scholarly journals Non-functional parathyroid cyst - diagnostic pitfall: A case-report

2015 ◽  
Vol 72 (11) ◽  
pp. 1032-1034 ◽  
Author(s):  
Snezana Polovina ◽  
Zoran Andjelkovic ◽  
Dragan Micic
Keyword(s):  
Vitamin D ◽  
Case Report ◽  
Serum Calcium ◽  
Thyroid Peroxidase ◽  
Thyroid Lobe ◽  
Cystic Fluid ◽  
Parathyroid Cyst ◽  
Parathyroid Cysts ◽  
Serum Pth ◽  
Left Thyroid Lobe

Introduction. Parathyroid cysts are relative rare and they may be misdiagnosed with thyroid nodules. Parathyroid cysts are characterized by elevated level of parathyroid hormone (PTH) in cystic fluid. Case report. We reported about middle-aged woman with palpable node in the left thyroid lobe. Ultrasound showed anechoic 40 ? 25 mm lesion in the left thyroid lobe. Fine needle aspiration (FNA) obtained 13 mL colorless, watery cystic fluid. PTH value in cystic fluid was ten fold more in comparison with serum PTH. Serum PTH was slightly elevated, D vitamin was under the reference range, serum calcium and phosphorus were normal as well as thyroid hormones. Thyroglobulin antibodies (TgAb) and thyroid peroxidase antibodies (TPOAb) were not detected. Radionuclide parathyroid scintigraphy indicated at physiological metaiodbenzyl-guamidine (MIBG) distribution. After six months of vitamin D supplementation, serum calcium, phosphorus, vitamin D and PTH were normal. This finding was indicative that was a nonfunctional parathyroid cyst. Conclusion. This case report points out that thyroid cystic lesions with thin walls, and reverberation in ultrasound, must be observed as a potential parathyroid cyst. These cysts require caution during diagnostic aspiration because of danger of hypercalcemic crises due to FNA, which can be a life-threatening condition.

scholarly journals Nonfunctional parathyroid cyst: case report

2009 ◽  
Vol 127 (6) ◽  
pp. 382-384 ◽  
Author(s):  
Carlos Eduardo Molinari Nardi ◽  
Ricardo Adriano Nasser Barbosa da Silva ◽  
Cynthia Maria Massarico Serafim ◽  
Rogério Aparecido Dedivitis
Keyword(s):  
Case Report ◽  
Surgical Excision ◽  
Neck Mass ◽  
Thyroid Lobe ◽  
Parathyroid Cyst ◽  
Neck Masses ◽  
Thyroid Lobectomy ◽  
Ionic Calcium ◽  
Parathyroid Cysts ◽  
Left Thyroid Lobe

CONTEXT: Parathyroid cysts are rare clinical and pathological entities, with less than 300 cases reported. The inferior parathyroid glands are most commonly involved, with left-side predominance. Parathyroid cysts may be functional or nonfunctional, depending on their association with hypercalcemia. CASE REPORT: A 25-year-old man presented a palpable asymptomatic left-side neck mass. Ultrasound revealed a cystic structure contiguous with the left thyroid lobe. Serum ionic calcium was normal. The patient underwent left thyroid lobectomy plus isthmectomy with excision of the cyst. The histological findings revealed a parathyroid cyst. Parathyroid cysts typically present as asymptomatic neck masses, and surgical excision appears to be the treatment of choice.

scholarly journals Preventing calcium and vitamin D deficiencies following weight loss and metabolic surgery

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Reshi Suthakaran ◽  
Imeshi Indigahawela ◽  
Krinal Mori ◽  
Kiat Lim ◽  
Ahmad Aly
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Metabolic Surgery ◽  
Surgical Techniques ◽  
Serum Vitamin ◽  
Nutritional Deficiencies ◽  
Serum Vitamin D ◽  
Metabolic Bone ◽  
Vitamin D Levels ◽  
Serum Pth

