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  • Recurrent multinodular goitre and primary hyperparathyroidism due to adenoma arising in a parathyroid autotransplant more than 20 years after near-total thyroidectomy

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Case Reports: Rare disease
Recurrent multinodular goitre and primary hyperparathyroidism due to adenoma arising in a parathyroid autotransplant more than 20 years after near-total thyroidectomy
  1. Victoria Boggiano1,
  2. Kathleen Barnhouse1,
  3. Tahereh Ghorbani Rodriguez2 and
  4. Lawrence Kim3
  1. 1Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Department of Endocrinology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3Division of Surgical Oncology, UNC, Hillsborough, North Carolina, USA
  1. Correspondence to Dr Victoria Boggiano; victoria.boggiano{at}unchealth.unc.edu

Abstract

The patient is a female in her 60s with a remote history of a near-total thyroidectomy in 1997 for multinodular goitre. At the initial operation, she sustained a left recurrent laryngeal nerve injury. A devascularised parathyroid gland was autotransplanted into the right sternocleidomastoid muscle. She had been off of thyroid hormone for long periods, and her most recent levothyroxine requirement had fallen to only 25 mcg daily. The patient presented more than 20 years after her thyroidectomy with hoarseness, fatigue and dyspnoea. Laboratory studies suggested primary hyperparathyroidism. Imaging demonstrated bilateral pulmonary emboli and bulky thyroid tissue extending into her mediastinum. She underwent a completion thyroidectomy with the removal of a parathyroid adenoma arising in the autotransplanted parathyroid. This case illustrates the possibility of regrowth of benign thyroid tissue after thyroidectomy. In addition, to our knowledge, this is the first case report of a parathyroid adenoma arising from autotransplantation of a normal parathyroid.

  • Thyroid disease
  • Pituitary disorders

http://dx.doi.org/10.1136/bcr-2023-256177

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    Footnotes

    • Twitter @vboggiano

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: VB, KB, TGR and LK. The following authors gave final approval of the manuscript: VB, KB, TGR and LK.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.