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Liu Z, Zhao Y, Han X, Hu X, Zhang Y, Xu L, Chen G, Liu C, Xu S. Ultrasound-guided microwave ablation in the treatment of recurrent primary hyperparathyroidism in a patient with MEN1: a case report. Front Endocrinol (Lausanne) 2023; 14:1175377. [PMID: 37795364 PMCID: PMC10546301 DOI: 10.3389/fendo.2023.1175377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Multiple endocrine neoplasia type 1 (MEN1) is an inherited endocrine syndrome caused by the mutation in the tumor suppressor gene MEN1. The recurrence rate of primary hyperparathyroidism (PHPT) in patients with MEN1 after parathyroidectomy remains high, and the management of recurrent hyperparathyroidism is still challenging. Case presentation We reported a 44-year-old woman with MEN1 combined with PHPT who was diagnosed through genetic screening of the patient and her family members. After parathyroidectomy to remove one parathyroid gland, the patient suffered from persistent high levels of serum calcium and parathyroid hormone, which returned to normal at up to 8 months after ultrasound-guided microwave ablation (MWA) for bilateral parathyroid glands, suggesting an acceptable short-term prognosis. Conclusion Ultrasound-guided MWA for parathyroid nodules may be an effective therapeutic strategy for recurrent PHPT in MEN1 patients.
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Affiliation(s)
- Zhoujun Liu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yueting Zhao
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xue Han
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xin Hu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yuzhi Zhang
- Department of Ultrasound, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Lan Xu
- Department of Endocrinology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Guofang Chen
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of Tradtional Chinese Medicine Syndrome & Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Chao Liu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of Tradtional Chinese Medicine Syndrome & Treatment of Yingbing (Thyroid Disease) of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Endocrine and Diabetes Center, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
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Combination Therapy of Ethanol Ablation and Radiofrequency Ablation to Treat Parathyroid Adenoma in a Case with Primary Hyperparathyroidism. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-120869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction: Ethanol ablation (EA) and radiofrequency ablation (RFA) are minimal invasive therapeutic modalities to treat primary hyperparathyroidism (PHPT). Case Presentation: A 77-year-old man presented a 3.5-cm parathyroid adenoma with mixed cystic and solid components. He was ineligible for parathyroidectomy because of his age and the surgical history of the coronary artery bypass graft. First, EA was performed to remove cystic component. After that, the volume of parathyroid adenoma was decreased (volume reduction rate: 94%); however, the level of serum parathyroid hormone (PTH) was persistently high (88 pg/mL). Subsequent RFA was performed to remove the remaining parathyroid adenoma. Further, it was completely disappeared on the following ultrasound examination, and PTH was normalized. The results during a 2-year follow-up confirmed clinical success, and no relevant complication was reported. Conclusion: The combination therapy of EA and subsequent RFA is safe and effective as an alternative therapeutic method to treat PHPT in patients ineligible for parathyroidectomy.
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Ebrahiminik H, Chegeni H, Mosadegh Khah A, Salouti R, Ghomashchi G, Deldar Pasikhani M, Heydari I, Shamsi K, Beiranvand B, Azimi Aval MR, Mohammadi A, Mirza-Aghazadeh-Attari M, Fadaee N. Radiofrequency ablation of parathyroid adenomas causing primary hyperparathyroidism: A report of 27 patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:540-546. [PMID: 35278235 DOI: 10.1002/jcu.23181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To study treatment outcome of parathyroid adenomas using ultrasound-guided radiofrequency ablation. METHODS Twenty-seven patients with a single adenoma of the parathyroid gland were included in the study. Using color Doppler ultrasonography, the lesion and its characteristics were determined, and dextrose was injected to dissect the gland from the surrounding structures. The ablation process was done with 6-12 watts of power. RESULTS No complications were seen in any of the subjects. A significant reduction was seen in serum parathyroid hormone (PTH) and calcium levels after treatment. PTH levels showed a median decrease of 13.8%, and a median decrease of 8.2% was seen in serum calcium levels (p < 0.001). Phosphorus levels did not change significantly after treatment. In 1-month follow-up of patients, the lesion size had decreased considerably. In long-term follow-up, 11 of 20 patients having subsequent imaging had indistinguishable lesions. CONCLUSION Our results showed that RFA of parathyroid adenomas caused a significant reduction in biomedical indicators of disease and resulted in a significant reduction or disappearance of the lesion in the majority of the patients while having no considerable complications.
