Rare finding of a large parathyroid adenoma with thyroid aplasia

Abstract

Rare finding of a large parathyroid adenoma with thyroid aplasiaA 63-year-old lady presented with asymptomatic hypercalcaemia due to primary hyperparathyroidism. The previous history includes hypothyroidism since the age of 6 (on a total thyroxine replacement of 900 mcg/week), anterior mediastinal cyst, vitamin D deficiency and osteoarthritis.Routine blood examination performed by general practitioner (GP) found a serum calcium level of 3.06 mmol/L. Further workup showed parathyroid hormone (PTH) of 26 nmol/L and osteoporosis in the lumbar spine.Parathyroid scintigraphy with 99mTc-sestamibi (Fig. 1) revealed an methoxyisobutylisonitrile-avid right lower neck lesion with persistent uptake on delayed views, possibly within the right thyroid lobe. Computed tomography and ultrasound suggested an enlarged heterogeneous right thyroid lobe with cystic areas and absence of the left lobe.