CASE 274: PTA OR NOT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 50YO, AFTER 5 YEARS TREATED HYPERTHYROIDISM AS STABLE STAGE,  BUT  BLOOD TESTS DETECTED  PTH VALUE VERY HIGH  AND  HYPERCALCEMIA. IT  SUGGESTED HYPERPARATHYROIDISM (SEE BLOOD TEST RESULT).

ULTRASOUND DETECTED ONE MASS AT  RIGHT LOWER LOBE, HARD WITH
ELASTO, AND HYPOVASCULAR, SIZE OF 2 CM.

MRI WITH GADO CE, ALSO CONFIRMED  ONE MASS AT  LOWER  POLE OF
THYROID GLAND, SUSPECTING  PTA, SIZE ARROUND 2 CM.

IN PREOPERATION  ENDOCRINOLOGIST  REQUESTED GAMMA SPECT  MIBI.
BUT THE REPORT WAS  NOT ABNORMAL ISOTOPE, MEANING  NOT  PTA.
(SEE  SCAN MIBI UPTAKE) . 

Discussion:
This case  is  very complexe; the clinical onset  was hyperthyroidism , medical treatment was   good response. But  in biology  blood test is evident about hyperparathyroidism. Ultrasound  and MRI  made the same  diagnosis of  PTA.   But  gamma SPECT scan MIBI is  negative; it cannot  rule out  PTA , so operation was done  for  remove this tumor.

And  pathologist  diagnoses PTA ( see  pathology report).

Review  in internet:  many  cases with  SPECT scan MIBI  were  negative.. And  indication  for   this scan helps to make  clear  Indication and Interprettation..

Conclusion:

For  diagnosis  PTA , the gamma scan MIBI cannot  rule out  clinical  diagnosis.

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