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parathyroid enlargement?

This patient had a mildly increased iCa.  The PTH, PTHrp, and recheck iCa are pending.  While I was performing abdominal ultrasound for other issues, I scanned the thyroid and parathyroid glands.  The picture is the left side.  Other glands were not prominent. 

This patient had a mildly increased iCa.  The PTH, PTHrp, and recheck iCa are pending.  While I was performing abdominal ultrasound for other issues, I scanned the thyroid and parathyroid glands.  The picture is the left side.  Other glands were not prominent. 

kromero

18 responses to “parathyroid enlargement?”

  1. Some information from my

    Some information from my certification notes from Dr Steve Joselyn:

    Hypercalcemia 

    Primary: Parathyroids are large and hypoechoic 

    Hypercalcemia of malignancy (PTHrp): Parathryoids are usually undetectable 

    Secondary Renal 

    Nutritional

     

    Hyperplastic: < 4mm in largest diameter 

    Neoplastic masses: > 4mm in diameter 

    Adenomas: Hypoechoic, round, 5-7mm in length 

    Vet Rad 1997 

    33 Hypercalcemic dogs, with definitive dx

     

    Parathyroids and renal failure 

    Control: 2 – 4.6mm (median 3.3 mm) 

    ARF: 2.4 – 4 mm (median 2.7 mm) 

    CRF: 3.9 – 8.1 mm (median 5.7 mm) Dogs with CRF have significantly larger parathyroids

     

    Parathyroids-size based on weight 

    Dogs < 10kg: 3 mm in length 

    Dogs 10 – 19 kg: 3.5 mm in length 

    Dogs 20-29 kg: 4 mm in length 

    Dogs > 30kg: 4.6 mm in length 

    Primary Hyperparathyroidism: 6 – 30 mm

     

    Conclusion:

    The parathyroid you show here may be normal in lenght and diameter- although maybe this could be early changes conistent with primary hyperparhathyroidism. May be worthwhile to follow the blood work and re-ultrasound at a later date

    I hope this information is helpful. Maybe others can weigh in here.

     

     

     

  2. Some information from my

    Some information from my certification notes from Dr Steve Joselyn:

    Hypercalcemia 

    Primary: Parathyroids are large and hypoechoic 

    Hypercalcemia of malignancy (PTHrp): Parathryoids are usually undetectable 

    Secondary Renal 

    Nutritional

     

    Hyperplastic: < 4mm in largest diameter 

    Neoplastic masses: > 4mm in diameter 

    Adenomas: Hypoechoic, round, 5-7mm in length 

    Vet Rad 1997 

    33 Hypercalcemic dogs, with definitive dx

     

    Parathyroids and renal failure 

    Control: 2 – 4.6mm (median 3.3 mm) 

    ARF: 2.4 – 4 mm (median 2.7 mm) 

    CRF: 3.9 – 8.1 mm (median 5.7 mm) Dogs with CRF have significantly larger parathyroids

     

    Parathyroids-size based on weight 

    Dogs < 10kg: 3 mm in length 

    Dogs 10 – 19 kg: 3.5 mm in length 

    Dogs 20-29 kg: 4 mm in length 

    Dogs > 30kg: 4.6 mm in length 

    Primary Hyperparathyroidism: 6 – 30 mm

     

    Conclusion:

    The parathyroid you show here may be normal in lenght and diameter- although maybe this could be early changes conistent with primary hyperparhathyroidism. May be worthwhile to follow the blood work and re-ultrasound at a later date

    I hope this information is helpful. Maybe others can weigh in here.

     

     

     

  3. You can FNA with 25 gauge and

    You can FNA with 25 gauge and hsould get adenoma if a pth tumor vs hyperplasia but those are usually rounder. Thyroids become remodeled often. See attached image for typical pth adenoma. Scan the abdomen and cranial mediastinum looking for lsa or simlar and palpate the anal glands as well if not already done.

    Here is my algorythm for hypercalcemia excerpt form the curbside guide in editing:

    High total & ionized Ca, Low PTHrp, normal/high PTH >> PTH tumor

    (German Shepherdshepherd, Keeshond, Golden Retriever predisposed)

     

    High  total & ionized Ca, Low PTHrp, Low  PTH, >> Hypercalcemia of Malignancy (Lymphoma, adenocarcinoma, multiple myeloma).

    Perform rectal palpation, cranial mediastinal imaging, abdominal sonogram, full CNS exam.

     

    High  total & ionized Ca, Low PTHrp, normal/Low PTH >>  Vitamin D Toxicity

     

    High total & ionized Ca, Low  PTHrp, Low PTH >> Granulomatous Disease

     

    High  total & normal ionized Ca, High BUN, High K, increased plasma protein binding of calcium >> Addison’s

     

    High/normal total Ca, Low ionized Ca, Low  PTHrp, High PTH, High BUN & Creatinine, Low urine specific gravity >> Renal Failure

    • Great algorythm – thank you!

      Great algorythm – thank you! How does hyperplasia differ from andenomas, but visually (round too?) and functionally?

