Utility of 99mTc-Sestamibi SPECT/CT in the Early Localization of Metastatic Parathyroid Carcinoma

• Main Authors: Patrick Earl Fernando, Patricia Bautista
• Format: Article
• Language: English
• Published: Mashhad University of Medical Sciences 2018-06-01
• Series: Asia Oceania Journal of Nuclear Medicine and Biology
• Subjects: Parathyroid carcinoma; SPECT/CT; 99mTc-sestamibi
• Online Access: http://aojnmb.mums.ac.ir/article_10183_00a21d1ee413ff4349db1d29f0e6748e.pdf

Parathyroid carcinoma is very rare, with only a few documented cases. Hence, metastatic lesions are infrequently documented on scintigraphic imaging. We present a case of a 63-year-old female presenting with elevated serum levels of ionized calcium and parathyroid hormone (PTH) who was referred to our department for a parathyroid scan with SPECT/ CT. Parathyroid scintigraphy showed a focus of increased 99mTc-sestamibi uptake corresponding to a solid mass with calcification in the inferior pole of the right thyroid lobe; tracer retention was noted on delayed images. Incidentally, focal uptake was also seen in a soft tissue mass on the 7th right rib. The patient soon underwent total thyroidectomy, with biopsy revealing parathyroid carcinoma on the right lobe. A bone scan done 7 months after surgery confirmed the presence of metastatic bone disease. The concomitant detection of intrathyroidal and extrathyroidal sestamibiavid masses on parathyroid scintigraphy should increase clinical suspicion of a metastatic process from parathyroid carcinoma.