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Endocrine Abstracts (2024) 99 P94 | DOI: 10.1530/endoabs.99.P94

ECE2024 Poster Presentations Endocrine-Related Cancer (40 abstracts)

Cervico-mediastinal hematoma: Atypical presentation of parathyroid carcinoma associated to hashimoto thyroiditis

Martina Cicia 1 , Giampaolo Papi 2 , Alfredo Scillitani 3 , Stefania Corrado 4 , Pietro Locantore 1 & Alfredo Pontecorvi 1


1Fondazione Policlinico Universitario A. Gemelli, Endocrinology and Diabetology, Rome, Italy; 2Azienda USL Modena, Endocrinology Unit, Modena, Italy; 3Casa del Sollievo della Sofferenza in San Giovanni Rotondo, Endocrinology Unit, Foggia, Italy; 4University of Modena and Reggio Emilia, Pathology Unit, Modena, Italy


Introduction: Parathyroid carcinoma (PC) accounts for <1% of all forms of primary hyperparathyroidism. PC is characterized by very high serum PTH and calcium levels and presents with osteopenia/osteoporosis, nephrolithiasis, asthenia, neuropsychiatric symptoms. Here, we report the unusual presentation of a PC.

Case presentation: A 48-year-old woman was referred to our Center for the sudden appearance of a large painful hematoma in the cervico-mediastinal area. Neck US showed a solid, markedly hypoechoic lesion (40×80×55 mm), extending from the right thyroid lobe to the mediastinum, associated to blood leakage in the right perithyroid area. The thyroid displayed a diffusely hypoechoic structure, without nodules. Lab tests showed: TSH 2.1 mIU/ml, Calcitonin <1 pg/ml, PTH 460 pg/ml, Calcium 14 mg/dl, Calcium ion 2.1 mmol/l, Calciuria 535 mg/24 h, Phosphorus 2.5 mg/dl, Creatinine 0.65 mg/dl, 25-OH vitamin D 10 ng/ml, CEA 2 ng/ml. Femoral-lumbar DXA detected osteopenia and renal US showed a stone within the left kidney. Neck CT demonstrated a huge mass extending from the right thyroid lobe up to the right upper bronchus and displacing the esophagus and the trachea controlaterally.

Treatment: The patient was rehydrated, treated with furosemide, cholecalciferol and bisphosphonate and submitted to right lower parathyroidectomy + right hemithyroidectomy + lymphadenectomy of the right VI cervical level. Histological examination was diagnostic for non-angio-nor neuro-invasive PC associated to lymphocytic thyroiditis; all removed lymph nodes were benign.

Outcome and follow-up: The post-operative course was regular. The patient was discharged with calcitriol and calcium carbonate therapy, then suspended. The search for mutation of the CDC73 gene was negative. The 30-day follow-up included blood tests showing normal PTH and calcium concentrations and subclinical hypothyroidism with TSH elevated at 18 mcIU/ml Neck US did not detect residual neoplasm and 99mTc-MIBI parathyroid scan was negative. Levothyroxine therapy 50 μg/day was undertaken. Eight years after diagnosis, the patient is in good general condition, with no clinical, biochemical or imaging evidence of disease persistence/recurrence.

Conclusions: We have described the unique case of a PC presenting with pain and hematoma in either the anterior neck and the mediastinum, associated with autoimmune thyroiditis. Although parathyroid hemorrhage is a rare event, it should always be suspected when a painful swelling suddenly appears in the neck region in a hypercalcemic patient. Given the high prevalence of HT in the general population, we believe that the association between PC and autoimmune thyroiditis in our patient should be considered casual.

Volume 99

26th European Congress of Endocrinology

Stockholm, Sweden
11 May 2024 - 14 May 2024

European Society of Endocrinology 

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