Fortis Escorts Jaipur becomes the First in North India to Remove Rare large Parathyroid Cyst Affecting Nerves Controlling Vocal Cords

A team of doctors, led by Dr. Mohan Kulhari & Dr Baljeet Khanduja, Consultant - ENT/ Otorhinolaryngology, Fortis Escorts Hospital, Jaipur successfully performed hemithyroidectomy (the surgery to remove part of the thyroid gland) and removed the cyst from the 53-year-old man.

The patient was suffering from the symptoms such as pain in throat, difficulty in swallowing and fullness in the left side of the neck. Upon performing a contrast-enhanced computed tomography (CECT) and an ultrasonography (USG), a large cyst adjacent to the left lobe of the thyroid, abutting the trachea and esophagus was diagnosed. Upon testing through fine needle aspiration cytology (FNAC), suggestive of a colloid goiter (benign, noncancerous enlargement of thyroid tissue) was diagnosed though he had no symptoms of hyperparathyroidism, and calcium level was normal.

 Cystic disease of the parathyroid gland is quite rare as compared to adenomas (a benign tumor) and only around 300 cases of parathyroid cyst have been reported worldwide till date. This case was tricky because radiological examinations and FNAC indicated two different conditions – thyroid nodule with cystic degeneration and parathyroid cyst. The team finally decided to go ahead with hemithyroidectomy (surgical removal of all or part of the thyroid gland and the cyst). Besides, the patient has a family history of cancer, the challenge was to remove the thin wall cysts intact to prevent recurrence and for definitive diagnosis.

The recurrent laryngeal nerves lie on both sides of the windpipe in the area where the parathyroid glands are located. These nerves control the vocal cords and any injury to one of the nerves may cause hoarseness or a whispering quality to the voice. The nerve was detached very carefully from the cyst. We removed the left half of his thyroid gland and brought out the cyst intact which was detected as large parathyroid cyst (6.5 x 5.5 x 4.5 cm) through histopathology.

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