A 62-year-old man with a history of chronic hemodialysis for 13 years was admitted for secondary hyperparathyroidism. Preoperative imaging studies demonstrated an enlarged parathyroid gland. During the survey, two additional enlarged glands were identified and removed. Extensive surgery including thymic tongues failed to find the left inferior gland. The left thyroid lobe was resected. Histological examination revealed an ectopic intrathyroidal parathyroid gland. The numbers and locations of parathyroid glands vary among cases. If parathyroid glands are left in situ, hyperparathyroidism will persist or recur. If extensive survey of the neck including thymic tongues fails to identify at least two parathyroid glands on either side, an ipsilateral thyroid lobectomy is recomended because of a possible ectopic intrathyroidal gland.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)