Abstract：
Variations in parathyroid gland positions often cause failure in initial parathyroid adenoma surgery, especially when imaging fails to localise the adenoma. This report describes a female patient with primary hyperparathyroidism for which preoperative localisation studies did not determine the position of the hyperfunctioning gland. The initial approach with bilateral cervical exploration and intraoperative parathyroid hormone monitoring was performed unsuccessfully. A mediastinal adenoma was suspected due to meticulous negative neck exploration and repeated negative images for a neck adenoma. Subsequently, a second approach involving mediastinal exploration was performed. After the removal of remnant thymic tissue in the mediastinal space, a significant drop in intraoperative parathyroid hormone levels was achieved. The pathological result confirmed the presence of a tiny pathological parathyroid adenoma within the thymus. At 6 months follow-up, postoperative biochemical assessment was consistent with normal calcium and parathyroid hormone levels.
摘要：
甲状旁腺位置的变化通常会导致初次甲状旁腺腺瘤手术失败，尤其是当成像无法定位腺瘤时。该报告描述了一名原发性甲状旁腺功能亢进症的女性患者，术前定位研究并未确定功能亢进症的位置。初次入路双侧宫颈探查术和术中甲状旁腺激素监测均未成功。由于精心的阴性颈部探查和重复的阴性颈部腺瘤图像，怀疑纵隔腺瘤。随后，进行了涉及纵隔探查的第二种方法.切除纵隔残余胸腺组织后，术中甲状旁腺激素水平显著下降.病理结果证实胸腺内存在微小的病理性甲状旁腺腺瘤。随访6个月时,术后生化评估与正常钙和甲状旁腺激素水平一致.
