Echogenic parathyroid glands?

[David Fetzer]

OK, am I totally stupid? Did is miss this class in medical school?

All of the sudden I’m seeing cases of homogeneous echogenic extrathyroidal nodules being called normal parathyroid glands. Previous to this, myself and all of my colleagues were calling these fatty-replaced lymph nodes.

However, a recent manuscript says otherwise:

http://www.e-ultrasonography.org/journal/view.php?number=1637

Any assistance would be helpful!

David

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[Maitray D. Patel]

thanks David, this is really helpful information IMO…the paper has FNA washout confirmation that the observation was parathyroid, so looks legit to me…I love having this as a label for these occasional echogenic observations

[Nirvikar Dahiya]

Ever since David pointed this out , I am seeing them more. They do seem more prominent in post thyroidectomy patients

 

 

[Nirvikar Dahiya]

Just read the study – seems pretty legit !

[Jill Jones]

We see these echogenic, almond-shaped nodules below the thyroid nearly every day in our practice. I agree – we used to call them fatty-replaced lymph nodes and ignore them. However, there’s never a correlate on CT. I’ve discussed this topic with our ENT colleagues who specialize in parathyroid surgery. They see them at surgery and often remove them, but say they don’t usually come back as parathyroid tissue on path. We’ve started calling them fatty thyrothymic rests (essentially fatty replaced ectopic thymic and/or thyroid tissue) – and still ignore them.

The article is interesting, but I think it’s misleading to patients and providers who may think we routinely see normal parathyroid glands with US. I plan to discuss the article at our next parathyroid conference and get some other opinions.

[Maitray D. Patel]

I can’t say that I see these daily, and we do a lot of thyroid studies.  In my experience, we see these occasionally. It seems like everyone agrees that these should be ignored as “normal”.  It’s hard to argue with PTH confirmation that the authors of the paper indicate. Having said that, it seems reasonable that SOME of these are normal parathyroid glands and OTHERS are not (but not pathologic).

Jill, you say that they “usually” don’t come back as parathyroid, but it must be difficult if not impossible to know if what your ENT surgeons have taken out are actually the observation made on ultrasound given the small size.  Not that it matters, I think, but it might be interesting to get the take of your parathyroid conference colleagues, so do share when you get some feedback.

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