Ectopic intrathyroid parathyroid adenoma: diagnostic and therapeutic challenges due to multiple osteolytic lesions. Case report.

ABSTRACT

Intrathyroid parathyroid adenoma is a rare lesion. Its location is usually achieved by cervical ultrasound and scintigraphy. We present the case of a 48-years old woman admitted for malaise, weight loss, generalized bone pain, and important limitation of hip and scapular-humeral joints mobility. Cervical ultrasound identified a 4 cm nodular mass in the right thyroid lobe. Computed tomography revealed multiple osteolytic lesions in the pelvis, femur, ribs, phalanx, and humerus. Imagery and elevated serum levels of calcium and parathormone led to primary hyperparathyroidism, right parathyroid adenoma and bone "brown tumors". Intraoperatively, the adenoma was found in intrathyroid location. Total right lobectomy was performed. Postoperatively, the patient developed "hungry bone" syndrome requiring prolonged calcium and vitamin D treatment.