The Calcium Chase: Unmasking Parathyroid Carcinoma with Concurrent Papillary Thyroid Microcarcinoma
https://doi.org/10.15605/jafes.041.S1
- Author:
Fatin Liyana Binti Shahabudin
1
;
Nur Nisrina Binti Yahya
1
;
Nor Shaffinaz Yusoff Azmi Merican
1
;
Shartiyah Ismail
1
Author Information
1. Endocrinology Unit, Department of Medicine, Hospital Sultanah Bahiyah
- Publication Type:Journal Article
- MeSH:
Papillary Thyroid Microcarcinoma;
Calcium;
Parathyroid Neoplasms
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):72-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Parathyroid carcinoma is a rare endocrine malignancy found
in 1–5% of patients with primary hyperparathyroidism.
It commonly presents with severe hypercalcemia and markedly elevated parathyroid hormone (PTH) levels.
We report a challenging case of parathyroid carcinoma
presenting with refractory hypercalcemia with incidental
papillary thyroid microcarcinoma.
Case:A 63-year-old female with hypertension, diabetes mellitus,
dyslipidemia, and ischemic heart disease had been followed
for primary hyperparathyroidism since 2014 (PTH5.5
pmol/L, calcium range 2.3–4.7 mmol/L). Initial neck
ultrasound was suggestive of parathyroid adenoma over
left side, but parathyroid scintigraphy failed to localize
a lesion. She refused surgical intervention initially until
April 2025, then she later agreed. Re-evaluation prior to
operation revealed PTH level 76 pmol/L, and repeated
parathyroid scintigraphy showed mild sestamibi avid
uptake on left thyroid nodule. While awaiting surgery, she
was admitted with a hypercalcemic crisis (serum calcium
3.7–5.38 mmol/L), complicated with acute kidney injury.
Repeated ultrasound neck revealed extrathyroidal lesion
adjacent to inferior pole of left thyroid (1.6 × 1.7 × 1.2 cm).
She required aggressive intravenous hydration, intravenous
pamidronate, calcitonin, and Denosumab to optimize her
calcium level peri-operatively. She underwent left neck
exploration with en-bloc left inferior parathyroidectomy,
left hemithyroidectomy, and central neck dissection in
November 2025. Histopathological examination confirmed
parathyroid carcinoma (pT3N1) with nodal metastasis (1/4
lymph nodes positive) and an incidental papillary thyroid
microcarcinoma measuring 1 mm (pT1a).
Conclusion:This case highlights the challenges of perioperative hypercalcemia management in parathyroid carcinoma. Effective
preoperative control often requires multiple treatment
modalities. Severe refractory hypercalcemia and high PTH
level should raise a high index of suspicion for malignancy.
Early complete resection is the cornerstone of treatment and
is associated with optimal outcomes.
- Full text:202608041035221824EP_A096.pdf