Abstract Introduction Uncertain nutritional outcomes following common metabolic surgical techniques are concerning given the long-term potential for postoperative metabolic bone disease. This study aims to investigate the variations in serum calcium, vitamin D, and parathyroid hormone (PTH) levels following Roux-en-Y Gastric bypass (RYBP) and Sleeve Gastrectomy (SG). Methods A retrospective analysis of 370 patients who underwent metabolic surgery at a single-centre group practice in Melbourne, Australia, over 2 years. Results Patients underwent SG (n = 281) or RYGP (n = 89), with 75% and 87% of the cohort being female, respectively. Postoperative mean serum calcium levels and median serum vitamin D levels improved significantly by 24 months within both cohorts. Serum PTH levels within the RYBP group were significantly higher than the SG group across all time points. PTH levels significantly fell from 5.7 (IQR 4.2–7.4) to 5.00 (4.1–6.5) pmol/L by 24 months following SG. However, PTH levels following RYBP remained stable at 24 months, from 6.1 (IQR 4.7–8.7) to 6.4 (4.9–8.1) pmol/L. Furthermore, we failed to notice a significant improvement in PTH levels following RYBP among those with higher PTH levels preoperatively. Conclusion Higher PTH levels following RYBP, compared to SG, may imply we are undertreating patients who are inherently subjected to a greater degree of malabsorption and underlying nutritional deficiencies. This finding calls for a tailored supplementation protocol, particularly for those with high preoperative PTH levels undergoing RYBP, to prevent deficiencies.

scholarly journals Vitamin D Intoxication Presenting as Subacute Encephalopathy—A Case Report

2021 ◽  
Vol 8 ◽  
pp. 2329048X2110080
Author(s):  
Naik Tripty ◽  
Jagzape Tushar ◽  
Jondhale Sunil
Keyword(s):  
Vitamin D ◽  
Case Report ◽  
Serum Calcium ◽  
Volume Status ◽  
Developmental Milestones ◽  
Frequent Monitoring ◽  
Vitamin D Intoxication ◽  
Life Threatening ◽  
High Doses

Vitamin D intoxication is uncommon in children and is more commonly suspected in the setting of ingestion of high doses of vitamin D. Its manifestations can be non specific and varied ranging from mild like constipation and vomiting to life threatening like arrhythmias and encephalopathy. Here we present a 14 month female who presented with loss of milestones, floppiness, and poor interaction with mother. She was detected to have hypercalcemia and was subsequently diagnosed with vitamin D intoxication. She was successfully treated with hydration, furosemide, prednisolone and frequent monitoring of electrolytes, electrocardiography and volume status. Subsequently as her serum calcium levels normalized with therapy, she became alert, conscious and started achieving developmental milestones.

A case of severe, irreversible hypocalcemia after one dose of pamidronate administered for hypercalcemia of malignancy

2018 ◽  
Vol 25 (7) ◽  
pp. 1787-1793 ◽  
Author(s):  
Sophie Kim
Keyword(s):  
Vitamin D ◽  
Case Report ◽  
Vitamin D Deficiency ◽  
Cancer Patients ◽  
Serum Calcium ◽  
Calcium Level ◽  
Serum Calcium Level ◽  
Elevated Serum ◽  
Baseline Serum ◽  
Hypercalcemia Of Malignancy

This is a case report of a patient who developed severe, irreversible hypocalcemia after receiving one dose of pamidronate 90 mg for hypercalcemia of malignancy. Hypocalcemia is a known risk of bisphosphonate treatments, but the incidence of severe hypocalcemia is rare, and the risk factors are well established. However, in the treatment of hypercalcemia of malignancy, the treatment objective is to reduce the elevated serum calcium level, and the bisphosphonate is usually given as one time dose only. The potential for developing severe hypocalcemia may not be considered a significant concern in this setting compared to the setting of the treatment of bone metastasis, where the baseline serum calcium level is not elevated and the bisphosphonate is administered at a regular interval of every three to four weeks. Furthermore, there is unawareness of prevalence of vitamin D deficiency in cancer patients, especially in those with advanced cancer, which may lead to inadvertent, severe hypocalcemia from bisphosphonate treatment. The objective of this case report is to bring awareness to the risk of severe hypocalcemia in patients with hypercalcemia of malignancy and the high prevalence of unrecognized vitamin D deficiency in cancer patients.