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Affiliation(s)
- Hojat Ebrahiminik
- Department of Interventional Radiology and Radiation Sciences Research Center, Aja University of Medical Sciences, Tehran, Iran
| | | | - Ali Mosadegh Khah
- Department of Endocrinology, Aja University of Medical Sciences, Tehran, Iran
| | - Rambod Salouti
- Interventional Radiology Department, Tirad Imaging Institute, Tehrn, Iran
| | - Ghazal Ghomashchi
- Interventional Radiology Department, Tirad Imaging Institute, Tehrn, Iran
| | - Maryam Deldar Pasikhani
- Department of Obstetrics and Gynecology, School of Medicine, Vali Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Heydari
- Endocrinology Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Khosro Shamsi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Afshin Mohammadi
- Department of Radiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Narges Fadaee
- Department of Family Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Evaluation of the Early Results of Percutaneous Ethanol Ablation in Patients with Primary Hyperparathyroidism. ACTA MEDICA BULGARICA 2022. [DOI: 10.2478/amb-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Percutaneous ethanol ablation (PEA) is an alternative non-surgical method for the treatment of patients with primary hyperparathyroidism (PHPT), suitable in cases with comorbidities and high surgical risk.
The aim of the present study was to evaluate the results of PEA in patients with PHPT at the early stages of follow-up.
Materials and methods: The study included 35 patients (30 women and 5 men, mean age 59.7 ± 12.4 years) with biochemical and hormonal data of PHPT and localized parathyroid adenoma (PTA) by ultrasound, nuclear scan, FNB with cytology and evaluation of PTH in the needle washout. All patients were at high surgical risk or refused surgical treatment. PEA was applied and changes in the PTA volume and calcium-phosphate metabolism were monitored at the third (M3) and sixth (M6) months after the procedure.
Results: Normocalcaemia was achieved in 26 patients (74.3%) at M3 and persisted at M6 in 22 of them. A second course of PEA was administered in 11 patients with persistent hypercalcaemia at M3 and M6, respectively. Compared to the baseline, the mean PTA volume decreased significantly by 53% at M3 and 67% at M6 (p < 0.001). Side effects including local pain, edema and dysphonia were observed in 5 patients (14.3%).
Conclusion: PEA is an efficient and safe treatment modality for the management of PHPT. A significant reduction in PTA volume and a normalization of serum calcium and PTH levels were observed at the early stages of follow-up.
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Yazdani AA, Khalili N, Siavash M, Shemian A, Goharian AR, Karimifar M, Tavakoli B, Yazdi M. Ultrasound-guided ethanol injection for the treatment of parathyroid adenoma: A prospective self-controlled study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:93. [PMID: 33273938 PMCID: PMC7698383 DOI: 10.4103/jrms.jrms_553_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/02/2019] [Accepted: 06/08/2020] [Indexed: 12/03/2022]
Abstract
Background: Parathyroidectomy, the standard treatment of primary hyperparathyroidism (PHP) due to parathyroid adenoma, is not suitable for all patients. We evaluated the efficacy of ultrasound-guided ethanol ablation of parathyroid adenoma in a group of patients with PHP. Materials and Methods: In a prospective self-controlled trial, 39 patients with parathyroid adenoma, who were not candidates for surgery, were enrolled. Ethanol injections were performed by two experienced interventional radiologists under the guidance of real-time ultrasonography. Adenoma size changes were assessed at about 1 month later. Serum levels of parathyroid hormone, calcium, phosphate, 25-OH Vitamin D, and alkaline phosphatase were evaluated at the baseline, 1, 3, 6, and 12 months after the injections. The treatment effects on outcome variables were assessed by repeated measures analysis. Results: Volume of the adenomas decreased during the study period from 1.87±6.45 cm3 to 0.38± 0.48cm3 (P < 0.001). Corrected serum calcium levels decreased from 10.40 ± 0.96 mg/dl to 8.82 ± 0.58 mg/dl (P < 0.001), and remained stable during one year follow-up. Serum levels of parathyroid hormone decreased gradually from 129.85 ± 63.37 to 72.58 ± 53.86 pg/mL after 3 months and to 44.78 ± 28.04 pg/mL after 1 year (P < 0.001). Overall, 46% of the patients improved after 1 month of ethanol ablation therapy which increased to 84.5% during 1-year follow-up. No major complications were observed. Conclusion: The current study showed the efficacy of ultrasound-guided ethanol injection in PHP and may be considered as a suitable alternative treatment in patients who are not candidates for the surgery. It has also a good safety profile without major complications if performed by experienced hands.
