Parathyroid adenoma mimicking multinodular goiter: Cases report

Tóm tắt

Parathyroid adenomas and cysts can closely mimic thyroid nodules on imaging, leading to frequent misdiagnoses and unnecessary thyroid surgeries. This report presents two cases of patients initially diagnosed with thyroid nodules based on ultrasound findings, then proved to have parathyroid tumors following surgical intervention. Both patients exhibited hypercalcemia and prolonged symptoms of bone and joint pain; however, parathyroid hormone (PTH) testing was not conducted in previous evaluations, delaying accurate diagnosis. In the first case, a parathyroid adenoma was discovered embedded within the thyroid gland, while in the second case, a large parathyroid cyst was located external to the thyroid, further complicating differentiation. Postoperatively, a significant decline in PTH and calcium levels confirmed the parathyroid origin of the lesions, leading to symptom resolution in both patients. These cases highlight the limitations of conventional imaging techniques, such as ultrasound, in differentiating between thyroid and parathyroid pathology. Standard imaging often fails to differentiate between the two, making it essential to incorporate biochemical markers such as serum calcium and PTH levels in the initial diagnostic workup. Additionally, advanced imaging modalities, including sestamibi scintigraphy and intraoperative PTH monitoring, play a crucial role in preoperative localization and intraoperative confirmation of complete lesion removal. Without these additional diagnostic tools, parathyroid lesions may be mistaken for thyroid nodules, leading to inappropriate management strategies and prolonged patient morbidity. A multimodal diagnostic approach that integrates biochemical assessment, targeted imaging, and intraoperative PTH monitoring is essential for the accurate identification and treatment of parathyroid disorders. These cases emphasize the importance of routine serum calcium and PTH testing in patients with suspected thyroid nodules to prevent misdiagnosis and unnecessary thyroidectomies. Future advancements in imaging techniques and standardized diagnostic protocols will be key to improving preoperative localization of parathyroid pathology and optimizing surgical outcomes.