02/13/2026
Interesting Case of the Week 🩺🥼
We recently treated a 66-year-old man whose elevated calcium was discovered during routine labs for prostate cancer. Further evaluation showed a calcium level of 11 and a PTH of 173—clear evidence of primary hyperparathyroidism. Although his symptoms were mild, he chose to pursue surgery for a definitive cure.
Preoperative ultrasound revealed small thyroid nodules but did not identify an enlarged parathyroid gland. However, his nuclear medicine scan told a different story—showing abnormal activity deep in the chest, 7.1 cm below the sternal notch. During surgery, his parathyroid gland was ultimately found hidden within the thymus. Because the lower parathyroid glands and thymus develop and migrate together, they can occasionally travel into the chest. Thankfully, we were able to safely remove the gland, and his post-operative PTH dropped to 19—confirming a cure.
Ultrasound cannot see through the bones of the chest, which is why his abnormal gland was missed. Without advanced nuclear imaging, his surgery may not have been successful.
Expert evaluation matters. At the Norman Parathyroid Center, we perform more parathyroid operations than any institution in the world—currently about 10 times more annually than any other hospital or university.
Learn more: https://www.parathyroid.com/about-parathyroid.htm