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Affiliation(s)
- Amir Ali Yazdani
- Jam Medical Imaging and Interventional Radiology Center, Isfahan, Iran
| | - Nooshin Khalili
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansour Siavash
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Albert Shemian
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Reza Goharian
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mozhgan Karimifar
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Tavakoli
- Arman Medical Imaging and Interventional Radiology Institute, Isfahan, Iran
| | - Maryam Yazdi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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6
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Shenoy MT, Menon AS, Nazar PK, Moorthy S, Kumar H, Nair V, Pavithran PV, Bhavani N, Menon VU, Abraham N, Jayakumar RV. Radiofrequency Ablation Followed by Percutaneous Ethanol Ablation Leading to Long-Term Remission of Hyperparathyroidism. J Endocr Soc 2017; 1:676-680. [PMID: 29264521 PMCID: PMC5686659 DOI: 10.1210/js.2017-00094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/13/2017] [Indexed: 11/19/2022] Open
Abstract
A 30-year-old male with cerebral palsy and motor impairment presented with right femur fracture. He had gradually worsening mobility and contractures of all extremities for the preceding 5 years. Evaluation showed multiple vertebral and femoral fractures, severe osteoporosis, a large parathyroid adenoma, and parathormone (PTH) exceeding 2500 pg/mL. Because of poor general health and high anesthetic risk, parathyroidectomy was deemed impractical. Ultrasound-guided radiofrequency ablation (RFA) helped achieve 50% size reduction and PTH levels with better control of hypercalcemia. Later, as calcium and PTH remained elevated, percutaneous ethanol ablation was performed with resultant normalization of PTH and substantial symptomatic improvement. Two years later, he still remains normocalcaemic with normal PTH levels. We propose that RFA and percutaneous ethanol ablation be considered as effective short-term options for surgically difficult cases, which could even help achieve long-term remission. Although not previously reported, our case illustrates that both RFA and percutaneous ethanol ablation could be safely performed successively achieving long-term remission.
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Affiliation(s)
- Mohan T Shenoy
- Department of Endocrinology, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum, Kerala 695607
| | - Arun S Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
| | - P K Nazar
- Department of Radiodiagnosis, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
| | - Srikanth Moorthy
- Department of Radiodiagnosis, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
| | - Harish Kumar
- Department of Endocrinology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
| | - Vasantha Nair
- Department of Endocrinology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
| | | | - Nisha Bhavani
- Department of Endocrinology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
| | - Vadayath Usha Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
| | - Nithya Abraham
- Department of Endocrinology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala 682041
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The Results of Ultrasonography-Guided Percutaneous Radiofrequency Ablation in Hyperparathyroid Patients in Whom Surgery Is Not Feasible. Cardiovasc Intervent Radiol 2017; 40:596-602. [DOI: 10.1007/s00270-016-1544-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/09/2016] [Indexed: 01/20/2023]
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8
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Sung JY. Parathyroid ultrasonography: the evolving role of the radiologist. Ultrasonography 2015; 34:268-74. [PMID: 25971897 PMCID: PMC4603207 DOI: 10.14366/usg.14071] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 12/27/2022] Open
Abstract
Previously, radiologists played a limited role in the treatment of parathyroid disease, primary focusing on the preoperative localization of parathyroid lesions responsible for hyperparathyroidism. But, the widespread use of high-resolution ultrasound has lead to the increasing detection of parathyroid incidentalomas (PTIs). Consequently, radiologists may be required to differentiate PTIs from thyroid lesions, which is most reliably accomplished through the fine needle aspiration-parathyroid hormone analysis. Various nonsurgical treatment modalities for hyperfunctioning parathyroid lesions have been developed with some efficacy. Especially for symptomatic nonfunctioning parathyroid cysts, simple aspiration is a first-line procedure for diagnosis and treatment, while ethanol ablation is a subsequent treatment modality for recurrent cases.
