Endocrine Abstracts

JOINT2501

Introduction: Primary hyperparathyroidism (PHPT) and thyroid disease are two relatively common conditions that can coexist in the same patient. The etiology and risk factors remain unclear. We report here the case of a 55-year-old female patient presenting with a parathyroid adenoma, two normo vesicular thyroid adenomas discovered during an etiological work-up for kidney stones.

Case Report: 55-year-old female patient with a history of recurrent kidney stones, right thyroid loboisthmectomy with anatomopathological examination: appearance of atypical reworked thyroid adenoma, referred to our training for further management of primary hyperparathyroidism. Cervical palpation revealed a 1 cm thyroid nodule lateralized to the left, biological workup showed hypercalcemia at 117 mg/l and PTH at 257 pg/ml. Cervical ultrasonography showed 2 left nodular formations classified as EuTirads 3, the largest measuring 13×10 mm. Parathyroid scintigraphy with Sesta-MIBI 99mTc showed a left sub lobar area preferentially fixing the MIBI-Tc 99m tracer, in favour of a parathyroid origin with no ectopic focus capturing the tracer. The patient underwent surgery involving removal of the left thyroid lobe and the left inferior parathyroid. Anatomopathological examination showed the coexistence of a normo vesicular thyroid adenoma and a parathyroid adenoma. Postoperative calcemia levels normalized.

Discussion: The coexistence of parathyroid and normovesicular thyroid adenomas is extremely rare. A combination of clinical, radiological and histological findings should lead to a diagnosis in the presence of an atypical presentation. Because of the risk of concomitant thyroid damage, thyroid imaging must be carried out prior to any surgical treatment of the parathyroid glands. Ultrasound provides a precise anatomical image, but cannot visualize certain parathyroid adenomas. Ultrasound symptomatology must be understood, as well as the pitfalls and difficulties involved. MIBI scintigraphy confirms the location of the parathyroid adenoma, while MIBI SPECT/CT offers greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology.

Conclusion: The association of a parathyroid adenoma with normo vesicular thyroid adenomas is extremely rare. Removal of the parathyroid adenoma should be completed by loboisthmectomy or total thyroidectomy, depending on the indication.