Thyroid Ultrasonography and Fine Needle Aspiration Biopsy: A Practical Guide and Picture Atlas

Ultrasound of Parathyroid Glands

Author(s): Samer El-Kaissi and Jack R Wall

Pp: 80-84 (5)

DOI: 10.2174/9781681086859118010011

* (Excluding Mailing and Handling)

Abstract

When considering surgery for the treatment of primary hyperparathyroidism, accurate pre-operative localisation of the hyperfunctioning parathyroid adenoma is associated with successful resection of the adenoma and correction of hypercalcaemia using minimally invasive parathyroid surgery. Hyperparathyroidism is most commonly caused by a single parathyroid adenoma, while multiple gland hyperplasia is less common and parathyroid carcinoma is rarely encountered. Neck ultrasound is an excellent tool for the localisation of a single parathyroid adenoma and allows examination of the thyroid gland for thyroid nodules which are seen in up to 40% of patients with hyperparathyroidism. The presence of thyroid nodules requires preoperative evaluation and exclusion of thyroid malignancy and may change the surgical approach. Parathyroid scintigraphy is complementary to ultrasound with the added advantage of identifying an ectopic parathyroid adenoma outside the field of ultrasound imaging. Parathyroid ultrasound and scintigraphy are both less sensitive for the detection of multiple parathyroid gland hyperplasia. Parathyroid gland fine needle aspiration biopsy and measurement of parathyroid hormone in the needle washout confirms the diagnosis when parathyroid imaging is inconclusive.


Keywords: Cervical lymphadenopathy, Colour Doppler study, Ectopic, Feeding artery, Fine needle aspiration, Neck ultrasound, Parathyroid adenoma, Parathyroid hyperplasia, Parathyroid carcinoma, Parathyroid lipoadenoma, Parathyroid nuclear scan, Primary hyperparathyroidism, Parathyroid hormone, Parathyromatosis, Parathyroid exploration, Parathyroidectomy, Thyroid nodule.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314520269 and j.to_ip >=314520269 )) and ((j.from_date <= 1740775960 and j.to_date >= 1740775960 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12820) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314520269 and j.to_ip >=314520269 )) and ((j.from_date <= 1740775960 and j.to_date >= 1740775960 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12820) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 314520269 and j.to_ip >=314520269 )) and ((j.from_date <= 1740775960 and j.to_date >= 1740775960 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 12820)
      2.74msalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 2636 and `b`.`banner_from_date` <= 1740775960 and `b`.`banner_to_date` >= 1740775960 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.11msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 2636
      • 3: 1740775960
      • 4: 1740775960
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='f8001e5dc47434bc01f019dcf05cb5dd'
      330μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:291
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    17Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        GiatGtyTtX8jlOfpCGmNBUVmTdQk9DzhppXKAbtu
        uc_cart_id
        f8001e5dc47434bc01f019dcf05cb5dd
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/12820" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/12820
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:16 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        []
        
