Hyperparathyroidism

Question 1

Hyperparathyroidism is more common in…

Males or females?

Answer 1

Females

3:1

Question 2

What percentage of hyperparathyroidism patients have a single adenoma?

Answer 2

85 - 90%

Question 3

What percentage of hyperparathyroidism patients have multiple adenomas?

Answer 3

2 - 4%

Question 4

What percentage of hyperparathyroidism patients have hyperplasia?

Answer 4

6 - 8%

Question 5

US is localization and not a diagnostic study in hyperparathyroidism.

True or false?

Answer 5

True

Question 6

What needs to be done other than biochemically confirm hyperparathyroidism before localization with ultrasound?

Answer 6

Rule out FHH

Fractional excretion of urine calcium

Question 7

When is ultrasound not useful for localizing parathyroids?

Answer 7

Posterior and intrathoracic locations

Question 8

Name three reasons for doing an ultrasound in hyperparathyroidism?

Answer 8

• Localization (parathyroid adenoma)
• coexisting thyroid nodules (thyroid cancer incidence 2 - 6%)
• ethanol ablation in select patients

Question 9

What is the most common frequency used for parathyroid adenomas?

Answer 9

7 - 10 mHz

Question 10

How should the patient be positioned for parathyroid ultrasound?

Answer 10

With neck extended

Question 11

Inferior parathyroid glands take a longer migratory route along with the thymus gland.

True or false?

Answer 11

True

Question 12

Which pair of parathyroid glands is more constant?

Answer 12

Superior

Question 13

Which pair of parathyroid glands migrates posteriorly?

Answer 13

Superior

Question 14

Which pair of parathyroid glands migrates anteriorly and medially?

Answer 14

Inferior

Question 15

Superior parathyroid: Location (%)

Carotid sheath?

Answer 15

1%

Question 16

Superior parathyroid: Location (%)

Upper pole of thyroid?

Answer 16

10%

Question 17

Superior parathyroid: Location (%)

Mid portion thyroid lobe?

Answer 17

77%

Question 18

Superior parathyroid: Location (%)

Paraesophageal?

Answer 18

11%

Question 19

Inferior parathyroid: Location (%)

Undescended?

Answer 19

2%

Question 20

Inferior parathyroid: Location (%)

Mid thyroid?

Answer 20

3%

Question 21

Inferior parathyroid: Location (%)

Inferior pole of thyroid?

Answer 21

56%

Question 22

Inferior parathyroid: Location (%)

Thyrothymic ligament?

Answer 22

26%

Question 23

Inferior parathyroid: Location (%)

Mediastinal?

Answer 23

9%

Question 24

Parathyroid glands conform to surrounding structures.

True or false?

Answer 24

True

Question 25

Parathyroid glands have a vascular pedicle from polar artery. True or false?

Answer 25

True

Question 26

Are parathyroids hypo- or hyperechoic?

Answer 26

Hypoechoic

Question 27

What can 'bring out' a parathyroid lesion that is located in the tracheo-esophageal groove?

Answer 27

Valsalva

Question 28

What is the concern when biopsy-ing a parathyroid adenoma?

Answer 28

Fibrosis from biopsy

Question 29

When biopsy-ing a parathyroid how should the needle be moved?

Answer 29

Rotation and instead of jabbing

Question 30

When biopsy-ing a parathyroid what gauge needle should be used?

Answer 30

27 G

Question 31

What are the absolute contra-indications to parathyroid biopsy?

Answer 31

- Parathyroid carcinoma | - Familial jaw tumor - HPT syndrome

Question 32

What are the relative contra-indications to parathyroid biopsy (4)

Answer 32

- Anti-coagulation - Partial or complete obscuration by vessels - Significant respiratory movements - Morbid obesity

Question 33

When is cytology performed on parathyroid biopsies?

Answer 33

When PTH analysis is negative.

Question 34

Is cytology useful in the identification of parathyroid adenomas?

Answer 34

No PTH level from syringe washing more useful