Ultraschall Med 2016; 37 - PS7_03
DOI: 10.1055/s-0036-1587889

Ultrasonography of tertiary hyperparathyroidism: a pictorial review

AL Wong 1, R Abu Bakar 1, LW Tan 1, SK Sanamandra 1
  • 1Singapore General Hospital, Diagnostic Radiology, Singapore, Singapore

Purpose: This didactic exhibit aims to

  • Review the efficacy of ultrasound in detecting parathyroid hyperplasia in tertiary hyperparathyroidism and post parathyroidectomy with autotranplantation

  • Recognize the abnormal sonographic appearances of parathyroid glands

  • Recognize the normal and usual ectopic locations of parathyroid glands.

Materials and methods: Ultrasound parathyroid scans in patients with tertiary hyperparathyroidism were retrospectively reviewed from the Picture Archiving System (PACS). A few ultrasound parathyroid scans in patients who had parathyroidectomy followed by autotranplantation were also reviewed. The sonographic appearances and locations of parathyroid glands were evaluated. Where available, correlation with laboratory results, other imaging modalities and histopathology will be presented.

Results: Tertiary hyperparathyroidism is seen in patients with long-term secondary hyperparathyroidism with resultant hyperplasia of multiple parathyroid glands, usually seen in patient with chronic renal failure. The hypertrophied parathyroid glands could be easily identified with ultrasound scan in the expected anatomical locations posterior to the thyroid gland. They appear hypoechoic and oval or rounded in shape on ultrasound with the larger ones being multilobulated. Cystic component and calcification may be noted in the glands. Colour Doppler shows a characteristic extrathyroidal-feeding vessel and arc vascularity around the periphery of the glands.

Conclusion: Ultrasound is a widely available cost effective first line imaging modality in detecting and locating the abnormal parathyroid glands in patients with tertiary hyperparathyroidism as well as in cases with recurrent hyperparathyroidism following parathyroidectomy. Recognition of abnormal sonographic features and normal as well as usual ectopic locations of the parathyroid glands helps in more thorough search of all abnormal parathyroid glands to achieve early diagnosis and necessary treatment.