A Case Report: Synchronous Normocalcemic Primary HyperParathyroidism and Multinodular Goitre - A Diagnostic and Therapeutic Challenge

Dr. Vinod Duraisami, Dr. Manivannan D, Dr. Sateesh Krishnasamy

Abstract: Background: The synchronous presentation of primary hyperparathyroidism (PHPT) and multinodular goitre (MNG) is a relatively common clinical scenario. However, PHPT caused by multi-glandular parathyroid hyperplasia co-existing with MNG presents significant diagnostic and surgical challenges. Pre-operative localization studies like 99mTc-Sestamibi SPECT/CT can be equivocal in such cases. Case Presentation: We report the case of a 45-year-old female who presented with a swelling in the front of her neck. Her biochemical profile was suggestive of primary hyperparathyroidism, with a serum calcium of 11 mg/dL and an intact parathyroid hormone (PTH) level of 97 pg/mL. Thyroid function tests were normal. An ultrasound of the neck confirmed a multinodular goitre. A 99mTc-Sestamibi parathyroid SPECT/CT scan was inconclusive for a dominant adenoma, instead showing two nodular lesions with non-significant uptake in the superior paraesophageal regions, suggestive of possible hyperplasia. The patient underwent a total thyroidectomy and bilateral superior parathyroidectomy. Post-operative histopathology confirmed colloid goitre and primary parathyroid hyperplasia. Conclusion: This case highlights the diagnostic complexity when parathyroid hyperplasia and nodular thyroid disease coexist. Surgeons and endocrinologists must maintain a high index of suspicion for multi-gland disease when pre-operative imaging is atypical, and plan the surgical strategy accordingly to ensure curative treatment and avoid persistent or recurrent hyperparathyroidism.

Keywords: Normocalcemic Hyperparathyroidism, Parathyroid Clear Cell Hyperplasia, Multinodular Goitre, Sestamibi SPECT/CT, Parathyroid Autotransplantation

How to Cite?: Dr. Vinod Duraisami, Dr. Manivannan D, Dr. Sateesh Krishnasamy, "A Case Report: Synchronous Normocalcemic Primary HyperParathyroidism and Multinodular Goitre - A Diagnostic and Therapeutic Challenge", Volume 14 Issue 8, August 2025, International Journal of Science and Research (IJSR), Pages: 1432-1434, https://www.ijsr.net/getabstract.php?paperid=SR25824190451, DOI: https://dx.doi.org/10.21275/SR25824190451