A large intrathyroidal parathyroid adenoma presenting as a cold lesion on thyroid scintigraphy

K K Balan, S Y J Wat, N Seshadri, M Barkej, E English, L Berman, Gordon C Wishart

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Intrathyroidal parathyroid adenomas are rare and are often misdiagnosed as thyroid nodules. Accurate diagnosis and preoperative localization is important for a successful surgical outcome, especially in the context of minimally invasive parathyroid surgery. Nuclear medicine imaging has been invaluable in differentiating between thyroid and parathyroid pathologies, but ultrasound scanning also has a prominent role. Cases of intrathyroidal adenomas showing significant uptake of Tc-99m pertechnetate appearing as a hyperfunctioning thyroid nodule have previously been reported. Using sonographic as well as scintigraphic methods of localization, we describe an unusual case of a large intrathyroidal parathyroid adenoma (confirmed on surgery), which appeared “cold” on a Tc-99m pertechnetate scan falsely giving the impression of a hypofunctioning nodule, mimicking thyroid neoplasm. The decision to proceed to surgery without a fine needle aspiration was taken because the clinical picture was more suggestive of a parathyroid adenoma/carcinoma than thyroid malignancy.
Original languageEnglish
Pages (from-to)237-238
Number of pages2
JournalClinical Nuclear Medicine
Issue number3
Publication statusPublished - Mar 2007


  • Adenoma
  • Diagnosis, Differential
  • Humans
  • Parathyroid Neoplasms
  • Radiopharmaceuticals
  • Sodium Pertechnetate Tc 99m

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