scholarly journals Evaluation of Ergocalciferol or Cholecalciferol Dosing, 1,600 IU Daily or 50,000 IU Monthly in Older Adults

2011 ◽  
Vol 96 (4) ◽  
pp. 981-988 ◽  
Author(s):  
N. Binkley ◽  
D. Gemar ◽  
J. Engelke ◽  
R. Gangnon ◽  
R. Ramamurthy ◽  
...  
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Serum Calcium ◽  
Urinary Calcium ◽  
Community Dwelling ◽  
Individual Response ◽  
Specific Alkaline Phosphatase ◽  
Bone Specific Alkaline Phosphatase ◽  
Hydroxyvitamin D ◽  
Serum Pth

Abstract Context: Whether ergocalciferol (D2) and cholecalciferol (D3) are equally effective to increase and maintain serum 25-hydroxyvitamin D [25(OH)D] concentration is controversial. Objective: The aim of the study was to evaluate the effect of daily and once monthly dosing of D2 or D3 on circulating 25(OH)D and serum and urinary calcium. Design, Setting and Participants: In a university clinical research setting, 64 community dwelling adults age 65+ were randomly assigned to receive daily (1,600 IU) or once-monthly (50,000 IU) D2 or D3 for 1 yr. Main Outcome Measures: Serum 25(OH)D, serum calcium, and 24-h urinary calcium were measured at months 0, 1, 2, 3, 6, 9, and 12. Serum PTH, bone-specific alkaline phosphatase, and N-telopeptide were measured at months 0, 3, 6, and 12. Results: Serum 25(OH)D was less than 30 ng/ml in 40% of subjects at baseline; after 12 months of vitamin D dosing, levels in 19% of subjects (n = 12, seven receiving daily doses and five monthly doses) remained low, despite compliance of more than 91%. D2 dosing increased 25(OH)D2 but produced a decline (P < 0.0001) in 25(OH)D3. Substantial between-individual variation in 25(OH)D response was observed for both D2 and D3. The highest 25(OH)D observed was 72.5 ng/ml. Vitamin D administration did not alter serum calcium, PTH, bone-specific alkaline phosphatase, N-telopeptide, or 24-h urine calcium. Conclusions: Overall, D3 is slightly, but significantly, more effective than D2 to increase serum 25(OH)D. One year of D2 or D3 dosing (1,600 IU daily or 50,000 IU monthly) does not produce toxicity, and 25(OH)D levels of less than 30 ng/ml persist in approximately 20% of individuals. Substantial between-individual response to administered vitamin D2 or D3 is observed.

scholarly journals A Case of Primary Hyperparathyroidism due to Intrathyroidal Parathyroid Cyst

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Yavuz Yalcin ◽  
Turkan Mete ◽  
Recep Aktimur ◽  
Gultekin Ozan Kucuk ◽  
Gulhan Duman ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Cystic Degeneration ◽  
Ipth Level ◽  
Parathyroid Cyst ◽  
Parathyroid Adenomas ◽  
Parathyroid Lesions ◽  
Cyst Aspiration ◽  
Left Lobectomy ◽  
Parathyroid Cysts ◽  
Left Thyroid Lobe

Parathyroid cysts constitute 0.08–3.41% of all parathyroid masses. Intrathyroidal parathyroid cysts, however, are rare conditions with only a few cases being reported. Most of the parathyroid cysts are found to be nonfunctional and functional cysts are generally thought to be due to cystic degeneration of parathyroid adenomas. A cystic, smooth contoured lesion of 24 × 19 × 16 mm was observed in left thyroid lobe of a 76-year-old woman during ultrasonography which was performed as routine workup for primary hyperparathyroidism. It was defined as a cystic thyroid nodule at first. Tc99msestamibi scintigraphy was performed to see any parathyroid lesions, but no radioactive uptake was observed. Intact parathormone (iPTH) level was found to be >600 pg/mL in cyst aspiration fluid. Left lobectomy was performed, with a diagnosis of primary hyperparathyroidism due to functional parathyroid cyst. Serum iPTH level was decreased >50% postoperatively and histopathological evaluation was consistent with an encapsulated parathyroid adenoma with a cystic center. Parathyroid cysts are among rare causes of primary hyperparathyroidism. Diagnosis is made by markedly increased iPTH level in cyst fluid and observation of parathyroid epithelium lining the cyst wall.