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Affiliation(s)
- Jin Yong Sung
- Department of Radiology, Thyroid Center, Daerim St. Mary’s Hospital, Seoul, Korea
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9
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Alherabi AZ, Marglani OA, Alfiky MG, Raslan MM, Al-Shehri B. Percutaneous ultrasound-guided alcohol ablation of solitary parathyroid adenoma in a patient with primary hyperparathyroidism. Am J Otolaryngol 2015; 36:701-3. [PMID: 26026702 DOI: 10.1016/j.amjoto.2015.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
Abstract
Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a single parathyroid adenoma, which represents the most common cause of chronic hypercalcemia. However, in few cases, surgery may be technically difficult or risky. We report the use of percutaneous ultrasound-guided alcohol ablation of a parathyroid adenoma as an alternative to surgery in an 88-year-old male patient with significant medical comorbidities.
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10
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Jiang T, Chen F, Zhou X, Hu Y, Zhao Q. Percutaneous Ultrasound-Guided Laser Ablation with Contrast-Enhanced Ultrasonography for Hyperfunctioning Parathyroid Adenoma: A Preliminary Case Series. Int J Endocrinol 2015; 2015:673604. [PMID: 26788059 PMCID: PMC4695663 DOI: 10.1155/2015/673604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/30/2015] [Accepted: 11/15/2015] [Indexed: 02/05/2023] Open
Abstract
The study was to evaluate the safety and effectiveness of ultrasound-guided percutaneous laser ablation (pLA) as a nonsurgical treatment for primary parathyroid adenoma. Surgery was contraindicated in, or refused by, the included patients. No lesion enhancement on contrast-enhanced ultrasound immediately after pLA was considered "complete ablation." Nodule size, serum calcium, and parathyroid hormone level were compared before and after pLA. Complete ablation was achieved in all 21 patients with 1 (n = 20) or 2 (n = 1) sessions. Nodule volume decreased from 0.93 ± 0.58 mL at baseline to 0.53 ± 0.38 and 0.48 ± 0.34 mL at 6 and 12 months after pLA (P < 0.05). At 1 day, 6 months, and 12 months after pLA, serum PTH decreased from 15.23 ± 3.00 pmol/L at baseline to 7.41 ± 2.79, 6.95 ± 1.78, and 6.90 ± 1.46 pmol/L, serum calcium decreased from 3.77 ± 0.77 mmol/L at baseline to 2.50 ± 0.72, 2.41 ± 0.37, and 2.28 ± 0.26 mmol/L, respectively (P < 0.05). At 12 months, treatment success (normalization of PTH and serum calcium) was achieved in 81%. No serious complications were observed. Ultrasound-guided pLA with contrast-enhanced ultrasound is a viable alternative to surgery for primary parathyroid adenoma.
