thyroid nodules and parathyroid adenoma

[nook]

I have calcium levels in the low to mid 10's, PTH high normal. I had a scan which showed adenoma below right thyroid. I then went for an ultrasound and am now frightened. Can you tell me what this means:

Right lobe) mid pole- solid nodule 8x7x4mm
                   mid pole- complex, less than 25% cystic 6x6x4mm
                  lower pole-  complex, less than 25% cystic 7x6x4mm
Left lobe: upper pole - complex, 25-50% cystic  8x8x5mm  
                 lower pole-   complex, 25-50% cystic  8x5x4 mm

Parathyroid galnd:
               two hypoechoic lesions inferior to the right lower pole of thyroid measuring: 8x6x3mm and 7x7x6 mm

IMPRESSION:  1.    two hypoechoic lesions inferior to the right lower lobe of thyroid  
                                possible parathyroid adenoma vs. node
                         2. small thyroid nodules

If you only have 4 parathyroid glands, what can the other hypoechoic lesion be? what does it mean by possible parathyroid adenoma vs. NODE? what node???

I Is it possible I have thyroid cancer on top of the parathyroid adenoma?

I don't see the surgeon for another three weeks and I have not idea what how I can have two parathyroid adenomas in the same place so am wondering what it could be
                        

[Mark Lupo, M.D.]

It is unlikely to have thyroid cancer.  He had small thyroid nodules and nonspecific areas inferior to the right lobe.  The key here is to see an experienced parathyroid surgeon who can evaluate the thyroid at the same time.  Based on the calcium and PTH levels, the diagnosis is likely primary hyperparathyroidism.  The other thing to consider with this ultrasound appearance is to test for Hashimoto's with TPO antibody and TSH.

[nook]

thank you.