hi, Case Study: Primary Hyperparathyroidism Idid for her surgery left inferior parathyroidectomy Kindly find the below details and make case study as per the attached file ( attached file is a sample of another case study ) ????T1A4-410E | Munierah | 11000045419 | Parathyroid Elective Admission 54-year-old unmarried female, known DM on OHA, HTN on Amlodipine & Valsartan, Osteoporosis, NKA. Surgical history of hysterectomy 7 years ago for AUB. She had a history of chronic bone pain, her brother sought medical care upon lab investigations she was found to have high calcium levels. Denied any renal, abdominal, nor psychiatric symptoms. No background history of any renal diseases. Referred to our OPD through Al-Diryah Hospital. Admitted Electively as case of Primary Hyperparathyroidism for Localized Parathyroidectomy +/- Bilateral Neck Exploration, +/- Left Hemithyroidectomy, and Proceed O/E: -Conscious, alert, oriented -Vitally stable -Neck: No apparent swellings, no scars, bruises, normal overlying skin, no palpable masses, non-tender, no increased warmth, no appreciated LNs Labs: CBC (22/1/25) - WBC 7.3 || HGB 14.4 || PLT 251 Bone Profile (22/1/25) - Ca 2.86 || Albumin 51 || Phos 0.70 Coag (22/1/25) - PT <10 || PTT 34.4 KFT (22/1/24) - Cr 60.8 || BUN 4.8 || K 4.6 -Vitamin D 73.3 -PTH (4/7/24) 901.73 TFT (4/7/24) - TSH 2.64 || FT3 4.33 || FT4 11.41 Imaging: US Neck (8/6/24) FINDINGS: Thyroid of normal echotexture and volume (right lobe volume measuring (5) cm, left lobe volume measuring (2.55) cm and isthmus measuring (0.15.) mm in anteroposterior diameter), no nodules detected. At lower posterior aspect of left thyroid lobe : an isoechoic mass lesion measured 4x2.5 cm with retrosternal extension is noticed , needs further assessment. No lymphadenopathy detected. Impression: At lower posterior aspect of left thyroid lobe : an isoechoic mass lesion measured 4x2.5 cm with retrosternal extension is noticed , needs further assessment. US Kidney (8/6/24) Impression: No nephrolithiasis on either side. BMD (8/7/24): FINDINGS: Lumbar spine(L1-L4) BMD: 0.711 T-score, -3.1 Z-score -2.3 Femoral BMD: 0.828 T-score, -1.5 Z-score -1.0 No prior similar exam is available for comparison. IMPRESSION. BMD: Osteoporosis. Sesta-MIBI Scan (10/16/24) FINDINGS: PLANAR IMAGES: Both thyroid lobes are within normal location and exhibit homogeneous tracer distribution with almost complete washout on delayed images. The right lobe size measures about 2.8 x 2 cm, left lobe 2.4 x 1.9 cm. A large focus of increased radiotracer uptake is seen inferior and medial to the lower pole of left thyroid lobe with persistent uptake in the delayed image. SPECT CT: Fused images showed evidence of a large nodule seen in the anterior mediastinum posterior and superior to the manubrium with increased radiotracer uptake, measures about 1.7 x 1.2 cm in axial dimensions. CONCLUSION: Positive study for large parathyroid adenoma in the anterior mediastinum as detailed above. CT Neck (10/23/24): FINDINGS: There is lower anterior centrum cervical space lobulated enhancing soft tissue lesion just inferior to the left thyroid lobe, measuring about 2.4 cm by 3 cm with a small (1cm) retrosternal extension. A thin tissue plane separates the lesion from adjacent vasculature , muscles and left thyroid lobe. No calcifications or cystic component. The inferior portions of the brain are normal. Right orbital macrophthalmia, likely due to axial myopia. The nasopharynx, oropharynx and oral cavity appear normal. the larynx and hypopharynx are normal. the major salivary glands appear normal. The lung apices are clear. Vascular enhancement is normal. No pathologic lymphadenopathy is identified. Osseous structures are normal. 2 mm right palatine tonsillar stone. Impression: Large lobulated heterogeneously enhancing lesion inferior to the thyroid left lobe with retrosternal extension, either exophytic thyroid nodule versus parathyroid tumor. CT Chest (10/23/24): FINDINGS: Lungs and airways: Patent tracheobronchial airway. Diffuse bilateral mosaic attenuation. Nonspecific left upper lobe sub-solid nodule measures 4 mm (series 5 image 170) Mediastinum and lymph nodes: No enlarged lymph nodes on a size criteria. Small thymic hyperplasia. Pleura and pericardium: No effusions. Heart and coronaries: Minimal coronary artery calcifications. Vascular structures: Within normal limits. Visualized part of the thyroid, lower neck and esophagus: CT neck reported separately. A small size hiatal hernia Chest wall and bones: No aggressive bony lesions. Well-defined sclerotic lesion involving T11 vertebral body suggests bony island. Partially visualized upper abdomen: No gross abnormality. IMPRESSION: - Small left upper lobe nonspecific nodule. - Once again noted 3 x 1.5 cm upper mediastinal/inferior to thyroid lesion. - CT neck reported separately. Plan: - For OR tomorrow (Localized Parathyroidectomy +/- B/L Neck Exploration, +/- Left Hemithyroidectomy, and Proceed) -Allow DM, low salt regular diet as tolerated until NPO time -Allow home medications – once NPO allow morning doses with sips of water -Insulin Sliding Scale -Full labs (CBC, KFT, LFT, COAG, PTH, Bone Profile) -CXR, ECG, Pregnancy test -2U PRBC standby -Omeprazole 40mg IV OD -Heparin 5000IU SQ TID – to be held pre-op -Anesthesia review -Keep NPO on D5 ½ NS 100ml/hr starting at 12am midnight -Hold morning/night dose of anticoagulants & apply pneumatic compression -Cefazolin 2g IV On-Call to OR -Surgical and Blood Consents -PTH Requests for OR (entered) -Encourage mobilization -Routine monitoring of vital signs
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