Başak KARBEK, Erman ÇAKAL, Sinan GÜLTEKİN, Müyesser SAYKI ARSLAN, Mustafa ÇALIŞKAN, Tuncay DELİBAŞI, Oya TOPALOĞLU

İki olgu nedeniyle intratiroidal paratiroid adenomu

Paratiroid adenomuna bağlı primer hiperparatiroidizm (PHP) tanısı alan hastaların tedavisinde güncel eğilim, adenomun yerleşim yerinin preoperatif dönemde kesin olarak belirlenmesi yönündedir. Ancak, tiroid ve paratiroid lezyonlarının sitolojik özelliklerindeki benzerlikler preoperatif dönemde ayırıcı tanıda zorluk oluşturmaktadır. Bu çalışmada iki olgu sunulmaktadır. İlk olgumuz, hiperkalsemiyle başvuran ve biyokimyasal hiperparatiroidizm tanısı konulan, tiroid ultrasonografisi ve teknesyum-99m sestamibi kullanılarak yapılan tek foton emisyon bilgisayarlı tomografi protokolüne uygun paratiroid sintigrafisi bulgularına göre preoperatif dönemde intratiroidal paratiroid adenomu saptanan 48 yaşındaki bir kadın hastadır. Bu hastada sağ lobektomi ile intratiroidal paratiroid adenomuna bağlı PHP tanısı kesinleştirilmiştir. İkinci olgumuz ise preoperatif dönemde klinik, biyokimyasal hiperparatiroidizm saptanıp ultrasonografi ve sintigrafi ile teyid edilen ancak postoperatif intratiroidal paratiroid adenomu olmadığı anlaşılan 43 yaşında bir erkek hastadır. Bu olgu sunumu, nadir görülen paratiroid adenomuna bağlı hiperparatiroidizm olgularında preoperatif dönemdeki tanısal zorluklara ışık tutmak ve olası çözümleri tartışmak amacıyla sunulmaktadır.

Intrathyroidal parathyroid adenoma with two cases

The current trend is toward definitive preoperative localization of parathyroid adenoma in management of patients diagnosed as primary hyperparathyroidism due to parathyroid adenoma. However, the similarities in the cytological features of both thyroid and parathyroid lesions make the preoperative differential diagnosis harder. We here present two case reports. The first case is a 48-year-old woman presented with hypercalcemia from biochemical hyperparathyroidism and diagnosed preoperatively as intrathyroidal parathyroid adenoma according to the findings obtained thyroid ultrasonography and parathyroid scintigraphy by the protocol using single photon emission computed tomography with technetium-99m sestamibi The diagnosis of primary hyperparathyroidism due to intrathyroidal parathyroid adenoma was confirmed with the followed right lobectomy. The second case is a 43 year old man with clinical and biochemical hyperthyroidism confirmed by ultrasonography and scintigraphy however it was understood in the postoperative period that the case were not intrathyroidal parathyroid adenoma. This case reports presented to shed some light on the potential preoperative diagnostic difficulties in the rare cases of hyperparathyroidism due to intrathyroidal parathyroid adenoma and to discuss the possible solutions.

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