Co-author(s): Garth Olson MD, Von Samedi MD

Parathyroiditis low power demonstrating parathyroid tissue with inflammatory cells and germinal centers.

Parathyroiditis higher power showing parathyroid tissue with inflammatory cell infiltrate and a germinal center.

Parathyroiditis highest power showing interface

Parathyroiditis highest power showing parathyroid cells.

Germinal center on highest power.

Focal lymphocytic infiltration of the parathyroid tissue can be demonstrated at autopsy in roughly 10% of patients but is seldom associated with functional parathyroid problems in life.1

This entity is rare but described by several authors as presenting with hypoparathyroidism or hyperparathyroidism. This particular patient presented initially with hyperparathyroidism and subsequent late hypocalcemia and hypoparathyroidism several months after removal of the parathyroid tissue depicted here. This case demonstrates the duplicitous nature of this disease.

In patients with hyperparathyroidism associated with this condition, subtotal parathyroidectomy has been described2 . In this particular case, the patient presented with hyperparathyroidism which was treated with single gland exploration and excision of a presumed adenoma found on a preoperative localizing scan. Immediate postoperative measurement of parathyroid hormone and calcium levels were normal. Three months later the patient presented with hypocacemia and hypoparathyroidism and was treated with corticosteroids which brought the parathyroid function up to normal levels. After tapering of corticosteroids, this patient remains with normal parathyroid function.