Unusual presentations of functional parathyroid cysts: a case series and review of the literature

Cysts of parathyroid origin are sometimes encountered and can easily be mistaken as thyroidal cysts. Functional parathyroid cysts, with symptoms and signs of hyperparathyroidism, are rare and may be a diagnostic challenge to clinicians. We report here on three cases of functional parathyroid cysts that illustrate diagnosis difficulties related to unusual clinical presentations in three Caucasian women, including negative parathyroid scintigraphy.

Patient 1, an 87-year-old Caucasian woman presented with confusion and dysphagia. She had hypercalcemia and elevated parathyroid hormone levels suggesting primary hyperparathyroidism. Parathyroid scintigraphy did not reveal any focal uptake, but a computed tomography scan of her neck identified a large cyst in the upper right thyroid region. At cervicotomy, a parathyroid cystic adenoma was removed. Patient 2, a 31-year-old Caucasian woman was investigated after a hypertensive crisis related to primary hyperparathyroidism. Cervical ultrasound identified a large cystic lesion in the lower left thyroid lobe that was removed by minimally invasive cervicotomy. Patient 3, a 34-year-old Caucasian woman presented with an indolent growing mass of the neck and a past medical history of kidney stones. Primary hyperparathyroidism was diagnosed. Ultrasound showed a cystic mass, but parathyroid scintigraphy was negative. Cervical exploration revealed a large cystic adenoma, containing high parathyroid hormone levels.

Diagnosis of functional parathyroid cysts can be challenging due to various clinical presentations and negative parathyroid scintigraphy. Surgery, but not fine-needle sclerotherapy, appears to be the safest treatment option. Despite its rarity, differential diagnosis of cystic lesion of the neck should include primary hyperparathyroidism due to functional parathyroid cysts.