This middle-aged woman presented with hyperparathyroidism. A parathyroid sestamibi scan showed intense activity in the left lower parathyroid gland, 2 hours after the administration of the Tc 99 isotope. A slight activity was also detected on the right side, raising the possibility that another parathyroid adenoma might be present on the right.
On a thyroid ultrasound study a mass is noted posterior to the left thyroid lobe.
This is the same ultrasound depicted above. The isthmus and left lobe of the thyroid were colored blue. The left lower parathyroid mass was colored yellow.
This CT scan study of the same patient shows the parathyroid adenoma
posterior to the left thyroid lobe.
The left inferior parathyroid was explored with a minimally invasive technique (MIRP)and after an intravenous infusion of methylene blue. A left lower parathyroid adenoma was easily identified, removed and confirmed by frozen section (see picture of surgical specimen above). Intraoperative serum intact PTH and calcium levels dropped to normal immediately after the removal of the adenoma. With this abrupt drop in PTH and calcium levels, It was obvious that the suspicious activity on the right side was not an adenoma., and therefore, the right side did not require exploration.