Endocrine Abstracts

In 2016–2020, 181 patients (mean age – 54.8; range 31–77 years) with tumors of parathyroid glands (PG) were operated. All patients had hyperparathyroidism. The diagnosis was confirmed by high levels of ionized calcium and parathyroid hormone (PTH) in the blood. Ultrasound was performed in all patients before surgery. The evaluation of ultrasound images of PG tumors was carried out according to the following parameters: echogenicity, echostructure, shape, clarity and evenness of contours, the presence of calcinates, features of vascularization. The PG sizes and localization were recorded.

Results

It was possible to accurately determine the localization of tumors in 92.4% of cases. In 14 cases, ultrasound was ineffective: in 5 cases, the PG tumor was mistakenly interpreted as a thyroid node, in 3 cases it was located behind the trachea, in 2 cases – in the mediastinum, in 4 cases-the PG tumor was not visualized. Most tumors were located in the projection of the right lobe of the thyroid – at 55.2% and 44.8% – on the left. In the projection of the lower poles of the thyroid was up 29.6% of the tumors, on the rear surface of the middle segments doll TG – 19.7%, and for the upper poles of the thyroid of 2.8%. When measuring the volume, most tumors were up to 1 cm³ – 50.7%, from 1 cm³ to 10 cm 3–40.9% of all adenomas, from 10 cm³ and – 8.4%. The tumors had an oval or irregular shape on 87.3%. The majority of PG tumors (92.3%) had clear contours. Smooth contours had 61.5% of tumors, uneven contours – 38.5%. Tumors of PG were identified by ultrasound as hypoechoic focus (85.5%), as isoechoic (8%) and anechoic (2.8%) formations. PG tumors had a heterogeneous structure in 58.5%, homogeneous-41.5%. In 63.4%, PG tumors were hypervascular, while in 32.4%, the incoming vessel was clearly visualized, forming a ’vascular arc’. In 36.6%, the blood flow was hypovascular. The liquid component in PG tumors was rarely observed – in 12.7% of cases, and calcification elements were detected only in 4.2%.

Conclusion

The most likely ultrasound signs of PG tumors are: a single hypoechoic formation, with clear uneven contours, an irregular, elongated shape, located outside the thyroid gland, along its posterior surface, more often in the projection of its lower poles. An important criterion characteristic of a PG tumor is the hypervascular type of blood flow and the presence of an incoming feeding vessel.