Fig 2.

A 78-year-old woman with multigland disease, with a single small candidate lesion. A, Axial noncontrast CT just inferior to the thyroid gland shows a 6-mm nodule just deep to the strap muscles on the right (arrow). B, Axial arterial phase CT scan shows intense enhancement of this nodule. The serum calcium level was 10.1, and the serum parathyroid hormone level was 76. Despite identification of only a single lesion with 4D-CT, the composite MGD score was 4, and the probability of multigland disease was moderate. Surgical exploration revealed hyperplasia of the gland seen here and also hyperplastic bilateral superior parathyroid glands, neither of which could be seen even in retrospect.