Case Study

Parathyroid mass with elevated Calcium and PTH in a 13 year old FS Shih tzu dog

A 13-year-old FS Shih Tzu dog was presented for routine dental prophylaxis. Physical examination was unremarkable. Abnormalities on preoperative blood work were hyperalbuminemia and hypercalcemia. Radiographs revealed severe loss of bone density and a separation in the front of the mandible. Abnormalities on follow-up blood chemistry were hypercalcaemia (both total and ionized), elevated triglycerides, and elevated PTH.

A 13-year-old FS Shih Tzu dog was presented for routine dental prophylaxis. Physical examination was unremarkable. Abnormalities on preoperative blood work were hyperalbuminemia and hypercalcemia. Radiographs revealed severe loss of bone density and a separation in the front of the mandible. Abnormalities on follow-up blood chemistry were hypercalcaemia (both total and ionized), elevated triglycerides, and elevated PTH.

Sonographic Differential Diagnosis

Likely parathyroid adenoma in the right cranial thyroid region 0.4 cm caudal to the carotid bifurcation.

Image Interpretation

Both the right and left thyroid regions were imaged in this patient. The left thyroid gland appeared smaller than the normal with mixed echogenic changes and fibrous retraction consistent with sclerosis and degenerative disease. The right thyroid also presented similar presentation, however a 0.6 cm hypoechoic nodule in the area of the parathyroid was present at 0.4 cm caudoventral to the carotid bifurcation. This is highly suggestive for parathyroid adenoma. This appears resectable.

DX

Parathyroid mass

Outcome

The patient underwent surgery with removal of the right parathyroid gland and recovered without event. Post-operative calcium levels normalized within 48 hours and the patient was discharged with Clavamox.