US features of normal parathyroid glands confirmed during thyroid surgery in adult patients
Seong Ju Kim1 , Wooyul Paik2 , Jong Cheol Lee3 , Yong Jin Song3 , Kwanghyun Yoon4 , Byeong-Joo Noh5 , Dong Gyu Na3
1Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
2Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
3Department of Otorhinolaryngology-Head and Neck Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
4Department of Sugery, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
5Department of Pathology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
Corresponding Author: Dong Gyu Na ,Tel: 82-33-610-4310, Fax: 82-33-610-3490, Email: nndgna@gmail.com
Received: June 5, 2024;  Accepted: July 8, 2024.  Published online: July 8, 2024.
ABSTRACT
Purpose:
This study aimed to investigate the US features of normal parathyroid glands (PTGs) identified on preoperative US and confirmed intraoperatively during thyroid surgery.
Methods:
This retrospective study included consecutive 161 patients (mean age, 56 years ± 14 [standard deviation]; 128 women) with 294 normal PTGs identified on preoperative US PTG mapping and confirmed during thyroidectomy. A small, round to oval, hyperechoic structure identified in the central neck was considered a normal PTG on US. The normal PTGs identified on preoperative US were mapped onto thyroid CT images and diagrams of the thyroid gland and neck for US PTG mapping. The location, size, shape, echogenicity, echotexture, and intraglandular vascular flow of identified normal PTGs were assessed during preoperative real-time US examinations, and those were compared between superior and inferior PTGs using the generalized estimating equation method.
Results:
Typical US features of homogeneous hyperechogenicity without intraglandular vascular flow were found in 267 (90.8%) PTGs, while atypical US features of isoechogenicity (1.0%), heterogeneous echotexture with focal hypoechogenicity (5.8%), and intraglandular vascular flow (3.7%) were observed in 27 (9.2%) PTGs. Inferior PTGs were more frequently identified in posterolateral (36.1% vs. 5.3%) and thyroid pole locations (29.9% vs. 5.3%), with less frequent in posteromedial locations (29.2% vs. 88.0%) compared to superior PTGs (P < .001, respectively).
Conclusion:
Most normal PTGs exhibited typical US features of homogeneous hyperechogenicity without intraglandular vascular flow. However, normal PTGs uncommonly exhibited atypical US features of isoechogenicity, heterogeneous echotexture with focal hypoechogenicity, and the presence of intraglandular vascular flow.
Keywords: Parathyroid glands; Parathyroid neoplasm; Thyroid gland; Thyroidectomy; Ultrasonography
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