Rocha José Vicente, Vaz Lopes Marta, Delfim Francisca, Peixe Carolina, Coelho Gomes Ana, Fernandes Leonor, Leitão João, Lacerda Nobre Ema
Endocrinology, Diabetes and Metabolism Department, Hospital de Santa Maria, ULS Santa Maria, Lisbon, Portugal.
Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
J Ultrasound. 2025 Jul 10. doi: 10.1007/s40477-025-01053-4.
Primary Hyperparathyroidism (PHPT) is a disorder of calcium metabolism most frequently due to a parathyroid adenoma. Although parathyroidectomy is the treatment of choice, Microwave Ablation Therapy (MWA) has also been applied for the treatment of PHPT. The incidence of ectopic parathyroid glands ranges from 10 to 22% with an intrathyroid parathyroid adenoma (IPA) being a possible cause of PHPT (0.7-6.7%). The best treatment for IPAs is still in debate.
A 47-year-old woman was referred to the endocrinology clinic following an incidental finding of PHPT. The patient had no personal history of bone fractures or nephrolithiasis. Biochemical analysis demonstrated elevated serum calcium (11.9 mg/dL), low serum phosphate (2 mg/dL), and elevated parathyroid hormone (PTH) levels (199 pg/mL). A [99mTc]Tc-MIBI scintigraphy scan showed slight persistent uptake in the inferior third of the left thyroid lobe and the neck ultrasound identified a mixed predominantly solid and slightly hypoechoic nodule, measuring 2.1 × 1.8 × 1.5 cm (LxTxAP). Fine-needle aspiration biopsy (FNAB) confirmed IPA. MWA of the IPA in the left thyroid lobe was performed with no complications and a 90% nodule volume reduction and a reduction of serum calcium and PTH values at 6 months were achieved, no longer reaching surgical criteria.
To our knowledge this is the first reported MWA of an IPA. Literature review identified a total of 5 patients that had IPAs treated with radiofrequency ablation. MWA ablation may be a viable alternative to surgery in the treatment of IPAs.
原发性甲状旁腺功能亢进症（PHPT）是一种钙代谢紊乱疾病，最常见的病因是甲状旁腺腺瘤。虽然甲状旁腺切除术是首选治疗方法，但微波消融治疗（MWA）也已应用于PHPT的治疗。异位甲状旁腺的发生率为10%至22%，甲状腺内甲状旁腺腺瘤（IPA）是PHPT的一个可能病因（0.7% - 6.7%）。IPA的最佳治疗方法仍存在争议。
一名47岁女性因偶然发现PHPT被转诊至内分泌科门诊。该患者无骨折或肾结石个人史。生化分析显示血清钙升高（11.9mg/dL）、血清磷降低（2mg/dL）以及甲状旁腺激素（PTH）水平升高（199pg/mL）。[99mTc]Tc - MIBI闪烁扫描显示左甲状腺叶下三分之一处有轻微持续摄取，颈部超声检查发现一个混合性为主的实性且略低回声结节，大小为2.1×1.8×1.5cm（长×宽×前后径）。细针穿刺活检（FNAB）确诊为IPA。对左甲状腺叶内的IPA进行了MWA，无并发症发生，6个月时结节体积缩小90%，血清钙和PTH值降低，不再达到手术标准。
据我们所知，这是首例关于IPA的MWA报道。文献回顾共发现5例接受射频消融治疗的IPA患者。MWA消融可能是治疗IPA的一种可行的手术替代方法。