  4. You can FNA with 25 gauge and

    You can FNA with 25 gauge and hsould get adenoma if a pth tumor vs hyperplasia but those are usually rounder. Thyroids become remodeled often. See attached image for typical pth adenoma. Scan the abdomen and cranial mediastinum looking for lsa or simlar and palpate the anal glands as well if not already done.

    Here is my algorythm for hypercalcemia excerpt form the curbside guide in editing:

    High total & ionized Ca, Low PTHrp, normal/high PTH >> PTH tumor

    (German Shepherdshepherd, Keeshond, Golden Retriever predisposed)

     

    High  total & ionized Ca, Low PTHrp, Low  PTH, >> Hypercalcemia of Malignancy (Lymphoma, adenocarcinoma, multiple myeloma).

    Perform rectal palpation, cranial mediastinal imaging, abdominal sonogram, full CNS exam.

     

    High  total & ionized Ca, Low PTHrp, normal/Low PTH >>  Vitamin D Toxicity

     

    High total & ionized Ca, Low  PTHrp, Low PTH >> Granulomatous Disease

     

    High  total & normal ionized Ca, High BUN, High K, increased plasma protein binding of calcium >> Addison’s

     

    High/normal total Ca, Low ionized Ca, Low  PTHrp, High PTH, High BUN & Creatinine, Low urine specific gravity >> Renal Failure

    • Great algorythm – thank you!

      Great algorythm – thank you! How does hyperplasia differ from andenomas, but visually (round too?) and functionally?

  5. When will the Curbside Guide

    When will the Curbside Guide be available?

    Will it be a dynamic document that we can update as information is added or changed?

     

  6. When will the Curbside Guide

    When will the Curbside Guide be available?

    Will it be a dynamic document that we can update as information is added or changed?

     

  7. its in editing im hoping for

    its in editing im hoping for digital download in about a month. It will have repeat editions every couple of years I imagine… Books take forever to produce:(

  8. its in editing im hoping for

    its in editing im hoping for digital download in about a month. It will have repeat editions every couple of years I imagine… Books take forever to produce:(

  9. re Hyperplasia form

    re Hyperplasia form adenomas… just off the top of my head hyperplasia looks more like your lesion… kind of blotchy but adenomas are round like my image usually well defined. The rare occasional adenocarcinoma is irregular and tentacle like and invasive… don;t know if we have any parathyroid adenoca in the archive… or as I like to say the bone collection:)… I’m not one to do histopathological ultrasound but those are the tendencies and you can do a search on them in the basic search in our archive and see what comes up. When in doubt put a needle in it. Its right under the skin so easy to hit if you are used to needles just corkscrew technique on it to get a good carve out of cells. Just angle away form the carotid and push the skin right down to the lesion which displaces the carotid. if you get cyto or histopath plaease update us. Nice post!

  10. re Hyperplasia form

    re Hyperplasia form adenomas… just off the top of my head hyperplasia looks more like your lesion… kind of blotchy but adenomas are round like my image usually well defined. The rare occasional adenocarcinoma is irregular and tentacle like and invasive… don;t know if we have any parathyroid adenoca in the archive… or as I like to say the bone collection:)… I’m not one to do histopathological ultrasound but those are the tendencies and you can do a search on them in the basic search in our archive and see what comes up. When in doubt put a needle in it. Its right under the skin so easy to hit if you are used to needles just corkscrew technique on it to get a good carve out of cells. Just angle away form the carotid and push the skin right down to the lesion which displaces the carotid. if you get cyto or histopath plaease update us. Nice post!

  13. Thank you all for your great

    Thank you all for your great comments.  I have attached the PTH results as follow up.  We have not aspirated yet, but I will offer that to the owner.  Otherwise, I am thinking of just monitoring that issue for right now. 

    To back up a bit, Jax is a 13 year MN old Golden.  The dog has a number of other issues we are trying to get under control after his initial presentation for GI upset.  He had been on pred for IBD symptoms, but we have weaned him off to perform some further testing.  He is very hypertensive (still 210 on enalapril) and has a UPC of 6.  Main abdominal ultrasound findings were a mottled liver parenchyma, suggestive of endocrinopathy.  CBC/Chem/lytes relatively unexciting other than mild inc. in iCa and globulins (liver values ok).  We plan to perform an ACTH stim and repeat thyroid panel in a few weeks (after has been off steroids an appropriate time).  The thyroid panel had low T4 and free T4, but normal TSH (middle of range). 

  14. Thank you all for your great

    Thank you all for your great comments.  I have attached the PTH results as follow up.  We have not aspirated yet, but I will offer that to the owner.  Otherwise, I am thinking of just monitoring that issue for right now. 

    To back up a bit, Jax is a 13 year MN old Golden.  The dog has a number of other issues we are trying to get under control after his initial presentation for GI upset.  He had been on pred for IBD symptoms, but we have weaned him off to perform some further testing.  He is very hypertensive (still 210 on enalapril) and has a UPC of 6.  Main abdominal ultrasound findings were a mottled liver parenchyma, suggestive of endocrinopathy.  CBC/Chem/lytes relatively unexciting other than mild inc. in iCa and globulins (liver values ok).  We plan to perform an ACTH stim and repeat thyroid panel in a few weeks (after has been off steroids an appropriate time).  The thyroid panel had low T4 and free T4, but normal TSH (middle of range). 

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