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T1 Age 2 13 45-year-old T2 Sex 14 19 woman T3 Clinical_event 20 28 presents E1 Clinical_event:T3 T4 Sign_symptom 97 101 pain E2 Sign_symptom:T4 T5 Nonbiological_location 36 56 general practitioner R1 MODIFY Arg1:T5 Arg2:E1 T6 Biological_structure 88 96 shoulder T7 Biological_structure 79 83 neck R2 MODIFY Arg1:T6 Arg2:E2 R3 MODIFY Arg1:T7 Arg2:E2 T8 Detailed_description 68 78 left-sided R4 MODIFY Arg1:T8 Arg2:E2 T9 Sign_symptom 107 111 pain E3 Sign_symptom:T9 T10 Severity 116 120 mild R5 MODIFY Arg1:T10 Arg2:E3 T11 Sign_symptom 3887 3891 pain E4 Sign_symptom:T11 A1 POLARITY E4 NEG T12 Biological_structure 3878 3886 shoulder T13 Biological_structure 3869 3873 neck R6 MODIFY Arg1:T12 Arg2:E4 R7 MODIFY Arg1:T13 Arg2:E4 T14 History 186 259 denied a history of smoking, excessive alcohol use and radiation exposure T15 History 156 180 history was unremarkable T16 Detailed_description 125 137 non-specific R8 MODIFY Arg1:T16 Arg2:E3 T17 Diagnostic_procedure 261 281 Physical examination E5 Diagnostic_procedure:T17 T18 Sign_symptom 320 335 lymphadenopathy E6 Sign_symptom:T18 T19 Biological_structure 311 319 cervical R9 MODIFY Arg1:T19 Arg2:E6 T20 Detailed_description 300 310 left sided T21 Severity 295 299 mild R10 MODIFY Arg1:T20 Arg2:E6 R11 MODIFY Arg1:T21 Arg2:E6 T22 Diagnostic_procedure 345 356 blood tests E7 Diagnostic_procedure:T22 T23 Diagnostic_procedure 386 393 calcium E8 Diagnostic_procedure:T23 T24 Lab_value 366 385 borderline elevated E9 Lab_value:T24 T25 Lab_value 397 407 10.5 mg/dL E10 Lab_value:T25 R12 MODIFY Arg1:E10 Arg2:E8 R13 MODIFY Arg1:E9 Arg2:E8 T26 Lab_value 490 499 286 pg/mL E11 Lab_value:T26 T27 Nonbiological_location 532 546 otolaryngology T28 Clinical_event 520 528 referred E12 Clinical_event:T28 R14 MODIFY Arg1:T27 Arg2:E12 T29 Diagnostic_procedure 461 480 parathyroid hormone E13 Diagnostic_procedure:T29 R15 MODIFY Arg1:E11 Arg2:E13 T30 Lab_value 452 460 elevated E14 Lab_value:T30 R16 MODIFY Arg1:E14 Arg2:E13 T31 Diagnostic_procedure 579 589 ultrasound E15 Diagnostic_procedure:T31 R17 SUB_PROCEDURE Arg1:E8 Arg2:E7 T32 Diagnostic_procedure 423 430 work up E16 Diagnostic_procedure:T32 R18 SUB_PROCEDURE Arg1:E13 Arg2:E16 T33 Biological_structure 571 578 Thyroid R19 MODIFY Arg1:T33 Arg2:E15 T34 Sign_symptom 610 616 nodule E17 Sign_symptom:T34 T35 Detailed_description 599 609 hypoechoic R20 MODIFY Arg1:T35 Arg2:E17 T36 Biological_structure 624 654 left lower lobe of the thyroid R21 MODIFY Arg1:T36 Arg2:E17 T37 Diagnostic_procedure 656 658 CT E18 Diagnostic_procedure:T37 T38 Biological_structure 671 675 neck R22 MODIFY Arg1:T38 Arg2:E18 T39 Sign_symptom 702 708 nodule E19 Sign_symptom:T39 T40 Detailed_description 