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Unexpected elevation of parathyroid hormone in an asymptomatic patient with multiple endocrine neoplasia syndrome type 2A
  1. Peter Wiesli,
  2. Jörg Furrer
  1. Medical Policlinic, Department of Internal Medicine, University Hospital, Zürich, Switzerland
  1. Dr P Wiesli, Endocrinology and Diabetes, Department of Internal Medicine, Kantonsspital St Gallen, CH-9007 St Gallen, Switzerland (email: maoa7{at}ms1.kssg.ch)

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Two years ago, a 19 year old man underwent total thyroidectomy because of medullary thyroid carcinoma in association with the multiple endocrine neoplasia syndrome type 2A. At the same time as total thyroidectomy, total parathyroidectomy and heterotopic autotransplantation of parathyroid tissue to the right forearm was performed. Postoperative course and follow up over two years was uneventful; this included repeated biochemical testing (including parathyroid hormone level, calcitonin, and urinary catecholamines). The patient did not complain of any symptoms on the occasion of the last routine check up, but laboratory investigations revealed the results shown in table1.

Table 1

Results of investigations

Questions

(1)
What is the differential diagnosis?
(2)
What is your assessment?

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