scholarly journals Non-functioning oxyphilic parathyroid carcinoma: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Masaomi Sen ◽  
Ryuta Nagaoka ◽  
Hiroko Kazusaka ◽  
Mami Matsui ◽  
Marie Saitou ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Parathyroid Carcinoma ◽  
Parathyroid Tissue ◽  
Thyroid Peroxidase ◽  
Endocrine Tumors ◽  
Thyroid Lobe ◽  
Normal Ranges ◽  
Rare Malignancy ◽  
Left Thyroid Lobe

Abstract Background Non-functioning parathyroid carcinoma is an extremely rare malignancy among endocrine tumors. We report a case in which non-functional oxyphilic parathyroid carcinoma was diagnosed from clinical symptoms and pathological diagnosis. Case presentation The patient was a 42-year-old man with no medical or family history of note. He had presented to a local hospital with a neck mass 2 months earlier. Medullary thyroid carcinoma was diagnosed and he was referred to our department. A 3.5-cm mass was observed in the left thyroid lobe. Laboratory data for thyroid functions, thyroglobulin, anti-thyroglobulin antibodies, anti-thyroid peroxidase antibodies, serum calcium, and parathyroid hormone (PTH) were all within normal ranges. Ultrasonography revealed a 40-mm irregular, hypoechoic mass throughout the left thyroid lobe. Follicular thyroid tumor was suspected from fine-needle aspiration cytology. Left lobectomy was performed. Pathological features revealed a thick fibrous capsule around the tumor, and a thick fibrous band was observed inside the tumor. Both capsular invasions and vascular invasions were observed. Tumor cells were eosinophilic and displayed solid growth. Immunohistochemically, tumor cells were negative for thyroid transcription factor-1, negative for thyroglobulin, negative for chromogranin A (positive for normal parathyroid tissue within the nodule), positive for PTH, and positive for parafibromin. Ki-67 labeling index was 10%. Based on these findings, non-functional oxyphilic parathyroid carcinoma was diagnosed. One and a half years postoperatively, calcium and PTH were within normal ranges, and he has shown no evidence of recurrence or metastasis. Conclusions Non-functioning oxyphilic parathyroid carcinoma is an extremely rare malignancy, and definitive diagnosis is difficult to obtain preoperatively. Few reports have been made worldwide, and information on the long-term prognosis is scarce. Long-term surveillance by imaging is mandatory, since no indices that can be used as a marker for postoperative recurrence and metastasis have been identified.

scholarly journals Vitamin D therapy in patients with primary hyperparathyroidism and hypovitaminosis D

2009 ◽  
Vol 161 (1) ◽  
pp. 189-193 ◽  
Author(s):  
J R Tucci
Keyword(s):  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Hypovitaminosis D ◽  
Intact Parathyroid Hormone ◽  
Prospective Audit ◽  
Urine Calcium ◽  
Biochemical Effects ◽  
Biochemical Measurements ◽  
Serum Pth

