.3 | 114.9 | 86.87 | 425 | |
Ultrasound features | ||||||||
Number | 1 | 2 | 1 | 1 | 1 | 1 | 1 | |
Echo | Hypoechoic/Homogeneous/Calcification | Hypoechoic/Homogeneous | Hypoechoic/Heterogeneous | Hypoechoic/Heterogeneous | Hypoechoic/Heterogeneous | Hypoechoic/Homogeneous | Hypoechoic/Homogeneous | Hypoechoic/Homogeneous/Calcification |
Size | 10 mm × 6 mm | 12 mm× 8 mm | 22 mm × 15 mm × 32 mm | 21 mm × 10 mm× 5 mm | 16 mm× 9 mm | 23 mm × 9 mm | 12 mm × 7 mm | 7.5 mm × 7.2 mm |
Location | Posterior to the right thyroid lobe, lower pole | Inferior pole of the right thyroid lobe, adjacent to the trachea | Zone of left thyroid lobe | Near the upper pole, posterior to the right thyroid lobe | Inferior pole of the left thyroid lobe | Posterior to the middle right thyroid lobe, adjacent to the trachea | Near the superior pole of the right thyroid lobe | Inferior pole of the left thyroid lobe |
Form | regular | regular | irregular | regular | regular | regular | regular | irregular |
Border | clear | unclear | unclear | clear | clear | clear | clear | clear |
Blood | II | III | III | III | III | III | III | III |
Elastography | 1 | 2 | 2 | – | – | – | – | 3 |
Other | Hypoechoic thyroid nodule measuring 8.6 mm × 9.1 mm to the upper pole of left lobe with irregular form, unclear border, calcification, a little blood. Elastography grade: 4. | Several hypoechoic thyroid nodules and cysts in the right lobe. | Hypoechoic thyroid nodule measuring 5.9 mm× 6.8 mm in the middle of right lobe next to the anterior membrane, taller-than-wide, irregular form, unclear border. No blood detected. | Hypoechoic thyroid nodule measuring 14 mm× 6 mm in the left lobe with irregular form, unclear border, micro-calcification, a little blood. | Several small (Diameter 3 mm to 10 mm) hypoechoic thyroid nodules highly suspicious malignant according to the ATA 2015 guideline. | Hypoechoic thyroid nodule measuring 11 mm × 7 mm near the inferior pole of the left thyroid lobe with irregular form, unclear border, micro-calcification, a little blood. Elastography grade: 4. Other two nodules of very low suspicious. | Several hypoechoic and mixed echo thyroid nodules in both lobes. The biggest one in the right lobe was in size of 23 mm× 16 mm with irregular form, unclear border, arc-like calcification, a little blood. | |
99mTc-MIBI or CT features | – | Cervical CT: Right lobe nodules, left side lesion suspicious series from parathyroid | – | 99mTc-MIBI: Highly suspicious of left side parathyroid adenoma. | – | 99mTc-MIBI: Suspicious of left side PHPT.Cervical CT: Nodule in the left lobe of malignant suspicious. Nodule inferior to the right lobe can not excepted the possibility of parathyroid original. | Cervical CT: Multiple nodules in both thyroid lobes. |
Ultrasound
CT and 99Tcm-MIBI SPECT
Patient | 1 | 2 | 3 | 4 | 5 | 6 | 7 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Characteristics | Th | Pth | Th | Pth | Th | Pth | Th | Pth | Th | Pth | Th | Pth | Th | Pth | |
Findinga | US | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ |
CT | – | – | √ | √ | – | – | – | – | – | – | √ | √ | √ | × | |
MIBI | – | – | – | – | – | – | × | √ | – | – | × | √ | – | – | |
Diagnosisa | US | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | √ | × |
CT | – | – | √ | Suspiciousb | – | – | – | – | – | – | √ | Cannot except the possibilityc | √ | × | |
MIBI | – | – | – | – | – | – | × | √ | – | – | × | Suspicious | – | – |
Pathological results and surgical managements
Characteristics | Patient | |||||||
---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | ||
