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Case of the Month



Parathyroid Adenoma

A 77 year-old gentleman presents to the emergency room after collapsing due to weakness and dehydration. Examination showed that he was suffering from heart palpitations and had a left thyroid nodule. He was rehydrated and discharged with instructions to see a cardiologist and undergo thyroid ultrasound at the outpatient clinic. Ultrasound showed a left lower pole nodule, 2.08 cm. Aspirate smears from the follow-up FNA biopsy of the thyroid nodule demonstrated microfollicular clusters. The nuclei were round to oval with cytoplasm that was finely vacuolar. Adequacy evaluation at the time of biopsy was suspicious for a follicular process, including intrathyroidal parathyroid. A dedicated pass was preserved specimen in formalin with the intent of performing immunocytochemical stains.

Immunostains showed that the cells were uniformly positive for PTH and negative for thyroglobulin, confirming that the nodule of interest was parathyroid and that the patient's symptoms were likely attributed to parathyroid adenoma. Follow-up blood work demonstrated calcium level of 14.4 and a PTH Intact of 805. Sestamibi scan further supported the presence of a left intrathyroidal parathyroid. Surgery was performed and a single parathyroid adenoma, 2.67 grams, was resected.