J Endocr Surg.  2024 Mar;24(1):14-18. 10.16956/jes.2024.24.1.19.

Intrathyroidal Parathyroid Hyperplasia Misdiagnosed as Hurthle Cell Neoplasm

• Kim JK
• Kim GJ
• Cha J
• Kang SW
• Jeong JJ
• Nam KH
• Chung WY

• KMID: 2562800
• DOI: http://doi.org/10.16956/jes.2024.24.1.19

Abstract

This case report details the medical history of a 60-year-old male with end-stage renal disease undergoing hemodialysis. The patient was referred for an assessment of thyroid nodules. Ultrasound revealed probably benign nodules of 2.6 cm and 1.4 cm in the right and left thyroid poles, respectively. The right thyroid nodule was confirmed as a Hurthle cell neoplasm through a core needle biopsy. Laboratory tests indicated elevated serum parathyroid hormone (PTH) and calcium levels, suggesting secondary hyperparathyroidism. Subsequent evaluations, including a parathyroid scan and single photon emission computed tomography-computed tomography, identified probable parathyroid adenomas displaying increased radiotracer uptake. Moreover, delayed images revealed heightened uptake in two intrathyroidal nodules detected during recent ultrasonography. Intraoperative PTH measurements exhibited a significant 66.5% decline following the resection of the right thyroid. While frozen sections of the right thyroid indicated Hurthle cell proliferative lesions, the final histopathological examination unveiled nodular parathyroid hyperplasia. This case underscores the challenges in distinguishing between thyroid and parathyroid pathologies and underscores the importance of comprehensive assessments in managing such cases.

Keyword

Parathyroid adenoma; Primary hyperparathyroidism; Hurthle cell tumor; Thyroid nodule