Intrathyroidal parathyroid carcinoma causing acute severe pancreatitis: an uncommonly used localisation technique

Erica Dean, Nina-Marie King, Jeff Donlon*, Andrew Thompson

Case Report

A 40-year-old lady presented with a fluctuating level of consciousness, severe hypercalcaemia, hyperglycaemia, pancreatitis and a right ankle fracture. With a provisional diagnosis of primary hyperparathyroidism, ultrasound and parathyroid-protocol CT were performed, but both failed to localise a parathyroid lesion. Sestamibi reported a possible parathyroid adenoma. To confirm the presence of a parathyroid adenoma, a novel localisation technique was used. Under bedside ultrasound the left thyroid cyst was aspirated with fluid sent for PTH assay; result 530mlU/L (reference range 1.6 – 6.9 pmol/L). Radiology review in light of this finding suggested the intrathyroidal cystic lesion could be consistent with parathyroid carcinoma. The patient underwent a left hemithyroidectomy and limited central lymph node dissection. Serum PTH dropped to <0.4pmol/L and corrected calcium normalised rapidly. The final histopathological diagnosis was low-grade parathyroid carcinoma. At postoperative follow up the patient remained clinically well and her serum calcium and PTH levels remained normal. Pre-operative FNA and PTH assay of the cyst fluid was a simple and novel technique to confirm the presence of intrathyroidal parathyroid tissue and allow a focused operative approach.
Patient consent
Written informed consent was obtained from the patient for publication of this case report.