LAUSR

Correspondence to: Dr. Jian Zhou, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical (NMTC) has been reported occasionally since 1956; meanwhile, the synchronous occurrence of pHPT and two distinct tumors (follicular and papillary thyroid carcinoma) has rarely been reported. Here, we report the case of a 66year-old female patient who was transferred to a surgery specialist with the complaints of pHPT and two distinct carcinomas. The patient was admitted to theDepartment of Endocrinology andMetabolism in our hospital onMay 21, 2018 because of an elevation of serum calcium level at 2.80 mmol/L (reference range 2.08–2.60 mmol/L). Laboratory examinations revealed that the parathyroid hormone (PTH) level was 111.4 ng/L (reference range 15–65 ng/L), which suggested the diagnosis of pHPT. However, the patient had no symptoms suggestive of hypercalcemia such as generalized weakness or nausea. Subsequent single-photon emission computed tomography (SPECT) in combination with computed tomography (CT) was performed. Both earlyand late-phase images showed enhanced focal retention of Tc–99mMIBI located at the middle-upper part of the right thyroid lobe, and the abnormal signal accumulation was localized specifically at the middle-upper part of the dorsal right thyroid lobe by the fusion imaging of SPECT/CT, which suggested the existence of right-sided parathyroid adenoma [Figure 1A]. The patient provided no significant medical history and family history associated with multiple endocrine adenomatosis (MEN), andherCTscanof adrenal areas and cranial magnetic resonance imaging (MRI) scan demonstrated no obvious abnormality, therefore ruling out the possibility of MEN. Radionuclide bone imaging was also performed, and no abnormity was found. The patient then received ultrasound examination and a right-side parathyroid adenoma and bilateral solid thyroid nodules were detected [Figure 1B and 1C]. Fine-needle aspiration cytology (FNAC) was performed under the guidance of ultrasound, and the pathological result indicated the co-