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Han YH, Jeong HJ, Lee SY, Lim ST. Incidentally detected follicular thyroid carcinoma mimicking parathyroid adenoma on Tc-99m MIBI scan: A case report. Medicine (Baltimore) 2024; 103:e38107. [PMID: 38701245 PMCID: PMC11062725 DOI: 10.1097/md.0000000000038107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
RATIONALE Primary hyperparathyroidism, though relatively prevalent among endocrine disorders, affecting 1% of the general population, often presents diagnostic challenges. Given its potential to precipitate severe complications including nephrolithiasis and fractures, timely diagnosis, and effective management are crucial. PATIENT CONCERNS A 38-year-old woman with hypercalcemia was referred to the Department of Nuclear Medicine for a Tc-99m MIBI scan. DIAGNOSES Tc-99m MIBI scan showed focal increased uptake in the left thyroid gland area, initially suggesting a parathyroid adenoma. Further examination using SPECT/CT revealed a nodular lesion within the left thyroid gland showing high Tc-99m MIBI uptake. INTERVENTIONS Left thyroid lumpectomy confirmed the lesion as follicular thyroid carcinoma. On the second Tc-99m MIBI scan conducted after total thyroidectomy, a parathyroid adenoma was eventually detected in the right lower area, enabling the subsequent appropriate treatment, a right lower parathyroidectomy. OUTCOMES Thirteen days after the parathyroidectomy, serum levels of total calcium and parathyroid hormone returned to normal. Furthermore, bone mineral density evaluated using DEXA remained within the expected range for her age even after 14 months. LESSONS When interpreting the Tc-99m MIBI scan, it is essential to keep in mind that various tumors rich in mitochondria, such as thyroid carcinoma, could show a high uptake of Tc-99m MIBI.
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Affiliation(s)
- Yeon-Hee Han
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Hwan-Jeong Jeong
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Seok Tae Lim
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
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Mousa AH, Rahman M, Alsadeq HR, Albukhari ZZ, Ibrahim AS, Khaled I. An atypical concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma: First case reported in Saudi Arabia. Int J Surg Case Rep 2023; 106:108199. [PMID: 37094415 PMCID: PMC10149331 DOI: 10.1016/j.ijscr.2023.108199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most frequent endocrine cancer and most common thyroid cancer. The concurrent occurrence of both tumors however is a very rare occasional finding. Surgical treatment via excision is the only definitive. Our study aims to highlight a rare occurrence of concurrent parathyroid adenoma and micropapillary thyroid carcinoma. CASE PRESENTATION We describe a 36-year-old female who presented to the outpatient clinic with a left thyroid nodule. Both a Tc-99m-MIBI parathyroid scan and Tc-99m thyroid scan were performed. A left total thyroidectomy was performed then subsequently the parathyroid adenoma was localized. Intra-operative parathyroid hormone decreased by >50 % from 531.5 pg/ml iPTH Stat to 39.8 pg/ml iPTH Stat which is diagnostic for proper localization. Two specimens were sent for histopathological evaluation. Histopathological evaluation of the first specimen confirmed the diagnosis of parathyroid adenoma. Histopathological evaluation of the second specimen revealed that the presence of papillary microcarcinoma of a size of 0.8 cm and pathologic staging to be pT1a, pNx, pMx. CONCLUSION To our knowledge, this is the first case of concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma reported in the Kingdom of Saudi Arabia. Intraoperatively, management was done by via excision and confirmation of the parathyroid localization was done via intraoperative parathyroid hormone level measurement. We recommend more extensive studies to identify any possible patterns or predictors of finding these two concurrent tumors.
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Affiliation(s)
- Ahmed Hafez Mousa
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia.
| | - Moshiur Rahman
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Hussain Raeid Alsadeq
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Zain Zuhair Albukhari
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Abdullatif Sheikh Ibrahim
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Islam Khaled
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; Department of Surgery, Faculty of Medicine, Suez Canal University Hospitals, Ismailia, Egypt
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Dosemane D, Khadilkar MN, Kini H, Kalathigal N. A Silent Non-thyroidal Adenoma in the Thyroid. Indian J Otolaryngol Head Neck Surg 2022; 74:2334-2336. [PMID: 36452836 PMCID: PMC9701939 DOI: 10.1007/s12070-020-02163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022] Open
Abstract
The surgeon needs to assess clinically significant thyroid nodules as they may represent aggressive forms of thyroid cancer or ectopic parathyroid glands. We discuss one such unusual nodule in the thyroid.
