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Clinical Problem Solving: Radiology
June 2007

Radiology Quiz Case 1

Author Affiliations

Oregon Health and Science University, Portland



Arch Otolaryngol Head Neck Surg. 2007;133(6):614. doi:10.1001/archotol.133.6.614

A 59-year-old woman presented to an outside institution with a history of renal stones, osteoporosis, and myalgias. Her serum calcium concentration was elevated at 11 mg/dL (2.75 mmol/L), with a simultaneous parathyroid hormone level (PTH) of 125 pg/mL (13 ng/L). Dual-energy x-ray absorbitometry scanning revealed T scores of –2.9 at the lumbosacral spine and –2.7 at the hip, which were decreased from measurements determined 5 years earlier. The patient's bone changes occurred despite biphosphonate therapy. A comprehensive head and neck examination and flexible endoscopy demonstrated no abnormalities. Technetium Tc 99m sestamibi imaging revealed an area of increased signal in the area posterior to the midpolar region of the left thyroid lobe (Figure 1). Parathyroid exploration revealed 2 normal-appearing glands, which were confirmed by biopsy on the right side. A single gland was identified and confirmed by biopsy on the left side. In light of the preoperative sestamibi scanning results, a left hemithyroidectomy was performed. After surgery, the patient remained hypercalcemic, with elevated serum PTH levels.

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