features of hypoparathyroidism

1. HYPERPARATHYROIDISM

2. BRIEF HISTORY – CASE 1
• GEETA TAPPULAL BHAMAR
• 59 YR OLD LADY
• RESIDENT OF CUMBALLA HILL, MUMBAI
• Chief complaints
discomfort in the neck for 3 weeks
Past history : history of low back pain for 3 years - left URS and DJ
stenting for ureteric stone on 11/06/2020
Appendicectomy done for acute appendicitis on 24/09/2020

3. BLOOD INVESTIGATION FEB 2021
• SE CALCIUM – 9.4 – wnl
• CALCITONIN – 2.3 pg/ml – wnl
• VITAMIN D – 62 ng/ml – wnl
• PTH – 363.8 pg/ml ( 7.5 – 53.5) - RAISED
• Rest wnl

4. Ultrasound of Parathyroid feb 2021
• Rt lobe of thyroid – 3.6x1.4x1.2 cms left lobe – 3x1.3x0.9 cms
• Isthmus – 0.8 cms
• Left lobe – 2 nodules 0.6x0.5cm and 0.8x0.4 cm
• Solid cystic lesion – adjacent to both lower lobes of thyroid
• Rt lower lobe adjacent lesion – 1.1x1.1 cms
• Lt lower lobe adjacent lesion – 0.8x0.7 cms
• Both lesions – inc. vascularity
• CONCLUSION – B/L PARATHYROID ADENOMAS + LEFT LOBE THYROID
NODULED TIRADS II

5. NUCLEAR SCANNING 25/02/2021
• SISTAMIBI PARATHYROID - EARLY AND DELAYED STATIC IMAGES
NORMAL TRACER UPTAKE IN BOTH LOBES- NO FOCAL RETENTION
• SPECT CT – NO APPRECIABLE FOCAL TRACER UPTAKE
• Tc04 THYROID SCAN – MILDLY REDUCED AND NON UNIFORM TRACER
UPTAKE IN BOTH LOBES
• COMMENTS – No scan evidence of MIBI avid foci in thyroid bed
region to suggest parathyroid adenoma
USG ABDOMEN 01/03/2021
Multiple uterine fibroids largest measuring 1.6x2.3 cm
Rest wnl

6. EXPLORATION FOR HYPERPARATHYROIDISM
UNDER GA 03/03/2021
- Nodules at lower pole of thyroid , one on right side and
2 on left side.
- Excised and sent for frozen – benign thyroid nodes
- No parathyroid gland
- No other adenoma detected
- Parathyroid not enlarged
- Hence no further procedure done after consulting with
DR Nishit Shah, Endocrinologist.

7. HISTOPATH REPORT
FEATURES SUGGESTIVE OF
• BENIGN THYROID TISSUE
• SECTION FROM THE NODULE WITHIN FAT REVEALS PARATHYROID
ADENOMA
• THERE IS NO EVIDENCE OF MALIGNANCY

8. CASE 2 – BRIEF HISTORY
• ATIKA AMIN GENERAL
• 37 YR OLD LADY
• RESIDENT OF MUMBAI
• OPERATED IN 2006 FOR PARATHYROID ADENOMA with presurgery
PTH – 432ng/mlOne parathyroid adenoma was removed – post
surgery PTH< 5
• PARATHYROID ADENOMA IN 2011 PRESURGERY PTH 400+ 2.5
parathyroid adenoma removed –pot surgery PTH<3
• 2019 – PCNL for b/l ureteric sones

9. Recent reports feb 2021
• PARATHYROID HORMONE – 150 (15-65)
• SERUM CALCIUM 10.9 (8.6- 10)
• SERUM PHOSPHOROUS 2.6 (2.5-4.5)
FAMILY HISTORY
HISTORY OF SIMILAR COMPLAINTS IN THE MOTHER
OPERATED TWICE IN 1980 AND 1990 – 3 PARATHYOID GLANDS REMOVED
1995 – RENAL FAILURE
STARTED ON DIALYSIS
DEATH 2002 due to dialysis complications