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Fri, 28 Feb 2025 20:52:40 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IktMN29KTitsSTAwREtyRE1RR0JvQkE9PSIsInZhbHVlIjoiZWg0b0hNSU5xQUIreFJYRDdzQ1pJM29RTklGTU5CdFJISzgzbnFickI4T2xNam1pdGR1RFlNWnRRZnVBWUtKcXVVRCtob3pqVlo1TGtUdEZzaUkzY0JzZGtTeE5lWTkyelJlWG1FUkw0emlYamlZV0txeFY0UWNuV0RjYjhaTXUiLCJtYWMiOiJkM2UxZjk4Y2ZjOWJmYWY0Y2E0YWVhM2NmYzBkZGI1MWNmZDZkMzQzNjE2MWM4MTQzYWEyN2IyYWQxMzYyYWQ0IiwidGFnIjoiIn0%3D; expires=Mon, 03 Mar 2025 08:52:40 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IktMN29KTitsSTAwREtyRE1RR0JvQkE9PSIsInZhbHVlIjoiZWg0b0hNSU5xQUIreFJYRDdzQ1pJM29RTklGTU5CdFJISzgzbnFickI4T2xNam1pdGR1RFlNWnRRZnVBWUtKcXVVRCtob" 1 => "alphaeurekaselectnet_session=eyJpdiI6InBkK0tBeDN0c2N2SEZtSHlFM2xBakE9PSIsInZhbHVlIjoiOHM0S0hkUm80NzlPcHlZUU9JVVBxTnRWcnpDWTBDbjJlbkJ5aEpaMThZYU5pWThNM0xMd1NqNTViOVNpQlpQYUg5NEcvNURCVXJjN2M3elZHc3BzTjRMczVXcm1aUUNtWmd3M3FMTXc2S0g3Q1hlZ2pOaFRLQkQvL00zT0JWZEMiLCJtYWMiOiI2NzdkNWE1NzA1YWM1YjM5YzgyMzBhOWI4NGUzNGU2ZjdmYjVmYzk5YjhhNzE2NmUyNGM0N2QxODNkODAxNGU4IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6InBkK0tBeDN0c2N2SEZtSHlFM2xBakE9PSIsInZhbHVlIjoiOHM0S0hkUm80NzlPcHlZUU9JVVBxTnRWcnpDWTBDbjJlbkJ5aEpaMThZYU5pWThNM0xMd1NqNTV" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IktMN29KTitsSTAwREtyRE1RR0JvQkE9PSIsInZhbHVlIjoiZWg0b0hNSU5xQUIreFJYRDdzQ1pJM29RTklGTU5CdFJISzgzbnFickI4T2xNam1pdGR1RFlNWnRRZnVBWUtKcXVVRCtob3pqVlo1TGtUdEZzaUkzY0JzZGtTeE5lWTkyelJlWG1FUkw0emlYamlZV0txeFY0UWNuV0RjYjhaTXUiLCJtYWMiOiJkM2UxZjk4Y2ZjOWJmYWY0Y2E0YWVhM2NmYzBkZGI1MWNmZDZkMzQzNjE2MWM4MTQzYWEyN2IyYWQxMzYyYWQ0IiwidGFnIjoiIn0%3D; expires=Mon, 03-Mar-2025 08:52:40 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IktMN29KTitsSTAwREtyRE1RR0JvQkE9PSIsInZhbHVlIjoiZWg0b0hNSU5xQUIreFJYRDdzQ1pJM29RTklGTU5CdFJISzgzbnFickI4T2xNam1pdGR1RFlNWnRRZnVBWUtKcXVVRCtob" 1 => "alphaeurekaselectnet_session=eyJpdiI6InBkK0tBeDN0c2N2SEZtSHlFM2xBakE9PSIsInZhbHVlIjoiOHM0S0hkUm80NzlPcHlZUU9JVVBxTnRWcnpDWTBDbjJlbkJ5aEpaMThZYU5pWThNM0xMd1NqNTViOVNpQlpQYUg5NEcvNURCVXJjN2M3elZHc3BzTjRMczVXcm1aUUNtWmd3M3FMTXc2S0g3Q1hlZ2pOaFRLQkQvL00zT0JWZEMiLCJtYWMiOiI2NzdkNWE1NzA1YWM1YjM5YzgyMzBhOWI4NGUzNGU2ZjdmYjVmYzk5YjhhNzE2NmUyNGM0N2QxODNkODAxNGU4IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6InBkK0tBeDN0c2N2SEZtSHlFM2xBakE9PSIsInZhbHVlIjoiOHM0S0hkUm80NzlPcHlZUU9JVVBxTnRWcnpDWTBDbjJlbkJ5aEpaMThZYU5pWThNM0xMd1NqNTV" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "GiatGtyTtX8jlOfpCGmNBUVmTdQk9DzhppXKAbtu" "uc_cart_id" => "f8001e5dc47434bc01f019dcf05cb5dd" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/12820" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-28 20:52:40GET/chapter/128201121919