Introduction: The otorhinolaryngologist can be confronted to multiple surprises after a thyroid surgery
Case description: We report the case of a 48 year-old woman admitted with post operative hypocalcaemia (after thyroidectomy?). The patient has a history of hypothyroidism since 5 years. She then presented a cervical swelling. The ultra-sound confirmed the presence of a suspicious thyroid nodule measuring 4 cm. A thyroidectomy was then conducted. Post operative, the patient presented with symptoms of hypocalcaemia, confirmed by low level of blood calcium at 1.59 mmol/. The anatomopathological examination showed no sign of thyroid tissue, along with the presence of five adenomatous parathyroid nodules. Post operative scintigraphy showed a conserved thyroid tissue, with absence of parathyroid glands. Hungry Bone Syndrome was confirmed led to the prolonged and severe hypocalcaemia, associated to the adenomatous aspect of the parathyroid measuring more than 6 cm. Because of the family history of pituitary prolactinoma, primary hyperparathyroidism and multinodular goitre and the personal history of uterine fibroma and hypothyroidism, Multiple Endocrine Neoplasia 1 (MEN1) was suspected. Genetic confirmation is underway.
Conclusion: This is the case of an asymptomatic hyperparathyroidism discovered by a severe post-thyroidectomy hypocalcaemia. This hyperparathyroidism is due to multiple parathyroid adenomas misdiagnosed as thyroid nodules, and probably falls within a multiple endocrine neoplasia type 1.
20 - 23 May 2017
European Society of Endocrinology