Yang Jun, Liu Ninghu, Wang Jili, Su Xinhui
Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China.
The Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R. China.
BMC Nephrol. 2025 Feb 3;26(1):53. doi: 10.1186/s12882-024-03878-3.
An intrathyroidal parathyroid adenoma (IPA) is a very rare cause of recurrent hyperparathyroidism after parathyroidectomy in patients undergoing long-term haemodialysis. An IPA is often difficult to localize preoperatively, making diagnosis and treatment challenging. We herein report a rare case of recurrent hyperparathyroidism due to a gradually increasing IPA in a fifth parathyroid gland.
A 24-year-old Chinese woman had end-stage renal disease secondary to chronic glomerulonephritis and started regular haemodialysis in March 2007. She was diagnosed with renal hyperparathyroidism as indicated by elevated parathyroid hormone and calcium levels in 2011. One year later, the parathyroidectomy with right forearm autotransplantation was performed in January 2012. Pathology revealed parathyroid nodular hyperplasia in four of the nodules. Twelve years after surgery, the nodule in the right thyroid was detected by multiple imaging modalities. In addition to the recurrence of renal hyperparathyroidism, the nodule gradually increased in size. Total right thyroid lobectomy was performed, and the patient was diagnosed with an IPA. At the 3-month follow-up examination, she had no signs of recurrence despite regular haemodialysis, and her PTH and serum calcium levels were stable.
This is a rare case of recurrent hyperparathyroidism due to a gradually increasing fifth parathyroid gland in a patient who underwent long-term haemodialysis after parathyroidectomy. We suggest vigilant postoperative monitoring for prompt and early identification of culprit parathyroid lesions, even if the four parathyroid glands have been dissected.
甲状腺内甲状旁腺腺瘤（IPA）是长期血液透析患者甲状旁腺切除术后复发性甲状旁腺功能亢进的一种非常罕见的病因。IPA术前常难以定位，这使得诊断和治疗具有挑战性。我们在此报告一例罕见的因第五个甲状旁腺中IPA逐渐增大导致复发性甲状旁腺功能亢进的病例。
一名24岁的中国女性因慢性肾小球肾炎继发终末期肾病，于2007年3月开始定期血液透析。2011年，她因甲状旁腺激素和钙水平升高被诊断为肾性甲状旁腺功能亢进。一年后，于2012年1月进行了甲状旁腺切除术并将甲状旁腺自体移植至右前臂。病理显示四个结节中有甲状旁腺结节性增生。手术后12年，通过多种影像学检查发现右甲状腺有结节。除了肾性甲状旁腺功能亢进复发外，该结节大小逐渐增大。遂行右侧甲状腺全叶切除术，患者被诊断为IPA。在3个月的随访检查中，尽管进行了定期血液透析，但她没有复发迹象，甲状旁腺激素（PTH）和血清钙水平稳定。
这是一例罕见的因甲状旁腺切除术后长期血液透析患者第五个甲状旁腺逐渐增大导致复发性甲状旁腺功能亢进的病例。我们建议术后进行密切监测，以便及时早期识别甲状旁腺病变的元凶，即使四个甲状旁腺已被切除。
