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Sestamibi Localization of a Parathyroid Adenoma in the Presence of a Thymoma: a Case Report and Review of the Literature Preoperative localization in the surgical management of primary hyperparathyroidism is complicated by widely variable parathyroid gland anatomy, coexisting thyroid pathology, incidence of supernumerary and ectopic parathyroid glands, and limitations of targeted imaging studies. Technetium 99mTcsestamibi scans have decreased accuracy, sensitivity and specificity in the presence of multi-gland parathyroid disease. A number of reports suggest that thymomas, which also show increased sestamibi uptake, are potential sources of false positives on 99mTc-sestamibi scans. Herein, we describe a thymoma in association with a parathyroid adenoma complicating localization of hyperfunctional parathyroid tissue. We review the literature of concurrent pathology between parathyroid adenomas and thymomas paying particular attention to how these cases present on preoperative 99mTcsestamibi scans.

Relationship of Vitamin D Levels in Thyroid Malignancy Vitamin D has been reported in several studies to have antiproliferative, anti-apoptotic and pro-differentiating effects in several tumor types. The role of vitamin D in the incidence and/or progression of thyroid malignancy remain largely unknown. We performed a retrospective chart review of postoperative 25-hydroxyvitamin D levels from 255 subjects receiving total (n=197) or completion (n=58) thyroidectomy for benign (n=190) and malignant (n=65) disease at the University of Arkansas for Medical Sciences between October 2005 and July 2013. No significant difference (P = 0.72) was observed between postoperative 25-hydroxyvitamin D levels in subjects with malignant pathology (median 25 ng/mL; range 21-37 ng/ml) versus benign pathology (median 27 ng/ml; range 19.5-35 ng/ml). In our limited study, there was no correlation between postoperative 25-hydroxyvitamin D status and pathological findings in subjects undergoing thyroidectomy.

Robot-Assisted Mediastinal Parathyroidectomy: Collaboration Between Otolaryngology and Thoracic Surgery There are only a few cases in the literature describing roboticassisted mediastinal parathyroidectomy. Herein, we present the largest cohort of patients (N=7) treated with roboticassisted mediastinal parathyroidectomy. All patients showed biochemical resolution of disease and no major complications were encountered. In our experience, robotic-assisted mediastinal parathyroidectomy is safe and effective in patients with primary hyperparathyroidism when performed in collaboration by experienced and robotically trained thoracic and head and neck surgeons.