692 701 hypodense R23 MODIFY Arg1:T40 Arg2:E19 T41 Distance 687 691 2 cm R24 MODIFY Arg1:T41 Arg2:E19 T42 Biological_structure 716 767 posterior inferior aspect of the left lower thyroid R25 MODIFY Arg1:T42 Arg2:E19 T43 Diagnostic_procedure 772 781 sestamibi E20 Diagnostic_procedure:T43 #1 AnnotatorNotes E20 Technetium (99mTc) sestamibi T44 Sign_symptom 794 810 increased uptake E21 Sign_symptom:T44 T45 Biological_structure 821 856 lower pole of the left thyroid lobe R26 MODIFY Arg1:T45 Arg2:E21 T46 Diagnostic_procedure 867 870 PTH E22 Diagnostic_procedure:T46 T47 Lab_value 858 866 Elevated E23 Lab_value:T47 R27 MODIFY Arg1:E23 Arg2:E22 T48 Sign_symptom 885 893 aberrant E24 Sign_symptom:T48 T49 Biological_structure 894 911 parathyroid gland R28 MODIFY Arg1:T49 Arg2:E24 T50 Diagnostic_procedure 915 922 imaging E25 Diagnostic_procedure:T50 T51 Disease_disorder 940 959 hyperparathyroidism E26 Disease_disorder:T51 A2 POLARITY E26 UNCERTAIN T52 Detailed_description 932 939 primary R29 MODIFY Arg1:T52 Arg2:E26 T53 Disease_disorder 975 994 hyperparathyroidism E27 Disease_disorder:T53 T54 Disease_disorder 1014 1026 bone disease E28 Disease_disorder:T54 T55 Disease_disorder 1028 1040 renal stones E29 Disease_disorder:T55 T56 Disease_disorder 1045 1070 neuromuscular dysfunction E30 Disease_disorder:T56 T57 Diagnostic_procedure 1098 1118 screening modalities E31 Diagnostic_procedure:T57 T58 Sign_symptom 1161 1173 asymptomatic E32 Sign_symptom:T58 T59 Disease_disorder 1184 1203 hyperparathyroidism E33 Disease_disorder:T59 T60 Detailed_description 1176 1183 Primary R30 MODIFY Arg1:T60 Arg2:E33 T61 Disease_disorder 1245 1252 adenoma E34 Disease_disorder:T61 T62 Biological_structure 1233 1244 parathyroid R31 MODIFY Arg1:T62 Arg2:E34 T63 Disease_disorder 1292 1303 hyperplasia E35 Disease_disorder:T63 T64 Biological_structure 1280 1291 parathyroid R32 MODIFY Arg1:T64 Arg2:E35 T65 Disease_disorder 1373 1382 carcinoma E36 Disease_disorder:T65 T66 Biological_structure 1361 1372 parathyroid R33 MODIFY Arg1:T66 Arg2:E36 T67 Diagnostic_procedure 1408 1411 PTH E37 Diagnostic_procedure:T67 T68 Lab_value 1393 1401 elevated E38 Lab_value:T68 T69 Detailed_description 1402 1407 serum R34 MODIFY Arg1:T69 Arg2:E37 R35 MODIFY Arg1:E38 Arg2:E37 T70 Diagnostic_procedure 1416 1423 calcium E39 Diagnostic_procedure:T70 R36 MODIFY Arg1:E38 Arg2:E39 T71 Severity 1442 1448 severe T72 Sign_symptom 1464 1478 manifestations E40 Sign_symptom:T72 T73 Biological_structure 1449 1454 renal T74 Biological_structure 1459 1463 bone R37 MODIFY Arg1:T74 Arg2:E40 R38 MODIFY Arg1:T73 Arg2:E40 R39 MODIFY Arg1:T71 Arg2:E40 T75 Disease_disorder 1511 1517 cancer E41 Disease_disorder:T75 T76 Disease_disorder 1593 1603 metastases E42 