PMC8573193_01
There was a grade II goiter (A), with a 4 x 4 cm mass palpable near the thyroid bilaterally. CT scan (A, B) of the neck revealed bilateral slightly hypointense cystic shadows below the thyroid. SPECT/CT fusion imaging (C, D) revealed an abnormal increase in uptake in part of the mass behind the right lobe of the thyroid during MIBI, which was considered relevant to hyperparathyroidism. There were a cystic-solid mass (E) on the posterolateral aspect of the right lateral lobe of the thyroid and a cystic-solid mass (F) on the left lateral lobe of the thyroid. Postoperative paraffin pathology (HE staining x100) results indicated that both the right (G) and left (H) space-occupying lesions represented parathyroid adenomas with cystic change.
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There was a grade II goiter ( Figure 1A ), with a 4 x 4 cm mass palpable in front of the neck. A CT scan of the neck ( Figure 1B ) revealed bilateral slightly hypointense cystic mass deep the thyroid, 4.4 x 3.2 cm size on the right, 4.2 x 2.1 cm size on the left, with a uniform density and clear borders. SPECT/CT fusion imaging (MIBI;  Figures 1C, D ) revealed an abnormal increase uptake during MIBI in part of the mass posterior to the right lobe of the thyroid, which point the possibility of parathyroid adenoma. According to the guidelines for the diagnosis and treatment of primary hyperparathyroidism and considering the patient's surgical requirements, the neck mass resection was performed at three weeks post-admission, during which the bilateral cystic-solid masses were found, 5 x 3 x 3.5 cm in size on the right ( Figure 1E ) and 5.5 x 4 x 3.5 cm on the left ( Figure 1F ). Postoperative paraffin pathology results indicated intracystic hemorrhage of bilateral parathyroid adenomas. ( Figures 1G, H ).
After admission, the blood calcium level was 3.6 mmol/L. After 2000-4000 ml of NS for 5 days and salmon calcitonin (300 IU ivgtt), the blood calcium level gradually decreased and remained within the normal range. After surgery, the blood calcium level decreased, reaching the lowest level (1.65 mmol/L). After that, the calcium level was gradually restored to normal. There was a progressive decrease in the PTH level; however, the PTH level was stabilized at 50-60 pmol/L at 12 days post-admission, and this situation persisted for 1 week. One day post-operatively the PTH level rapidly decreased to 1.95 pmol/L, followed by a slow, gradual increase.
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The serum creatinine levels returned to normal and PTH gradually decreased, but still above normal ( Figure 2 ).