Canberra parathyroid surgeon

CASE 1: 61 year old doctor


  • Serum calcium high – 2.85
  • PTH high at 19.5
  • Evidence of osteopaenia on bone mineral density study
  • 24 hr urinary calcium excretion high at 9.5
Biochemistry all confirmatory for primary hyperparathyroidism


  • Both a 4d-CT and SestaMIBI parathyroid scan were negative and did not offer any help with localisation of a parathyroid adenoma.
  • Pre-Surgery Ultrasound did suggest an abnormality at the lower pole of the right thyroid lobe not seen on other imaging.
  • Intra-operative ultrasound was used to examine the lower pole of the thyroid and an abnormality seen within the lower pole of the gland.
  • Intra-operative ultrasound image below showing hypoechoic abnormality within thyroid lobe.

SestaMIBI scan and intraoperative ultrasound are used in the investigation of parathyroid adenomas

Imaging for parathyroid adenoma: SestaMIBI scan on the left and intra-operative ultrasound on the right.


A wedge resection of the lower pole of the thyroid gland was carried out and histology examination confirmed the presence of a parathyroid adenoma within the thyroid gland.

This is an uncommon, but well known occurrence. Just 1% of parathyroid adenomas will exist within the thyroid gland substance.

Post surgery the serum calcium and PTH rapidly returned to normal levels – 2.35 and the PTH level to 6.1.

Photo taken in theatre showing successful removal of parathyroid adenoma located inside thyroid gland - uncommon but well known occuring 1% of the time.

Lessons From the Interesting Case:
Sophisticated imaging with 4D-CT and SESTAMIBI / SPECT techniques will not always identify parathyroid adenoma.
Thorough knowledge and experience of common and uncommon variations in position of parathyroid glands is required to achieve success in some cases.
The use of intra-operative ultrasound techniques can also  be extremely  useful.

Learn more about A/Prof A-J Collins at his website

For Canberra consultations, phone
  (02) 6282 1191

For Bega consultations, phone
  (02) 6491 9559

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