Parathyromatosis as a cause of recurrence primary hyperparathyroidism: A case report

Parathyromatosis is a rare cause of recurrent hyperparathyroidism. The main cause of this pathology is secondary implantation into the surrounding tissues of the damaged parathyroid gland (rough manipulation of the gland tissue) during the primary operation. Nowadays, parathyromatosis remain a difficult diagnostic and therapeutic task.

A 57-year-old woman 12 years ago underwent right inferior parathyroid adenomectomy. For the last 2 years, the patient began to worry about pain in large tubular bones, thoracic spine. In the biochemical analysis of the patient's blood, the serum ionized calcium level was increased - 1.56 mmol/l, parathyroid hormone - 144 pg/ml. Ultrasound scan of the neck showed the presence of two hypoechoic formations with dimensions of 24 × 12 × 6 mm and 14 × 9 × 8 mm behind the right lobe of the thyroid gland (the site of a previously operation).The patient underwent cervicotomy, removal of 3 fragments of the parathyromatosis tissue. According to a histological study, there fragments are presented by diffuse-nodular hyperplasia from dark main cells. Remission of primary hyperparathyroidism was achieved.

This clinical case shows the need for differential diagnosis in recurrence primary hyperparathyroidism with parathyroid cancer, secondary hyperparathyroidism, parathyromatosis.

The main method of treatment is the surgical removal of all foci of parathyromatosis. In the postoperative period, observation of such patients is required with laboratory and visual screening to exclude recurrence hyperparathyroidism.