- 10 year old mc Dachshund was diagnosed with primary hyperparathyroidism, solitary nodule (4.0mm) in the left cranial parathyroid gland. He was treated with ethanol ablation at a referral institution in another state in March of 2019.
- Pretreatment bloodwork showed iCA=1.78, PTH=6.2, PTHrp wnl.
- Follow up bloodwork performed at the referral institution later in March showed persistent elevations in iCa.
- Most recent bloodwork performed 4-16-19 at the client’s new primary clinic shows elevated iCa=1.84 (N=1.25-1.50).
- 10 year old mc Dachshund was diagnosed with primary hyperparathyroidism, solitary nodule (4.0mm) in the left cranial parathyroid gland. He was treated with ethanol ablation at a referral institution in another state in March of 2019.
- Pretreatment bloodwork showed iCA=1.78, PTH=6.2, PTHrp wnl.
- Follow up bloodwork performed at the referral institution later in March showed persistent elevations in iCa.
- Most recent bloodwork performed 4-16-19 at the client’s new primary clinic shows elevated iCa=1.84 (N=1.25-1.50).
- Cervical ultrasound performed today shows a 3.1mm hypoechoic nodule in the left thyroid region.
- What is the normal appearance of the thryroid and parathyroid glands post ethanol ablation?
- Is ethanol ablation supposed to make the nodule go away or just become nonfunctional?
- What would the best next step be? Surgical exploratory and removal? Repeat ethanol ablation? Would you check PTH and PTHrp first?
Comments
Most places have gone away
Most places have gone away from the ethanol ablation owing to ineffectiveness or complications or both. Sx is the way to go. Sometimes multiple adenomas can be present. You can 25g fna the noduel to see confirm PT adenoma as opposed to hyperplasia.
Thank you. Not sure how well
Thank you. Not sure how well a 3mm nodule will exfoliate into the needle. I will likely recommend surgery. Still just wondering, what does the region generally look like after ethanol ablation? Should the nodule dissappear? Would there be scar tissue?
I don’t do ethanol ablation
I don’t do ethanol ablation so not sure what they look like but just going by the recs Ive heard from lecturers on what to do with the pth adenomas and our experience. You can use the “corkscrew” technique on these small targets to get them to exfoliate. You twist the syringe as the needle goes into the lesion wihtout pulling back just twist the cells into the needle instead of woodpecker into the needle.
Ok, thank you!
Ok, thank you!
https://sonopath.com/educati
https://sonopath.com/educationevents/ultrasound-resources/ultrasound-guided-procedures/ultrasound-guided-lymph-node-cultu