Symptomatic nonfunctioning parathyroid cysts: Role of simple aspiration and ethanol ablation
Introduction
Parathyroid cysts (PCs) are reported to develop in 0.5% of parathyroid disease and in 1% of all cystic neck lesions [1], [2]. PCs are divided into two categories: functioning and nonfunctioning cysts. Functioning PCs, causing primary hyperparathyroidism, have been treated by surgery [3], [4], [5]. Nonfunctioning PCs are true cysts and usually asymptomatic; however, large one can cause symptoms such as neck bulging, dysphasia, pain, tracheal compression, and recurrent laryngeal nerve palsy [1], [3], [4], [6].
Ultrasound (US)-guided simple aspiration is the choice for diagnosis of nonfunctioning PCs [7]. The aspirated fluid from these cysts is usually clear and colorless [1], [7]. Elevated parathyroid hormone (PTH) levels in aspirated fluid is indicative of PC; however, elevated PTH levels do not specify that the PC is of the functioning type [1], [4], [8], [9].
Although simple aspiration has been used as an initial diagnosis and treatment for symptomatic nonfunctioning PCs, recurrent cases after aspiration have been reported [1], [3], [7], [10], [11]. In patients with recurrent cysts, repeat aspiration, surgical excision, tetracycline treatment, or ethanol ablation (EA) is performed [5], [7], [9], [12], [13], [14]. EA has been also used in the treatment of cystic thyroid nodules and thyroglossal duct cysts [15], [16], [17]; however, to the best of our knowledge, there are only two case reports for nonfunctioning PCs treated by EA [5], [14]. Therefore, the purpose of this study is to evaluate the role of simple aspiration and EA for symptomatic nonfunctioning PCs.
Section snippets
Materials and methods
This retrospective study was approved by the institutional review board of Daerim St. Mary's hospital, and the consent for this study was waved; however written informed consent for US guided aspiration and EA was obtained from all patients prior to each procedure.
Results
Patient data and baseline characteristics of nonfunctioning PCs are summarized in Table 1. Mean follow-up period of all enrolled patients was 19.2 ± 12.9 months (median, 15.0 months; range, 7–40 months). All patients in our study complained of palpable neck mass, neck bulging, dysphasia, or discomfort. US examination showed no definite solid components in the cysts, and aspiration of internal fluid was possible in all cases. The average amount of aspirated fluid was 26.9 ± 22.8 mL (range, 5–85 mL)
Discussion
In our study, the aspiration of fluid from nonfunctioning PCs was possible in all 12 patients, of which 33% (4/12) were successfully treated by a simple aspiration alone. Repeat aspiration was not effective in any of the four patients with recurrent cysts; but EA successfully treated all of these cases without major complications. The results of this study suggest that although the success rate of simple aspiration is relatively low (33%) it could be a first line procedure for diagnosis and
Conflict of interest
All authors declare that no conflict interests exist.
References (30)
Parathyroid cysts
American Journal of Surgery
(1978)- et al.
Successful treatment of parathyroid cyst using ethanol sclerotherapy
American Journal of the Medical Sciences
(1999) - et al.
Sclerotherapy for benign parathyroid cysts
American Journal of Surgery
(1992) - et al.
How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation
European Journal of Radiology
(2012) - et al.
Parathyroid hormone (PTH) assay of parathyroid cysts examined by fine-needle aspiration biopsy
American Journal of Clinical Pathology
(1986) - et al.
A single-institution 25-year review of true parathyroid cysts
Langenbeck's Archives of Surgery
(2006) - et al.
Cystic parathyroid lesions: functional and nonfunctional parathyroid cysts
Archives of Surgery
(2009) - et al.
Vocal cord paralysis secondary to a benign parathyroid cyst: a case report with clinical, imaging and pathological findings (2008:6b)
European Radiology
(2008) - et al.
Needle aspiration of nonfunctioning parathyroid cysts
American Surgeon
(1990) - et al.
Intraparathyroid cyst: a tumour of branchial origin and a possible pitfall for targeted parathyroid surgery
ANZ Journal of Surgery
(2003)
A benign parathyroid cyst presenting with hoarse voice
Journal of Laryngology and Otology
Treatment of parathyroid cysts with fine-needle aspiration
Annals of Internal Medicine
Treatment of a nonfunctioning parathyroid cyst with tetracycline injection
Head and Neck
A parathyroid cyst effectively treated with a sclerosing agent
Japanese Journal of Surgery
A large, nonfunctioning parathyroid cyst recurring after aspiration and subsequently cured by percutaneous ethanol injection
Journal of Clinical Ultrasound
Cited by (33)
A Middle-aged Woman With Recurrent Intrathyroidal Parathyroid Cyst Treated With Ethanol Sclerotherapy
2023, AACE Clinical Case ReportsA rare case of ectopic parathyroid cyst associated with Hashimoto thyroiditis
2021, Journal of Clinical and Translational Endocrinology: Case ReportsCitation Excerpt :In the presence of nonfunctioning PC therapeutic options are: aspiration, sclerosing therapy (with tetracycline or ethanol) and surgical excision. The reported cases in the literature propose as the first approach to be represented by fluid aspiration, while sclerotherapy to be recommended in case of recurrence [18,19] and surgical treatment only in functioning PC or non-functioning PC presenting with compressive symptoms [9]. PC is an uncommon benign neck lesion that should be considered in the differential diagnosis of a neck mass and ultrasound-guided FNA of cystic fluid with assay for PTH level is an effective method of differentiating PC from thyroid cyst.
Checklist for Informed Consent
2021, Surgery of the Thyroid and Parathyroid GlandsNon-functioning parathyroid cysts refractory to conservative treatment
2018, Cirugia EspanolaThe Parathyroid Gland: An Overall Review of the Hidden Organ for Radiologists
2024, Journal of the Korean Society of Radiology