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Affiliation(s)
- Tianan Jiang
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, Zhejiang 310003, China
| | - Fen Chen
- Hepatobiliary & Pancreatic Intervention Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, Zhejiang 310003, China
| | - Xiang Zhou
- Department of Ultrasound, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Wuhou, Chengdu, Sichuan 610041, China
| | - Ying Hu
- Department of Ultrasonography, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, Zhejiang 310003, China
| | - Qiyu Zhao
- Hepatobiliary & Pancreatic Intervention Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Qingchun Road No. 79, Hangzhou, Zhejiang 310003, China
- *Qiyu Zhao:
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11
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Kim BS, Eom TI, Kang KH, Park SJ. Radiofrequency ablation of parathyroid adenoma in primary hyperparathyroidism. J Med Ultrason (2001) 2013; 41:239-43. [DOI: 10.1007/s10396-013-0501-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
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12
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Possibilities of nontoxic autonomous thyroid nodules treatment by percutaneous ethanol injection. VOJNOSANIT PREGL 2011; 68:767-73. [DOI: 10.2298/vsp1109767a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. According to the current principles, autonomous functional
thyroid nodules are treated by surgery or by radioiodin therapy. Ultrasound
guided percutaneous ethanol injection into solid tumors of the soft tissues
was a starting point in attempts to treat the thyroid nodules by the same
method. The aim of the study was to assess the efficiency of percutaneous
injection in treating solitary, nontoxic, autonomous thyroid nodules of up to
15 mL volume. Methods. In 25 patients with solitary nontoxic autonomous
thyroid nodules diagnosed by tehnetium-99m scanning as an intensive area
having a complete supremacy in the paranodal tissue, an ultrasound guided
percutaneous ethanol injection was applied. The procedure was carried out
repeatedly once a week until the reduction in nodule size to 50% of the
initial size was achieved. Results. An average size of the nodule before
curing was 9.68 ? 5.01 mL. An average quantity of the injected ethanol was
9.52 ? 5.08 mL, ie 1.06 ? 0.48 mL/mg of the tissue. The regression of the
nodule size in the successfully (?vol% u = - 57.09 ? 13.75%, p < 0.001) and
partly successfully cured (?vol du = -48.45 ? 14.35%, p < 0.05) was
statistically significant compared to the size before the treatment. After
ceasing ethanol injection, 18 months later, a further size regression (?vol%
= -79.20 ? 9.89%) compared to the initial one (p < 0.001) was noticed. Soon,
after the procedure was finished, a statistically significant concentration
increase of Thyroid Stimulating Hormone (TSH) was noticed compared to the
initial values (0.18 ? 0.16 vs 0.34 ? 0.31 mU/L, p < 0.01). According to the
given criteria, in two female patients satisfactory results were not
achieved, but, a year later, in one of them the nodule was not seen by
repeated scintigram. The number and frequency of side effects were
insignificant. Conclusion. Repeated percutaneous ethanol injections into
nontoxic solitary autonomous thyroid nodules result in disappearing of
authonomy. The regression of the nodule size of more than 50% compared to its
initial volume, as well as the increase in concentration of TSH for more than
50% are the signs of a successful treatment.
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13
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:470-80. [PMID: 19858911 DOI: 10.1097/med.0b013e3283339a46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cappelli C, Rotondi M, Pirola I, De Martino E, Leporati P, Magri F, Rosei EA, Chiovato L, Castellano M. Prevalence of parathyroid cysts by neck ultrasound scan in unselected patients. J Endocrinol Invest 2009; 32:357-9. [PMID: 19636206 DOI: 10.1007/bf03345727] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Parathyroid cysts (PC) are a rare entity, representing only 0.5-1% of all parathyroid lesions and <1% of neck masses. Since its first description, in the second half of the 19th century, fewer than 300 cases have been reported. By reviewing the literature, it appears that the data available arose from surgical series, and the precise incidence of PC as detected by ultrasound (US) has not been described. The aim of this study was to review 5 yr of routine neck US, mainly performed for thyroid diseases, in order to estimate the prevalence of PC in a large series of patients. METHODS We reviewed our database of neck US investigations performed from 2003 to 2007: all data regarding patient's clinical history, US images, and fine needle aspiration cytology were retrospectively collected. RESULTS Among 6621 patients submitted to neck US investigation, a PC (mean diameter 36.4+/-14.2 mm; range 25-61 mm) was diagnosed in 5 cases. Serum PTH levels were high in all the patients (221+/-140.7 pg/ml; range 111-456 pg/ml), whereas serum calcium levels only in 3 subjects (10.8+/-1.4 mg/dl; range 9.2-12.9 mg/ml). CONCLUSION This is the first study evaluating the prevalence of PC in a large series of unselected patients by US. Our results demonstrate a much lower incidence (0.075%) of incidentally detected PC than previously reported.
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Affiliation(s)
- C Cappelli
- Internal Medicine and Endocrinology Unit, Department of Medical and Surgical Sciences, University of Brescia, c/o 2; Medicina Spedali Civili di Brescia, Piazzale Spedali Civili n degrees 1, 25100 Brescia, Italy.
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