Intraoperative findings | Lesion A1 in the left thyroid lobe, toughLesion A2 (about 1 cm) posterior to the right thyroid lobe, soft | Lesion B1 (2x3cm) in the left thyroid zone, adherence to adjacent tissueLesion B2 inferior pole of the right thyroid lobeLesion B3 in the right thyroid lobe | Lesion C1 in the right thyroid lobe, toughLesion C2 posterior to the right thyroid lobe | Lesion D1 in the left thyroid lobe, toughLesion D2 (about 1 cm) posterior to the left thyroid lobe, soft | Several nodules in both thyroid lobe, toughMultiple enlarged lymph nodes in the cervical central regionLesion E posterior to the right thyroid lobe | Lesion F1 in the left thyroid lobe, toughLesion F2 (about 1 cm) posterior to the left thyroid lobe | Lesion G1 (2.5 cm) in the right thyroid lobe, toughLesion G2 (4 cm) in the left thyroid lobe | |
Section frozen results | Lesion A1: PTCLesion A2: Parathyroid adenoma | Lesion B1: Wait for final pathologic resultLesion B2: Parathyroid adenomaLesion B3: PTMC (about 0.3 cm) | Lesion C1: PTC (0.4 cm)Lesion C2: Highly suspected parathyroid adenoma, wait for final pathologic result | Lesion D1: PTC (1.3 × 1 × 0.6 cm)Lesion D2: Parathyroid adenoma | Lesion E: Parathyroid adenomaBoth thyroid lobe: Multi-focal PTC (3 in the left, 1 in the right) | Lesion F1: PTC(0.5 cm)Lesion F2: Parathyroid adenoma | Lesion G1: PTC(2 × 1.5x1cm)Lesion G2: Thyroid adenoma with cystic degeneration and interstitial fibrosis; Suspected parathyroid carcinoma, wait for final pathologic result | |
Surgical approach | Left thyroid lobectomy + Dissection of left central cervical lymph nodes + Exploration of left recurrent laryngeal nerve + Right parathyroidectomy | Bilateral parathyroidectomy+ Right thyroid lobectomy + Dissection of right central cervical lymph nodes + Exploration of bilateral recurrent laryngeal nerve | Right thyroid lobectomy + Dissection of right central cervical lymph nodes + Exploration of right recurrent laryngeal nerve + Right parathyroidectomy | Left thyroid lobectomy + Dissection of left central cervical lymph nodes + Exploration of left recurrent laryngeal nerve + Left parathyroidectomy | Total thyroidectomy + Dissection of central cervical lymph nodes + Right parathyroidectomy | Left thyroid lobectomy + Dissection of left central cervical lymph nodes + Exploration of left recurrent laryngeal nerve + Left parathyroidectomy | Total thyroidectomy + Exploration of bilateral recurrent laryngeal nerve + Dissection of right central cervical lymph nodes | |
Pathological results | Parathyroid | Parathyroid adenoma | Parathyroid adenoma (Lesion B1 & B3) | Parathyroid adenoma | Parathyroid adenoma | Parathyroid adenoma | Parathyroid adenoma | Parathyroid carcinoma |
Thyroid | PTMC | PTMC | PTMC | PTC | Multi-focal PTC with metastasis of cervical lymph nodes | PTMC | PTC and Thyroid adenoma | |
Consistency with US | Y | Y | Y | Y | Y | Y | Y/N* |
Discussion
Author | Year | Number of patients with PHPT | Number of patients with NMTC | Incident rate(%) |
---|---|---|---|---|
Linos et al. [4] | 1982 | 2058 | 51 | 2.5 |
Lehwald et al. [2] | 2013 | 1464 | 41 | 2.8 |
Attie and Vardhan [8] | 1993 | 948 | 31 | 3.3 |
Burmeister et al. [9] | 1997 | 700 | 18 | 2.6 |
Bentrem et al. [10] | 2002 | 580 | 12 | 2.1 |
Hedman and Tisell [21] | 1984 | 426 | 25 | 5.8 |
Nishiyama et al. [22] | 1979 | 420 | 13 | 3.1 |
Strichartz and Giuliano [23] | 1990 | 388 | 11 | 2.8 |
Prinz et al. [24] | 1982 | 351 | 16 | 4.6 |
Krause et al. [25] | 1996 | 322 | 9 | 2.8 |
LiVolsi et al. [26] | 1976 | 272 | 31 | 11.4 |
Ogburn and Black [1] | 1956 | 230 | 4 | 1.7 |
Phillips et al. [27] | 2014 | 217 | 5 | 2.3 |
Morita et al. [28] | 2008 | 200 | 12 | 6.0 |
Xue et al. [29] | 2016 | 155 | 12 | 7.7 |
Beus et al. [30] | 2004 | 101 | 3 | 3.0 |
Arciero et al. [11] | 2012 | 94 | 6 | 6.4 |
Sidhu and Campbell [12] | 2000 | 65 | 4 | 6.2 |
Gul et al. [13] | 2010 | 60 | 9 | 15.0 |
Total | – | 9051 | 313 | 3.5 |