A 10-year-old female presented with incidental hypercalcemia (12.9 mg/dL) and elevated PTH (137 pg/mL). High-resolution neck ultrasound localized a left lower parathyroid adenoma, followed by successful, uncomplicated parathyroidectomy with recurrent laryngeal nerve preservation.
A 10-year-old female was incidentally found out to have hyperparathyroidism and hypercalcemia during routine laboratory investigations. Her past medical and surgical histories were unremarkable, with no history of chronic medication use.
Laboratory investigations revealed a serum calcium level of 12.9 mg/dL and an elevated parathyroid hormone (PTH) level of 137 pg/mL. Thyroid function tests showed a TSH level of 5.85 µIU/mL, with a normal FT4 level of 18.21 pmol/L and mildly elevated FT3 at 7.27 pmol/L. Total T3 and total T4 were within the reference ranges at 1.85 ng/mL and 9.28 µg/dL, respectively. The findings were consistent with hypercalcemia associated with an inappropriately elevated PTH level.
Thyroid ultrasonography demonstrated both thyroid lobes to be normal in size with homogeneous echotexture and no focal thyroid lesions. A well-defined, regular-surfaced, heterogeneously hypoechoic nodule measuring 10 × 8 × 5 mm was identified at the lower pole of the left thyroid lobe, located between the esophagus and the left common carotid artery. The nodule was hypervascular and sonographically suggestive of a parathyroid lesion. The isthmus measured approximately 2 mm in thickness. No significant cervical lymphadenopathy was identified. The parotid and submandibular glands appeared normal, with no focal lesions.
Under general anesthesia, the patient was placed in the supine position with the neck extended, a collar incision was made, followed by elevation of the upper and lower skin flaps. The strap muscles were opened, and a left lower parathyroidectomy was performed. The excised specimen was sent for histopathological examination. The left recurrent laryngeal nerve was identified and preserved. Hemostasis was secured, and the wound was closed in layers.
Histopathological examination of the left lower parathyroidectomy specimen revealed a unifocal parathyroid adenoma measuring 1 cm in maximum dimension. The tumor was well-defined, with no evidence of capsular or vascular invasion, necrosis, or cytological atypia. No mitotic figures were identified (0/50 high-power fields). Additionally, three small benign lymph nodes were identified, with no significant pathological abnormalities.
The patient had an uncomplicated postoperative course following left lower parathyroidectomy. She was followed postoperatively for wound healing and recovery, with monitoring of serum calcium and parathyroid hormone levels to assess biochemical response following surgery.
