Secondary hyperparathyroidism induced parathyroid adenoma masquerading as a solitary thyroid nodule-a case report

Abstract

Parathyroid adenoma is associated with both primary and secondary hyperparathyroidism (SHPT). Identification of the adenoma requires a combination of clinical evidence, imaging information and cytological findings due to the challenging distinction between thyroid and parathyroid lesions. Sometimes ultrasound and even fine needle aspiration studies cannot distinguish this lesion from thyroid lesions. We present a case who was incidentally detected to have nodule in the (R) lobe of thyroid on CE-MRI. FNAC was suggestive of follicular neoplasm so managed as right hemithyroidectomy but the final diagnosis was made as parathyroid adenoma on the basis of histopathological examination and immunohistochemistry. Patient was evaluated retrospectively utilizing serum PTH levels, 24 hours urine calcium levels, inorganic phosphorus and USG KUB which turn out to be vitamin D deficiency induced SHPT and was managed with vit D3 supplements.