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Affiliation(s)
- Deviprasad Dosemane
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001 India
| | - Meera Niranjan Khadilkar
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001 India
| | - Hema Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001 India
| | - Nahas Kalathigal
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001 India
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Cheng YJ, Cheng XY, Zhang YM, Wang F, Wang X, Meng LQ, Liu G, Cui Z, Zhao MH. Effects of hydroxychloroquine on proteinuria in membranous nephropathy. J Nephrol 2021; 35:1145-1157. [PMID: 34846713 DOI: 10.1007/s40620-021-01182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many patients with primary membranous nephropathy have severe proteinuria unresponsive to optimized renin-angiotensin-aldosterone system inhibitors (RAASi). We evaluated the efficacy and safety of hydroxychloroquine as an adjunctive agent in membranous nephropathy (MN) treatments. METHODS We prospectively recruited 126 patients with biopsy-proven primary membranous nephropathy and urinary protein 1-8 g/day while receiving optimized RAASi treatment for ≥ 3 months and well-controlled blood pressure. Forty-three patients received hydroxychloroquine and RAASi (hydroxychloroquine-RAASi group), and 83 patients received RAASi alone (RAASi group). Treatment responses, including proteinuria reduction, complete and partial remission rates, and autoantibody against phospholipase A2 receptor (anti-PLA2R) levels, were compared between the two groups at 6 months and over the long term. RESULTS At 6 months, the effective response rate (proteinuria reduction > 30%) (57.5% vs. 28.9%, P = 0.002), clinical remission rate (35.0% vs. 15.7%, P = 0.015), and percentage change in proteinuria (- 51.7% vs. - 21.9%, P < 0.001) were higher, and the rate of switching to immunosuppressants (25.0% vs. 45.8%, P = 0.027) was lower in the hydroxychloroquine-RAASi group than in the RAASi group. Hydroxychloroquine administration was an independent protective factor with an effective response (OR 0.37, P = 0.021). In the long term, the clinical remission rate was higher in the HCQ-RAASi group (62.5% vs. 38.6%, P = 0.013). Hydroxychloroquine therapy was associated with a higher rate of anti-PLA2R reduction (< 20 U/ml) (HR 0.28, P = 0.031). We observed no serious adverse events associated with hydroxychloroquine. CONCLUSIONS Hydroxychloroquine could be an option for patients with membranous nephropathy seeking to achieve proteinuria reduction and anti-PLA2R antibody reduction in addition to optimized RAASi. Randomized controlled trials are needed to confirm these findings. TRIAL REGISTRATION ChiCTR2100045947, 20210430, retrospectively registered.
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Affiliation(s)
- Yan-Jiao Cheng
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Xu-Yang Cheng
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China. .,Institute of Nephrology, Peking University, Beijing, People's Republic of China. .,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China. .,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China.
| | - Yi-Miao Zhang
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Fang Wang
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Xin Wang
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Li-Qiang Meng
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Gang Liu
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China. .,Institute of Nephrology, Peking University, Beijing, People's Republic of China. .,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China. .,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China.
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Institute of Nephrology, Peking University, Beijing, People's Republic of China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, People's Republic of China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100871, People's Republic of China
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Abdullah AM, Baba HO, Salih AM, Qaradakhy AJ, Kakamad FH, Abdulla BA, Mohammed SH. Co-occurrence of bilateral intrathyroidal parathyroid gland and papillary thyroid carcinoma; a case report. Int J Surg Case Rep 2021; 86:106315. [PMID: 34479113 PMCID: PMC8414177 DOI: 10.1016/j.ijscr.2021.106315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Intrathyroidal parathyroid is a parathyroid completely embedded within the thyroid parenchyma. The aim of this study is to present a case with co-occurring bilateral normal intrathyroidal parathyroid glands and papillary thyroid carcinoma (PTC). Case presentation A 35-year-old female presented with anterior neck swelling for a duration of a week. The patient was generally asymptomatic. Ultrasound showed mild enlargement of the thyroid gland, and a well-defined solid nodule measuring 9 ∗ 8 ∗ 7 mm in the left lobe with malignant characteristics. Laboratory findings were within normal limits. Fine needle aspiration of the nodule resulted in the diagnosis of PTC. The patient underwent total thyroidectomy. Histological examination confirmed the diagnosis of well differentiated multifocal bilateral PTC alongside two bilaterally located intrathyroidal parathyroid glands. Discussion The occurrence of normal ITP is exceedingly rare, and even rarer when simultaneous with other thyroidal lesions. It is theorized that inferior parathyroid glands arise from the third pharyngeal pouch, and during embryogenesis they might migrate to other anatomic locations. In this case, two bilateral normal ITP were present with PTC. Conclusion Normal ITP presents a diagnostic challenge due to their high insensitivity to current preoperative diagnostic techniques; hence, surgeons are required to carefully examine thyroid tissue during thyroidectomy when missing parathyroid glands are observed. Intrathyroidal parathyroid is completely embedded parathyroid gland within the thyroid parenchyma. The ectopic localization of parathyroid inside the thyroid is uncommon. It is even rarer when synchronous with another thyroidal tumor. In this study, a case of co-occurring bilateral normal ITP and papillary thyroid carcinoma is discussed.
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Affiliation(s)
- Ari M Abdullah
- Sulaimani Teaching Hospital, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
| | - Hiwa O Baba
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Aras J Qaradakhy
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Department of Radiology, Shorsh Teaching Hospital, Sulaimani, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq; College of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq.
| | - Berwn A Abdulla
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
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