Disease_disorder:T76 T77 Sign_symptom 1580 1588 invasion E43 Sign_symptom:T77 T78 Therapeutic_procedure 1553 1564 operatively E44 Therapeutic_procedure:T78 T79 Therapeutic_procedure 1633 1650 parathyroidectomy E45 Therapeutic_procedure:T79 T80 Therapeutic_procedure 1778 1785 surgery E46 Therapeutic_procedure:T80 T81 Clinical_event 2202 2209 brought E47 Clinical_event:T81 T82 Nonbiological_location 2217 2231 operating room R40 MODIFY Arg1:T82 Arg2:E47 T83 Therapeutic_procedure 2248 2265 parathyroidectomy E48 Therapeutic_procedure:T83 T84 Diagnostic_procedure 3050 3062 P57 staining E49 Diagnostic_procedure:T84 T85 Lab_value 3067 3075 negative E50 Lab_value:T85 R41 MODIFY Arg1:E50 Arg2:E49 * OVERLAP E1 E2 E3 R42 BEFORE Arg1:E3 Arg2:E5 * OVERLAP E5 E6 E7 E16 R43 BEFORE Arg1:E16 Arg2:E12 * OVERLAP E12 E15 E17 E18 E19 E20 E21 E22 E24 E25 E26 T86 Clinical_event 3308 3319 followed up E51 Clinical_event:T86 T87 Diagnostic_procedure 3347 3354 imaging E52 Diagnostic_procedure:T87 T88 Sign_symptom 3380 3386 tumour E53 Sign_symptom:T88 A3 POLARITY E53 UNCERTAIN T89 Detailed_description 3371 3379 residual R44 MODIFY Arg1:T89 Arg2:E53 T90 Diagnostic_procedure 3404 3413 sestamibi E54 Diagnostic_procedure:T90 T91 Diagnostic_procedure 3418 3446 positron emission tomography E55 Diagnostic_procedure:T91 T92 Diagnostic_procedure 3448 3451 PET E56 Diagnostic_procedure:T92 R45 IDENTICAL Arg1:E56 Arg2:E55 T93 Sign_symptom 2056 2060 pain E57 Sign_symptom:T93 T94 Diagnostic_procedure 2080 2083 PTH E58 Diagnostic_procedure:T94 T95 Lab_value 2071 2079 elevated E59 Lab_value:T95 R46 MODIFY Arg1:E59 Arg2:E58 T96 Age 2093 2118 younger than 50 years old T97 Therapeutic_procedure 2143 2150 surgery E60 Therapeutic_procedure:T97 R47 AFTER Arg1:E26 Arg2:E57 * OVERLAP E57 E58 R48 BEFORE Arg1:E58 Arg2:E60 R49 AFTER Arg1:E60 Arg2:E47 R50 BEFORE Arg1:E47 Arg2:E48 T98 Diagnostic_procedure 1852 1878 glomerular filtration rate E61 Diagnostic_procedure:T98 T99 Diagnostic_procedure 1891 1911 bone density T-score E62 Diagnostic_procedure:T99 T100 Disease_disorder 1946 1955 fractures E63 Disease_disorder:T100 T101 Diagnostic_procedure 1976 1983 calcium E64 Diagnostic_procedure:T101 T102 Detailed_description 1970 1975 serum R51 MODIFY Arg1:T102 Arg2:E64 T103 Sign_symptom 2313 2317 firm E65 Sign_symptom:T103 T104 Biological_structure 2289 2306 parathyroid gland R52 MODIFY Arg1:T104 Arg2:E65 T105 Sign_symptom 2330 2338 adherent E66 Sign_symptom:T105 T106 Detailed_description 2322 2329 densely R53 MODIFY Arg1:T106 Arg2:E66 R54 MODIFY Arg1:T104 Arg2:E66 T107 Biological_structure 2346 2361 thyroid capsule R55 MODIFY Arg1:T107 Arg2:E66 T108 Biological_structure 2376 2388 strap muscle R56 MODIFY Arg1:T108 Arg2:E66 T109 