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.

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Presentation transcript:

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: 3.2x2.7x1.1cm Weight 8.2 gms Inferior: 4.2x 3.1x2.6cm Weight 14.6 gms

Post op Serum CalciumSerum PTH Preop 20.1, , 15.2, 12.4, 11.4 ( after 3 doses of Bisphophonates) pg/ml Post op pg/ml (1 hour postop) Postop Day 27.2 Postop Day 38.1 (with calcium & Vit D Supplements)- discharged Patient did not develop symptomatic hypocalcemia, Voice normal, Wound healthy discharged with Oral Calcium & vitamin D supplements

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