Management of Type III Intrathyroidal Parathyroid Adenomas By Enucleation: Case Report and Literature Review

Parathyroid adenoma is a common endocrine disorder, but its intrathyroid presentation is relatively rare. The traditional approach, such as thyroid blind lobectomy, is the most frequent modality of treatment due to the possible unclear localization of the adenoma in the preoperative workup. This increases the risk of unnecessary probability of hypothyroidism.  We report a case of a 48-year-old male patient who was referred to the endocrinology outpatient clinic due to elevated calcium (Ca) and elevated parathyroid hormone (PTH) levels, indicating primary hyperparathyroidism (PHPT). Thyroid ultrasound (US) confirmed the presence of thyroid lobe nodule and the fine needle aspiration cytology (FNAC) revealed the presence of parathyroid cells. A thyroid scan with the single photon emission computed tomography (SPECT)/CT revealed a possible left inferior parathyroid adenoma. The patient underwent surgical excision of the left parathyroid adenoma by cervicotomy and thyroid lobe preservation with prompt normal PTH level recovery without complications. One year follow-up revealed no complications, and the patient's serum thyroid function, PTH, and Ca levels remained within the normal range. The management of type III intrathyroidal parathyroid adenomas (iT-PAs) by enucleation offers a viable alternative for selected PHPT patients. Advanced diagnostic imaging helps but is often not able to confirm exactly their location. Individualized surgical approaches contribute to successful outcomes while preserving thyroid tissue. The establishment of standardized guidelines is essential to optimize the management of iT-PAs and enhance patient care. We present a case of a type III iT-PA by enucleation preserving the thyroid tissues along with the analysis of the few cases previously reported.