ObjectiveTo determine whether vitamin D repletion of patients with primary hyperparathyroidism (PHPT) and vitamin D deficiency or insufficiency (hypovitaminosis D) has deleterious clinical and/or biochemical effects.DesignProspective audit of the effect of vitamin D repletion on biochemical data in 56 patients with PHPT. Patients were treated with 50 000 units of vitamin D2 weekly for 8 weeks with biochemical measurements at 5 and 10 weeks, and subsequently after 12 weeks on 800 units of vitamin D3 daily, and in those with hypovitaminosis D after 12 weeks of up to 100 000 units of vitamin D2 monthly.MethodsSerum calcium, albumin, phosphorus, 25-OHD, intact parathyroid hormone (PTH) and urine calcium/creatinine (Ca/Cr) ratios were measured before and during vitamin D therapy.ResultsPatients treated with 50 000 units of vitamin D2 weekly for 8 weeks resulted in a significant increase in serum 25-OHD levels from 36.4 to 89.4 nmol/l at 5 weeks (P<0.0001) and 88.6 nmol/l at 10 weeks (P<0.0001). There were no significant changes in serum calcium. At 10 weeks, there was a non-significant decrease in serum PTH and in urine Ca/Cr ratios. None of the patients developed any calcium-related adverse events. Subsequently, patients with subnormal 25-OHD levels on 800 units of vitamin D daily were treated for the next 12 weeks with up to 100 000 units of vitamin D2 monthly with normalization of serum 25-OHD in all but 4 patients.ConclusionThese data fail to demonstrate any adverse effects of vitamin D repletion in PHPT.

scholarly journals An Unusual Neck Mass: A Case of a Parathyroid Cyst and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Anand Goomany ◽  
Amy Rafferty ◽  
Ian Smith
Keyword(s):  
Imaging Techniques ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Review Of The Literature ◽  
Diagnostic Challenge ◽  
Anterior Neck ◽  
Cystic Fluid ◽  
Parathyroid Cyst ◽  
Parathyroid Cysts

Parathyroid cysts (PC) are an unusual cause of neck swellings. The majority are nonfunctioning and prove to be a diagnostic challenge given their nonspecific physical and radiological characteristics. This is compounded by their rare occurrence, leading them to be overlooked in the differential diagnosis of neck lumps. Imaging techniques fail to determine the origin of these lesions, but a preoperative diagnosis can be achieved by fine-needle aspiration and measurement of cystic fluid C-terminal parathyroid hormone levels. Treatment of nonfunctioning cysts remains controversial and includes needle aspiration, injection of sclerosant, or surgical excision. We present a case of a 44-year-old female presenting with an asymptomatic anterior neck swelling, diagnosed postoperatively as a parathyroid cyst.

scholarly journals Serum parathyroid hormone level is associated with body mass index. The 5th Tromso study

2004 ◽  
pp. 167-172 ◽  
Author(s):  
E Kamycheva ◽  
J Sundsfjord ◽  
R Jorde
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Vitamin D ◽  
Parathyroid Hormone ◽  
Relative Risk ◽  
Body Mass ◽  
Serum Calcium ◽  
Population Based ◽  
Serum Parathyroid Hormone ◽  
Serum Pth

OBJECTIVE: To study whether serum parathyroid hormone (PTH) and serum calcium are associated with body mass index (BMI), and their predicting role in obesity. DESIGN: Population based, cross-sectional study. METHODS: In 2001 a population-based health survey was held in Tromso, North Norway. Questionnaires on medical history and life-style factors were completed and anthropometric data were collected. Calcium and vitamin D intakes and a physical activity score were calculated. Serum calcium and PTH were measured in a subset of 3447 men and 4507 women. Pearson correlation and linear regression were used to evaluate associations between BMI, PTH and serum calcium, and logistic regression was used to test PTH and serum calcium as predictors of obesity and to calculate odds ratio. Relative risk was calculated using frequency tables. RESULTS: For serum calcium and PTH there was a significant positive relation to BMI in both genders (P<0.001), which to our knowledge has not previously been reported on the basis of a large epidemiological study. Age, low calcium and vitamin D intakes were explanatory variables for serum PTH. The highest quartile of serum PTH (>4.20 pmol/l) was a significant predictor for obesity (P<0.001) in both genders, adjusted for age, physical activity and serum calcium. Obesity rates were higher in those with PTH levels in the highest quartile compared with those in the lower quartiles, which resulted in a relative risk of 1.40 (95% confidence interval (C.I.) 1.20-1.60) for men and 1.48 (95% C.I. 1.31-1.67) for women. CONCLUSIONS: Serum PTH, adjusted for age, physical activity and serum calcium, is positively associated with BMI in both sexes, and serum PTH is an independent predictor of obesity in our statistical model.

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