{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:26Z","timestamp":1784557046101,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"\n Summary<\/jats:title>\n \n Primary hyperparathyroidism most commonly presents with hypercalcaemia. Rarely, parathyroid apoplexy or haemorrhage mimicking a thyroid bleeding cyst is the first presentation of a parathyroid adenoma. A woman presented with a sudden-onset painful \u2018goitre\u2019. Ultrasound showed a cystic nodule located posterior to rather than in the right thyroid lobe, suggesting parathyroid adenoma bleeding. Biochemistry showed mild primary hyperparathyroidism.\n 99m<\/jats:sup>\n Tc-pertechnetate\/sestamibi showed no uptake in the nodule, which was interpreted as a cold thyroid nodule.\n 18<\/jats:sup>\n F-fluorocholine PET\/CT showed uptake in the nodule, suggestive of a parathyroid adenoma. Persistent mild primary hyperparathyroidism complicated by nephrolithiasis and osteopenia favoured parathyroidectomy over a wait-and-see approach. The patient was referred for parathyroidectomy along with right thyroid lobectomy. Pathology showed an adenoma, with an eccentrically located cystic structure filled with red blood cells surrounded by a thickened fibrous capsule. In conclusion, cervical pain\/haemorrhage with hypercalcaemia points to the diagnosis of parathyroid apoplexy, mimicking a thyroid bleeding cyst. Workup with ultrasound and, if available,\n 18<\/jats:sup>\n F-choline PET\/CT allows for timely surgery, minimizing the risk of recurrent and severe bleeding.\n <\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n A bleeding cyst may be located posterior to rather than in the thyroid, suggesting a parathyroid haemorrhage.<\/jats:p>\n <\/jats:list-item>\n \n Neck pain and\/or haemorrhage along with primary hyperparathyroidism point to parathyroid apoplexy.<\/jats:p>\n <\/jats:list-item>\n \n A two-step presentation has been described, with a first phase of local symptoms to be followed by visible and possibly life-threatening compressing bleeding.<\/jats:p>\n <\/jats:list-item>\n \n Therefore, an expedited workup is needed, allowing for timely surgery.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-22-0385","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T06:40:36Z","timestamp":1702017636000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["Parathyroid adenoma apoplexy mimicking a thyroid bleeding cyst: a seemingly innocent condition that can be life-threatening"],"prefix":"10.1530","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9033-5060","authenticated-orcid":true,"given":"Jasmine","family":"Van de Kerkhof","sequence":"first","affiliation":[{"name":"Department of ENT, H&N Surgery, General Hospital Sint-Jan, Bruges, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Bijnens","sequence":"additional","affiliation":[{"name":"Department of ENT, H&N Surgery, General Hospital Sint-Jan, Bruges, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"De Geeter","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, General Hospital Sint-Jan, Bruges, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Dick","sequence":"additional","affiliation":[{"name":"Department of ENT, H&N Surgery, General Hospital Sint-Jan, Bruges, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascale","family":"De Paepe","sequence":"additional","affiliation":[{"name":"Department of Anatomopathology, General Hospital Sint-Jan, Bruges, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annick","family":"Van den Bruel","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, General Hospital Sint-Jan, Bruges, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Endocrine","first-page":"679","article-title":"The calcium-to-phosphorous (Ca\/P) ratio in the diagnosis of primary hyperparathyroidism and hypoparathyroidism: a multicentric study","volume":"68","author":"Madeo","year":"2020","unstructured":"Madeo BDe Vincentis SRepaci AAltieri PVicennati VKara EVescini FAmadori PBalestrieri APagotto U, The calcium-to-phosphorous (Ca\/P) ratio in the diagnosis of primary hyperparathyroidism and hypoparathyroidism: a multicentric study. 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