Category: Thyroid

Monitor: 11

11 - PALPATION/ TRAUMATIC THYROIDITIS FOLLOWING BILATERAL NECK SURGERY FOR PRIMARY HYPERPARATHYROIDISM

Thursday, Apr 25
11:30 AM – 12:00 PM

Objective :

To describe a case of Palpation/ traumatic thyroiditis following bilateral neck surgery for primary hyperparathyroidism  


Methods :

A 23 year male presented with tiredness, weight loss, recurrent renal calculi x 1 year and episodic pain abdomen x 2 years. He was evaluated for hypercalcemia and increased PTH. He was diagnosed with primary hyperparathyroidism due to bilateral parathyroid adenoma. Surgery was done and post operatively patient developed transient thyrotoxicosis, palpation thyroiditis which normalised after 15 days.


Results :

Endocrinology= S Calcium: 12.1 mg/dl, S Phosphorus: 3.3 mg/dl, S PTH: 137, S Alk Phosphatase: 78, 24 hour urine calcium: 297 mg, TSH: Post-Op Day-15: 0.01 (0.5-4.7 mcIU/ml), Day-32 1.8 mcIU/ml.


Imaging= USG Neck: A well-defined hypoechoic area 1.5 x 0.8cm lateral to the right hemithyroid, superior lobe and  hypoechoic area of 0.9x 0.4cm inferior and medial to left hemithyroid.


Sestamibi Scan: Hyperfunctioning parathyroid adenomas in the region of upper pole of right lobe and retrolobar region of upper left lobe.


C- Methionine PET Scan: Small methionine avid soft tissue nodules posterior to both lobes of thyroid gland Left- 10 x 6mm; Right- 9 mm representing “double” parathyroid adenomas.


Surgery: Neck exploration and excision of bilateral parathyroid adenomas.


Histopathology: Parathyroid hyperplasia of predominant oxyphil type cell.


Discussion :

Parathyroidectomy-induced thyroiditis and thyrotoxicosis is a common event which is under recognized. Literature review states 30% prevalence of low postop TSH [between days 7 and 21]; 50 % of these subjects exhibit low TSH + symptoms; in 100% thyroid functions return to normal by 12 weeks.


Conclusion :

Palpation thyroiditis and thyrotoxicosis should be kept in mind when we encounter low TSH values post parathyroid surgery; few predictors being: having procedure done in a community setting; bilateral vs. unilateral exploration; Lithium use; absence of a concurrent thyroid lobectomy. In our case, bilateral neck / parathyroid exploration during surgery contributed to transient thyroiditis.

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Chandraprabha S

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology Diabetes Metabolism
Clinical Interests: Pregnancy Diabetes, Pregnancy Thyroid Dysfunction, Women Health, Geriatric Endocrinology, Diabetes mellitus and Mental Health, Spiritual Medicine

Vasanthi Nath

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology, Diabetes, Internal Medicine, Geriatrics
Clinical Interests: Neuroendocrinology and Neurometabolism, Metabolic Myopathies; Thyroid tumors, Geriatric Endocrinology, Inpatient Diabetes Care and Endocrine Emergencies; Type 1 diabetes across ages

Kavitha Muniraj

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty; Director Medical ; Director Research; Trustee
Specialties: Endocrinology Diabetes; Clinical Research
Clinical Interests: Pituitary Adrenal disorders; Bone health; Cardiovascular Health; Thyroid dysfunction; Diabetes Pharmacotherapy; Clinical Pharmacology; Pharmacovigilance; Clinical research Safety and Audits

Reshma B. Vijay

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology Diabetes and Metabolism
Clinical Interests: Pediatric Endocrinology; Diabetes mellitus; Insulin Pumps, Continuous Glucose Monitoring and Artificial Pancreas; Growth and Puberty; Thyroid; Pituitary Adrenal disorders

Babitha D. T

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology, Diabetes
Clinical Interests: Endocrine disorders of pregnancy, Pregnancy Diabetes, Cardiovascular Health, Thyroid, Inpatient diabetes care and endocrine metabolic emergencies

Muralidhara Krishna

Consultant Faculty Endocrinology Diabetes Biochemistry
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty: Endocrinology Diabetes Metabolism; Associate Professor: Clinical Biochemistry and Laboratory Medicine
Specialties: Endocrinology Diabetes Metabolism; Clinical Biochemistry
Clinical Interests: Diabetes mellitus; Thyroid Disorders; Obesity; Dyslipidemia.

Jayalakshmi T

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty

Specialties: Endocrinology, Diabetes, Internal Medicine,
Clinical Interests: Diabetes mellitus, Cardiovascular Health, Thyroid, In Patient Diabetes Care, Endocrinology Metabolic emergencies and critical care

Nidhi Garg

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
bangalore, Karnataka, India

Designation: Senior Consultant and Faculty
Specialties: Diabetes and Metabolism
Clinical Interests: Comprehensive diabetes care, In-patient diabetes and metabolic care, Perioperative diabetes management, Diabetes and endocrine emergencies – Metabolic Intensive Care, Obesity management, Lipids and preventive cardiology, Gestational diabetes, Thyroid disorders, Type 1 diabetes across ages

Apoorva Govind

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, India

Designation: (a) Fellow: Endocrinology Diabetes Medicine, Samatvam Endocrinology Diabetes Centre and Jnana Sanjeevini Medical Centre and Diabetes Hospital ; (b) Co Investigator – Clinical Research, Samatvam Science and Research Center

Specialties: Endocrinology, Diabetes, Internal Medicine

Siddartha Dinesha

Resident, Medicine Diabetes Endocrinology
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center

Designation: Resident: Medicine; Endocrinology Diabetes, Samatvam Endocrinology Diabetes Centre and Jnana Sanjeevini Medical Centre and Diabetes Hospital
Specialties: Endocrinology, Diabetes, Internal Medicine

MD Chitra

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center

Designation: Consultant and Faculty; Trustee
Specialties: Endocrinology Diabetes; Clinical Research
Clinical Interests: Diabetes, Obesity, Dyslipidemia, Osteoporosis, Pituitary Adrenal disorders; Bone health; Cardiovascular Health; Thyroid dysfunction;

Vasudha Srikanth


India

Sathvik Reddy Chinna Bainagari

Resident Doctor
Samatvam jnana sanjeevini Diabetes hospital and medical center
Chittoor, Andhra Pradesh, India

Nalini Rayas

Monica Narayanaswamy

Resident doctor
Samatvam jnana sanjeevini diabetes hospital and medical centre
Chintamani, India

Namya Gaekwad

Sri Srikanta