title: [Intrathyroidal location of parathyroid glands. Atypical presentation of multiple endocrine neoplasia type 1 syndrome].
abstract: BACKGROUND
  The most common manifestation of MEN 1 syndrome is primary hyperparathyroidism (PHPT) with parathyroid multiglandular affectation. The intrathyroidal situation represents 3-4% of all glands, and it is the second most frequent location in the cervical ectopias.
  
  
  METHODS
  11 year old patient, with a family history of MEN1 syndrome and carrier of this same mutation. Patient presents HPTP with osteopenia. The cervical ultrasound shows three compatible images with pathological parathyroid glands (bilateral lower and upper left). The Scan and MRI are normal. Bone densitometry displays data on osteopenia. The patient is surgically intervened, only the upper parathyroid glands are located and removed, after this implantation is performed on the forearm, to prevent the possible devascularization in the dissection of the other glands. However, osteopenia persists and an elevated PTH, therefore new diagnostic tests are held which seem to show two lower parathyroid glands with intrathyroidal location. The patient is reoperated. A subtotal parathyroidectomy of the lower right gland and the resection of the left gland is performed, with the use of intraoperative ultrasound and placement of harpoon. The intraoperative pathology study confirms parathyroid tissue in both cases.
  
  
  CONCLUSIONS
  It is necessary to locate the parathyroid glands preoperatively in order to alert us of the existence of topographical and ectopia abnormalities, as well as their intrathyroidal location (0.5-3.6%).
  
  
  CONCLUSIONS
  The intraoperative ultrasound can be a complement to the experience of the endocrine surgeon for the localization of the parathyroid glands and therefore can help determine the best surgical strategy for each clinical case.
authors.affiliation: Cirugía General y del Aparato Digestivo A, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: martilladelafuente@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: de la Fuente-Bartolomé
authors.affiliation: Cirugía General y del Aparato Digestivo A, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Alejando
authors.initials: A
authors.lastname: Moreno-Bargueiras
authors.affiliation: Cirugía General y del Aparato Digestivo A, Hospital Fundación Jiménez Díaz, Madrid, España.
authors.forename: Irene
authors.initials: I
authors.lastname: Osorio-Silla
authors.affiliation: Cirugía General y del Aparato Digestivo A, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Martínez-Pueyo
authors.affiliation: Cirugía General y del Aparato Digestivo A, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Felipe
authors.initials: F
authors.lastname: de la Cruz-Vigo
authors.affiliation: Cirugía General y del Aparato Digestivo A, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Lara
authors.initials: L
authors.lastname: Gutiérrez-Ashling
mesh_terms: D001851:Bone Diseases, Metabolic / Q000209:etiology; D002648:Child; D002828:Choristoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D005542:Forearm; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications* / Q000473:pathology; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery / Q000637:transplantation; D016105:Parathyroidectomy / Q000379:methods; D013959:Thyroid Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D018084:Ultrasonography, Interventional
keywords: Atypical presentation; Glándula paratiroides; Intrathyroidal parathytoid glands; Localización atípica; Multiple endocrine neoplasia type 1 syndrome; Parathyroid gland; Paratiroides intratiroidea; Síndrome de neoplasia endocrina múltiple tipo 1