title: Delayed surgery for parathyroid adenoma misdiagnosed as a thyroid nodule and treated with radiofrequency ablation.
abstract: Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A (99m)technetium ((99m)Tc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the procedure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL. Neck ultrasonography and (99m)Tc sestamibi scan detected a 5-cm parathyroid neoplasm in the left lower lobe of the patient's thyroid; left parathyroidectomy was performed. This case indicated that thyroid ultrasonographers and pathologists need to be experienced enough to differentiate a parathyroid neoplasm from a thyroid nodule; (99m)Tc sestamibi scan, serum calcium, and iPTH levels can help to establish the diagnosis of parathyroid neoplasm.
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Ho-Su
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Bong Hoi
authors.initials: BH
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. ; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Jung Rang
authors.initials: JR
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. ; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Jong Ryeal
authors.initials: JR
authors.lastname: Hahm
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. ; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. ; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Soo Kyoung
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Sungsu
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Kyong-Young
authors.initials: KY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea. ; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Tae Sik
authors.initials: TS
authors.lastname: Jung
keywords: Parathyroid neoplasms; Thyroid nodule; Thyroid ultrasonography