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.
