ABSTRACT
Los incidentalomas paratiroideos (IP) fueron descriptos como hallazgos intraquirúrgicos y luego en estudios ecográficos de tiroides. Escasos estudios se han realizado, por lo que su incidencia no es clara. Más aún, la presencia de una imagen hipoecogénica en topografía paratiroidea puede también ser tejido tiroideo o linfático. Se evaluaron retrospectivamente las historias clínicas de 7 años buscando los pacientes en los que se diagnosticó un IP durante una ecografía tiroidea. Se diagnosticó IP en 24 pacientes (4,0% del total). Tenían hipotiroidismo autoinmune 21 pacientes y nódulos tiroideos 3 pacientes. En 10 casos la lesión fue única y en 14 eran 2 o más. En la evolución se repitió la ecografía en 13 pacientes, hallando imágenes similares a la primera en todas. La calcemia y la PTH fueron normales en 23 pacientes, pero en una de ellas, con una imagen de 6 mm, hubo PTH levemente elevada con calcemia normal, que luego se elevó, y se diagnosticó adenoma paratiroideo. El hallazgo de IP parece cada vez más frecuente; nuestra incidencia del 4% como imágenes compatibles (sin confirmar la naturaleza paratiroidea) es más alta que las escasas publicaciones existentes sobre el tema. Es posible que muchas no presenten cambios ni ecográficos ni de laboratorio, pero otros casos, como el hallado en una de nuestras 24 pacientes, pueden ser un estadio inicial de hiperparatiroidismo primario, por lo que el seguimiento es aconsejable.
Parathyroid incidentalomas (PI) were first described as intraoperative findings and then in ultrasound thyroid scan studies. Few studies have been performed to investigate this, so their incidence is unclear. Moreover, the presence of a hypo-echogenic image in parathy- roid topography may also be thyroid or lymphatic tissue. A retrospective evaluation was performed on the seven-year clinical records of patients in whom a PI was diagnosed during a thyroid ultrasound scan. PI was diagnosed in 24 patients (4.0%). Twenty one patients had autoimmune hypothyroidism and 3 patients had thyroid nodules. In 10 cases the lesion was unique, and in 14 cases there were two or more lesions. During follow-up, ultrasound was repeated in 13 patients, and all showe findings. Serum calcium and PTH were normal in 23 patients, but in one of them, with an image of a lesion of 6 mm, PTH was slightly elevated, with normal serum calcium. Later, hypercalcaemia was detected and a parathyroid adenoma was diagnosed. The incidence of PI seems to be increasing, with our rate of 4% of compatible images (without confirming the parathyroid origin of the lesion) is higher than that reported in the few existing publications on the subject. Many patients with PI may not present with biochemical abnormalities, but as our experience shows, these lesions may represent the first stage of primary hyperparathyroidism; therefore careful follow-up is advisable.
Subject(s)
Humans , Female , Parathyroid Diseases/diagnosis , Incidental Findings , Parathyroid Diseases/epidemiology , Argentina/epidemiologyABSTRACT
Despite the availability of expert surgeons and preoperative imaging investigations, some patients require re-operation for persistent or recurrent hyperparathyroidism. Ectopic Parathyroid Glands [PGs] are a cause for failed parathyroid exploration. To evaluate the prevalence and location of normal parathyroid glands and diseased glands taken from subjects with End-Stage Renal Disease [ESRD]. A total of 410 parathyroid glands were recovered from 116 postmortem subjects of whom 37 were diagnosed as suffering from ESRD. In the rest, the death had resulted from disease unrelated to parathyroid disorder. 155 [69.3%] of both normal left and right superior PGs were located at cricothyroid junction; 46 [29.3%] were behind the upper pole of thyroid gland; 2 [2.6%] were behind pharyngoesophageal junction. 68 [47.1%] of the normal inferior PGs were found at the lateroposterior surface of the lower pole of thyroid gland; 62 [43.7%] were within the thymic tongue and 14 [9.7%] along the carotid artery. The normal ectopic PGs were found only in 22 cases. The superior PGs were 4 [18.2%] in an extracapsular posterior position, 2 [9.1%] intrathyroidal and 1 [4.5%] retropharyngeal. The inferior ectopic PGs were 15 [68.2%] and were found within the mediastinal thymus. 19 [51.4%] of the enlarged PGs were found within the thyroid parenchyma, 8 [21.6%] within the thymic tongue, 6 [16.2%] within the thymus, 2 [5.4%] were within the carotid sheath and 1 [2.7%] in the retropharyngeal or retroesophageal position. The presence of ectopic PGs in secondary hyperparathyroidism is sufficiently important to justify their exhaustive search. As the preoperative image exams present low sensibility to locate them, it is necessary to develop an exploratory routine embracing the most common sites of location