Thyroid cancer - Radiofrequency - Puncture - Diagnosis - Treatment
4 glands 2 upper and 2 lower, in contact with the posterior face of the thyroid and they secrete parathormone (PTH), responsible for hypercalcemia.
5 mm in diameter, L = 8 mm W = 4 mm E = 2 mm
The normal parathyroid is a 5 mm gland in contact with the thyroid.
No attempt is made to visualize normal parathyroids
Clinically hyperparathyroidism is often discovered fortuitously without symptoms during a check-up or sometimes a decalcification discovered in bone densitometry
There is a bone form (pain asthenia) and a urinary form (lithiasis, nephrocalcinosis)
Hypercalcemia > 2.7 m mol/l
_cc781905-5cde-3194 -bb3b-136bad5cf58d_ > 3 m mol/l = acute HPT.
Faced with hyperparathyroidism, we essentially look for a parathyroid adenoma (90%) and hyperplasia (10 – 15%) and exceptionally a carcinoma.
The exploration is based on two examinations:
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morphological = ultrasound
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functional = scintigraphy MIBI
Other exams:
SCANNER, MRI, PET CHOLINE
The ultrasound appearance of parathyroid adenomas
In general, the parathyroid adenoma is a solid strongly hypoechoic or anechoic lesion with an oval shape, located in contact with the posterior edge of the thyroid lobe.
The appearance is the same for hyperplasia or exceptional carcinoma.
Documents of Dr. Haitham Sharara CHU of Nîmes.
The interface between the thyroid and the parathyroid is fine and sometimes difficult to dissociate from the thyroid.
Documents of Dr. Haitham Sharara CHU of Nîmes.
Identifying the vascular pedicle helps to avoid misinterpretations.
Documents of Dr. Haitham Sharara CHU of Nîmes.
In the literature we note between 15 and 20% of atypical forms :
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Presence of calcifications
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Cystic form
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Multi-lobed form
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Giant adenomas
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hematomas
Presence of calcifications
Partially cystic form.
Documents of Dr. Haitham Sharara CHU of Nîmes.
Giant form.
Documents of Dr. Haitham Sharara CHU of Nîmes.
Diagnosis and differential diagnosis.
The diagnosis of a parathyroid adenoma is not always easy and it is sometimes possible to confuse it with a thyroid nodule in an extra-thyroidal position or sometimes with adenopathies of lymph node territories VI in the context of chronic Hashimoto's thyroiditis.
An example: the typical case of a typical parathyroid adenoma with a strongly hypoechene echostructure in a classic retrothyroid position with an increase in PTH.
Documents of Dr. Haitham Sharara CHU of Nîmes.
A cytopuncture performed with a sample for cytological analysis and another to measure TG and PTH.
The cytology and the TG and PTH assay are related to a benign thyroid nodule in an extra-thyroid position.
Here is the case of a lesion in an extra-thyroidal position, therefore the diagnosis of a parathyroid adenoma is evoked without being able to rule out the hypothesis of a thyroid nodule in an extra-thyroidal position because of the weak hypoechogenicity of the lesion.
Diagnostic trap
Scintigraphy and MRI did not allow a formal diagnosis.
Operated patient
Histology:
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Right thyroid lobectomy: two subcentimetric vesicular nodules without histological sign of malignancy.
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Retrothyroid lesion: remodeled schwannoma.
Absence of signs of malignancy.
Another exceptional case
A highly hypoechoic-looking retrothyroid lesion could be related to a giant parathyroid adenoma.
The biological assessment shows the absence of biological abnormality with a normal PTH
Documents of Dr. Haitham Sharara CHU of Nîmes.
Cytopuncture performed with a sample for cytological analysis and another for PTH and TG dose
No diagnosis, cytology is not representative and low dosage for TG and PTH
parathyroid cancer
Cancer of the parathyroid glands is a very rare pathology and often presents with severe primary hyperparathyroidism.
Diagnosis is histological but not always easy. Treatment is based on surgery.
The clinical picture often corresponds to renal colic with renal lithiasis
Repeat offenders
A severe increase in PTH > 1000 pg /ml is to times normal
Surgical treatment with parathyroidectomy, with mediastinal-recurrent dissection.
Literature picture.
Conclusion
Ultrasound of the parathyroid glands is an essential morphological examination in the diagnosis of parathyroid adenoma.
It is recommended to perform a cytopuncture with TG and PTH assay for atypical lesions in order to avoid diagnostic pitfalls of thyroid nodules in an extra-thyroid position or parathyroid adenomas in an intra-thyroid position. thyroid.
Ultrasound is a morphological examination and it is necessary to confirm the diagnosis by a functional examination (scintigraphy +- PET with choline).