Case History

• 70/F , Known Diabetic, Hypertensive, Anemic (Hb7.6gms%), IHD, TMT Positive, Electrolyte imbalance, not able to walk or stand past 1 month

• Presented with Hypercalcemic crisis (Coma- 2 months back), Persistent nausea & Vomiting

• Evaluated

Very High Calcium & PTH

Biochemistry

Hypercalcemic crisis managed medically

Concordant USG & Sestamibi Findings

Sestamibi Scan

USG: Showed a Single Right adenoma

Anaesthetist view

Cardiologist Opinion: Very High surgical risk for Cardiac events

Transfused 1 pint of Packed RBCS the day before Surgery

Positioning

Plane between straps and sternocleidomastoid(SCM) muscle right side

SCM Straps

Parathyroid visulaisation

SCM

Parathyroid tumor

Visulalisation of both Parathyroid tumors

Inferior

Superior

Thyroid

Superior

Inferior

Double Parathyroid adenomas

Thyroid

Tumor bed after removal of both Parathyroid tumors,Wound Closed without a drain

Surgical Specimen

Closer view of the Double adenomas

Superior: 3.2x2.7x1.1cmWeight 8.2 gms

Inferior: 4.2x 3.1x2.6cmWeight 14.6 gms

Post opSerum Calcium Serum PTH

Preop 20.1, 19.0 15.6, 15.2, 12.4, 11.4( after 3 doses of Bisphophonates)

3864.6 pg/ml

Post op 9.1 304 pg/ml (1 hour postop)

Postop Day 2 7.2

Postop Day 3 8.1 (with calcium & Vit D Supplements)- discharged

Patient did not develop symptomatic hypocalcemia, Voice normal, Wound healthy discharged with Oral Calcium & vitamin D supplements