Ultrasonically guided fine needle aspiration of suspect parathyroid tissue to determine parathyroid hormone concentration.

Ultrasonically guided fine needle aspiration of suspect parathyroid tissue to determine parathyroid hormone concentration Since the study of Arima et al,1 several reports have confirmed that enlarged parathyroid glands can be located preoperatively using ultrasound. A general problem has been the difficulty of distinguishing nodular thyroid lesions from enlarged parathyroid glands.2 3 We report two cases in which parathyroid adenoma was correctly diagnosed using ultrasonically guided fine needle aspiration for determination of parathyroid hormone concentration. A 39 year old woman presented with hypercala. Two years previously she had had a stone removed from her left-kidney, and she had recently had a one day episode of severe haematuria. Serum creatinine concentration was normal. Intravenous pyelography showed four stones in the right kidney. Parathyroid subtraction scintigraphy of the neck was inconclusive, but ultrasonography showed a 4 x 1P5 x 1-5 cm nodule with a low intensity echogenic pattern posterior to the lower pole of the right lobe of the thyroid gland. Fine needle (22 gauge) aspiration of the abnormal area (parathyroid tissue) and the thyroid gland was performed under ultrasonic guidance after injection of 1 ml isotonic saline. The aspirated specimens (0 1 ml each) were diluted to a final volume of 1 ml with sterile water and centrifuged, ard finally the supernatant was analysed by C terminal radioimmunoassay.4 Parathyroid hormone concentrations were 150 pg/l in the parathyroid tissue and 2-0 Fg/l in the thyroid gland. At operation the ultrasonic mnding was confirmed and a parathyroid adenoma removed. Postoperatively, serum-calcium concentration returned to normal. A 69 year old woman presented with hypercalcaemia and intermittent sinoatrial block. She had had dyspnoea and chest pains on effort for two years. On admission serum calcium concentration was 3-08 mmol/l (12-3 mg/ 100 ml); ionised calcium 1-61 mmol/l (6-5 mg/100 ml); phosphate 0-71 mmol/l (2-2 mg/100 ml); and parathyroid-hormone P14 jug/l. Pyelography and radiography of the chest and skeleton yielded normal results. Echocardio-graphy showed stenosis of the aortic valves; Ultrasonography showed a 1 x 1 x 4 cm, well defined nodule with a homogenous low intensity internal echo pattern inferior to the upper pole of the thyroid gland. Aspiration of the abnormal area (parathyroid-tissue) and the thyroid gland was performed under ultrasonic guidance as in case 1; parathyroid hormone concentrations were 200 and 1-5 pgfl, respectively. A parathyroid adenoma was removed, and serum calcium concentration returned to normal post-operatively. Comment Distinguishing enlarged parathyroid glands from nodular …