Remission of primary hyperparathyroidism after fine needle aspiration of a parathyroid nodule mistaken for a thyroid nodule

Silva, Eugénia Maria Morado da; Ferreira, Rute Alexandra da Costa; Marques, Bernardo de Almeida Rodrigues; Chorão, Martinha Carlota Soares; Duarte, João Manuel Sequeira

doi:10.20945/2359-3997000000615

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Archives of Endocrinology and Metabolism

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Case Report • Arch. Endocrinol. Metab. 67 (6) • 2023 • https://doi.org/10.20945/2359-3997000000615 copy

Remission of primary hyperparathyroidism after fine needle aspiration of a parathyroid nodule mistaken for a thyroid nodule

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by hypercalcaemia and elevated or inappropriately normal concentrations of parathyroid hormone. Remission of PHPT caused by infarction or hemorrhage of a parathyroid adenoma rarely occurs, either spontaneously or induced, not always leading to a definitive cure. We report a case of 72-year-old women with primary hyperparathyroidism who underwent fine-needle aspiration cytology (FNAC) of a parathyroid adenoma mistaken for a thyroid nodule followed by normalization of parathyroid hormone (PTH) and serum calcium levels. Parathyroid origin was confirmed by immunohistochemistry. PTH levels began to rise at 4 months after FNAC demonstrating recurrence of the PHPT. This report shows that FNAC induced hemorrhage may cause remission of PHPT. Nevertheless, patient´s levels of PTH and serum calcium should be monitored, as remission may only be transitory.

Laboratory Parameter	Patient´s results at admission	Patient´s results after therapeutic	Reference Range
Albumin-corrected serum calcium (mg/dL)^* * Corrected calcemia (mg/dL) = total serum calcemia (mg/dL) +0.8× (4 – serum albumin (g/dL)).	15.6	12.4	8.9-10.2
Phosphate (mg/dL)	1.9	2.2	2.5-4.5
Parathyroid hormone (pg/mL)	229.0	–	15.0-65.0
Magnesium (mEq/L)	1.7	1.7	1.6 – 2.4
25-hydroxyvitamin D (mmol/L)	98.0	–	75.0-250.0
Creatinine (mg/dL)	0.6	0.6	0.5 – 0.9
Glomerular Filtration Rate (ml/min/1.73m²)^ Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula.	94.0	96.0	>60.0
Urinary Calcium (mg/24h)	–	180.0	100.0-300.0

Laboratory Parameter	Patient’s Results 2 months after FNAB	Patient’s Results 8 months after FNAB	Reference Range
Albumin-corrected serum calcium (mg/dL)^* * Corrected calcemia (mg/dL) = total serum calcemia (mg/dL) +0.8× (4 – serum albumin [g/dL]).	9.9	9.4	8.9-10.2
Phosphate (mg/dL)	2.6	2.6	2.5-4.5
Parathyroid hormone (pg/mL)	43.2	71.8	15.0-65.0
Magnesium (mEq/L)	–	2.1	1.6-2.4
25-hydroxyvitamin D (mmol/L)	84.0	76.0	75.0-250.0
Creatinine (mg/dL)	0.6	0.6	0.50-0.90
GFR (mL/min/1.73 m²)^ Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula.	95.0	94.0	>60.0
Urinary Calcium (mg/24 h)	–	214.0	100.0-300.0

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[1] Correspondence to: Departamento de Endocrinologia, Hospital de Egas Moniz, Rua da Junqueira, 126 1349-019 – Lisboa, Portugal, emsilva@chlo.min-saude.pt.