72-year-old male with recurrent hyperparathyroidism after two prior parathyroid operations. Status post partial thyroidectomy. Please evaluate for adenoma. RIGHT LOBE MEASUREMENTS: Again seen are changes consistent with the patient's history of right lobe thyroidectomy. There is interval development of a focus of hypoechoic tissue in the right thyroid bed, measuring 1.5 x 0.9 x 1.1 cm. LEFT LOBE MEASUREMENTS: 2.9 x 1.4 x 1.6 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Again seen are changes consistent with the patient's history of right lobe thyroidectomy. There is interval development of a focus of heterogenous but predominately hypoechoic tissue with internal vascularity in the right thyroid bed, measuring 1.5 x 0.9 x 1.1 cm. Additionally, note is made of an round, hypoechoic focus along the inferior margin of the right thyroid bed, measuring 6 x 4 x 4 mm without internal vascularity.LEFT LOBE: The left lobe is again noted to be diffusely heterogeneous and lobulated, appearing slightly decreased in size when compared to the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Note is made of an round, hypoechoic focus along the inferior margin of the right thyroid bed, measuring 6 x 4 x 4 mm without internal vascularity.LYMPH NODES: Normal appearing right level IV cervical lymph nodes are identified.OTHER: No significant abnormality noted.
Heterogenous left lobe of the thyroid with interval development of a 6 mm hypoechoic focus along the inferior margin of the surgical bed of the right lobe of the thyroid gland which may represent a parathyroid adenoma candidate. Further evaluation with a parathyroid nuclear medicine scintigraphic examination could be considered if clinically indicated. 