A Silent Non-thyroidal Adenoma in the Thyroid
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CLINICAL REPORT
A Silent Non-thyroidal Adenoma in the Thyroid Deviprasad Dosemane1 Nahas Kalathigal1
•
Meera Niranjan Khadilkar1
•
Hema Kini2
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Received: 1 September 2020 / Accepted: 21 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract The surgeon needs to assess clinically significant thyroid nodules as they may represent aggressive forms of thyroid cancer or ectopic parathyroid glands. We discuss one such unusual nodule in the thyroid.
normal and ectopic locations results in hyperparathyroidism, which is associated with symptoms of hypercalcemia, such as nausea, vomiting, renal colic or bone pain [3].
Keywords Immunohistochemistry Parathyroid adenoma Parathyroid neoplasms Thyroid nodule Thyroidectomy
Case Report
Introduction Thyroid nodules are extremely common. Studies have shown that 44–77% of nodules are benign colloid nodules, 15–40% are benign follicular adenomas, and 8–17% are differentiated thyroid cancer. Very small percentages of thyroid nodules turn out to be more aggressive forms of thyroid cancer [1] or ectopic intra-thyroid parathyroid glands (ETPG) [2]. Parathyroid hyperplasia or adenoma in & Meera Niranjan Khadilkar [email protected] Deviprasad Dosemane [email protected] Hema Kini [email protected] Nahas Kalathigal [email protected] 1
Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India
2
Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India
A 60-year-old woman presented to the outpatient department with a slowly progressing anterior midline neck mass for 3 months. She had no difficulty in swallowing, change in voice, symptoms indicating hypothyroidism, hyperthyroidism, or parathyroid disorder. She was a known diabetic and hypertensive on regular treatment. Physical examination revealed a swelling of 6 9 5 cm in the midline of the neck, more towards the left. It moved with deglutition, was firm in consistency, non-tender. Few more nodules were palpable in the left lobe, largest being 1 9 1 cm. Ultrasonography (USG) neck showed a large cystic lesion with multiple septae and low-level internal echoes, occupying left lobe (7 9 3.6 cm), extending inferiorly up to suprasternal notch. Left lobe measured 6.3 9 4 9 4.3 cm; right lobe measured 4.8 9 1.5 9 1.6 cm. Few cystic lesions of 3–4 mm were noted scattered in right lobe; no parathyroid abnormality was detected. Fine needle aspiration cytology was inconclusive. Thyroid and renal function tests were normal; parathyroid hormone and calcium levels were not tested. With a provisional diagnosis of colloid nodule, total thyroidectomy was performed. Intraoperatively, 3 of 4 parathyroid glands were found in normal location, appeared normal, and were preserved. The left inferior parathyroid gland was not visualized. Postoperative period was uneventful. Gross examination revealed a multiloculated cyst meas
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