Images in Endocrine Pathology: High-Grade Intrathyroidal Parathyroid Carcinoma with Crooke’s Hyalinization

Excerpt

A 72-year-old African American female initially presented with primary hyperparathyroidism: parathyroid hormone (PTH) was elevated at 316 pg/ml (normal: 14–72 pg/ml), serum calcium levels measured up to 13.0 mg/dl (normal: 8.6–10.6 mg/dl), and 24-h urinary calcium was high at 339 (normal 100–300 nl). Renal ultrasound showed renal pelvic calcinosis, and a DEXA showed osteoporosis and a new wrist fracture. A neck ultrasound showed possible bilateral parathyroid adenomas so the patient was scheduled for bilateral exploration. No sestamibi scan was pursued. A right inferior parathyroidectomy was performed, revealing a parathyroid adenoma. Postoperatively, the patient’s PTH and calcium levels continued to fluctuate, but stayed largely within normal limits. Two years following the initial procedure, the patient presented with a new left neck mass and polyuria. Ultrasound examination revealed an enlarged left thyroid lobe. The patient’s calcium level was within normal limits; however, PTH was slightly elevated (105.8 pg/ml). A left thyroid lobectomy was performed. …