Parathyroid carcinoma accounts for less than 1 per cent of cases of primary hyperparathyroidism. Its synchronous occurrence with thyroid carcinoma is rarer still, with only seven such patients previously reported in the literature. We report another case, unique not only because the parathyroid carcinoma was found within the left thyroid lobe but also because of the presence of a synchronous papillary thyroid carcinoma within the contralateral thyroid lobe. The case illustrates the need for surgeons to be aware of the possibility of concomitant thyroid pathology and the potential for the synchronous occurrence of other endocrine neoplasms. Our case is a 56-year-old female who presented with hypercalcemia, complaints of pain in her left shoulder and hip and a history of recurrent kidney stones over a period of several months. One year prior to the present admission she had undergone an extensive workup for an intrathyroidal lesion located within the central aspect of the left thyroid lobe and for bilateral adrenal incidentalomas measuring 4.3 cm on the right and 1.7 cm on the left. Fine-needle aspiration biopsy of the thyroid nodule revealed parathyroid tissue. Biopsy of the larger of the two adrenal lesions was negative for malignancy. At that time she had bilateral ureteral stents placed for obstructive uropathy. She was discharged with instructions to follow up after recovery from her ureteral stenting to undergo resection of her presumed intrathyroidal parathyroid adenoma. She subsequently was readmitted because of worsening bone pain. On her subsequent presentation, physical examination her of head, neck, and cervical nodal basins were normal. Laboratory evaluations revealed hypercalcemia with a serum level of 12.2 mg/dL and a parathyroid hormone (PTH) level of 1246 pg/mL.
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