Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Toxic thyroid adenoma with hypercalcemia mimicking an intra-thyroidal parathyroid adenoma

Document Type : Case report

Authors
Venkata Subramanian Krishnaraju
Ritesh Upadhyay
Ashwani Sood
Anish Bhattacharya
Bhagwant Rai Mittal
Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
10.22038/aojnmb.2021.57103.1398
Abstract
Hypercalcemia is a clinical condition characterized by elevated circulating serum calcium levels either due to raised parathyroid hormone in hyperparathyroidism or due to secondary causes of hypercalcemia without elevated parathyroid hormone levels. However, hyperthyroidism may occasionally present with incidentally detected hypercalcemia. We present a case of a 53-year-old woman with a previous history of an underlying thyroid disorder, now presented with features of hypercalcemia and mildly elevated parathyroid hormone levels. Her ultrasonography of the neck was suggestive of an intra-thyroidal parathyroid adenoma and it was localized as a tracer avid lesion within the thyroid gland on dual-phase 99mTc-sestamibi planar scintigraphy with single photon emission computed tomography/ computed tomography (SPECT/CT). However, a subsequent thyroid profile followed by 99mTc- pertechnetate thyroid scintigraphy showed a hot nodule in the thyroid gland which changed the diagnosis to a toxic thyroid adenoma. She was treated with radioactive iodine ablation and thyrotoxicosis resolved and the serum calcium levels normalized on her follow-up. 
Keywords
Thyroid adenoma hypercalcemia
Parathyroid adenoma
Sestamibi
Pertechnetate
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Asia Oceania Journal of Nuclear Medicine and Biology
Volume 10, Issue 1
January 2022
Pages 53-56