PMC6000994_01
Measures of ionized Ca2+ and PTH at the preoperative work-up (1-5), between the first and second operation (6), between the second and third operation (7-10), and after the third operation (11-15).
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Again the intraoperative PTH levels did not decrease significantly (Fig. 1) and hypercalcemia persisted with Ca2+ levels of 1.50 mmol/L after the second operation. Postoperatively PTH decreased to 1.4 pmol/L (Fig. 1) and ionized calcium normalized at 1.30 mmol/L.
Images from contrast enhanced computed tomography (2A), 11C-MET-PET/CT (2B), and from MIBI scintigraphy with thyroid scintigraphy with Tc-99m-Pertechnetate to the left and Tc-99m-sestamibi scintigraphy to the right (2C). Arrows point to the parathyroid gland behind the ascending aorta.
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Prior to the operation, a contrast enhanced CT scan was performed, to identify the precise localization of the process (Fig. 2).