GIANT
PARATHYROID ADENOMA
PATIENT: 62-year
old patient (female)
PREOPERATIVE
DIAGNOSIS: primary hyperparathyroidism / thyroid nodules
DAY OF
SURGERY: Preoperative PTH levels = 1007 pg/ml (!!!), Serum Calcium = 12.2 mg/ml
IMAGING:
ULTRASONOGRAPHY-LEFT
lobe, large thyroid nodule (d=3.2 cm), 2 more smaller nodules (1.7 cm and 1.2
cm). Large (5 X 1.7 cm) lesion behind the left thyroid lobe with increased
internal vasculature and echomorphological features suggestive of a parathyroid
adenoma).
Tc99m-SESTAMIBI
SCAN-increased uptake in a large area (near the left thyroid lobe)
SURGERY:
Total thyroidectomy with concomitant parathyroidectomy (resection of a giant
parathyroid adenoma). Parathyroid lesion without invasion of adjacent tissues
(clinical differential diagnosis from parathyroid carcinoma)
FROZEN BIOPSY-
pathological parathyroid gland (adenoma, with a rim of normal parathyroid
tissue at its periphery)
INTRAOPERATIVE
PARATHORMONE LEVELS MEASUREMENT following parathyroidectomy= 93 pg/ml
SERUM
CALCIUM LEVELS (day of surgery) = 10.9 mg/ml
1rst POSTOPERATIVE
DAY: PTH=12 pg/ml, Serum calcium=9.9 mg/ml
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