Therapeutic_procedure 2413 2420 dissect E67 Therapeutic_procedure:T109 A4 POLARITY E67 MAYBE_NEG R57 SUB_PROCEDURE Arg1:E67 Arg2:E48 T110 Sign_symptom 2443 2451 invasion E68 Sign_symptom:T110 A5 POLARITY E68 NEG T111 Biological_structure 2461 2468 capsule T112 Biological_structure 2482 2488 muscle T113 Biological_structure 2501 2512 lymph nodes R58 MODIFY Arg1:T111 Arg2:E68 R59 MODIFY Arg1:T112 Arg2:E68 R60 MODIFY Arg1:T113 Arg2:E68 T114 Diagnostic_procedure 2518 2535 resected specimen E69 Diagnostic_procedure:T114 T115 Color 2552 2565 brownish grey T116 Sign_symptom 2591 2604 necrotic foci E70 Sign_symptom:T116 T117 Texture 2610 2627 irregular texture R61 MODIFY Arg1:T115 Arg2:E69 R62 MODIFY Arg1:T117 Arg2:E69 T118 Disease_disorder 2697 2718 parathyroid carcinoma E71 Disease_disorder:T118 T119 Sign_symptom 2733 2741 invasion E72 Sign_symptom:T119 T120 Biological_structure 2724 2732 capsular R63 MODIFY Arg1:T120 Arg2:E72 T121 Sign_symptom 2749 2764 tumour necrosis E73 Sign_symptom:T121 T122 Detailed_description 2743 2748 focal R64 MODIFY Arg1:T122 Arg2:E73 T123 Sign_symptom 2775 2783 fibrosis E74 Sign_symptom:T123 T124 Detailed_description 2766 2774 reactive R65 MODIFY Arg1:T124 Arg2:E74 T125 Sign_symptom 2810 2818 invasion E75 Sign_symptom:T125 T126 Biological_structure 2794 2809 skeletal muscle R66 MODIFY Arg1:T126 Arg2:E75 T127 Therapeutic_procedure 2839 2860 Margins were resected E76 Therapeutic_procedure:T127 T128 Diagnostic_procedure 2862 2888 Immunohistochemical stains E77 Diagnostic_procedure:T128 T129 Diagnostic_procedure 2906 2911 Ki-67 E78 Diagnostic_procedure:T129 T130 Lab_value 2896 2905 increased E79 Lab_value:T130 R67 MODIFY Arg1:E79 Arg2:E78 R68 SUB_PROCEDURE Arg1:E78 Arg2:E77 T131 Diagnostic_procedure 2941 2946 Bcl-1 E80 Diagnostic_procedure:T131 T132 Diagnostic_procedure 2948 2957 cyclin D1 E81 Diagnostic_procedure:T132 R69 IDENTICAL Arg1:E81 Arg2:E80 T133 Lab_value 2934 2940 strong E82 Lab_value:T133 R70 MODIFY Arg1:E82 Arg2:E80 T134 Disease_disorder 3002 3023 parathyroid carcinoma E83 Disease_disorder:T134 R71 SUB_PROCEDURE Arg1:E80 Arg2:E77 T135 Disease_disorder 3102 3124 parathyroid carcinomas E84 Disease_disorder:T135 T136 Sign_symptom 3152 3166 hypercalcaemia E85 Sign_symptom:T136 T137 Therapeutic_procedure 3556 3565 operation E86 Therapeutic_procedure:T137 T138 Therapeutic_procedure 3590 3600 dissection E87 Therapeutic_procedure:T138 T139 Therapeutic_procedure 3610 3627 hemithyroidectomy E88 Therapeutic_procedure:T139 T140 Detailed_description 3605 3609 left R72 MODIFY Arg1:T140 Arg2:E88 T141 Biological_structure 3585 3589 neck T142 Detailed_description 3580 3584 left T143 Detailed_description 3572 3579 radical R73 MODIFY Arg1:T141 Arg2:E87 R74 MODIFY Arg1:T142 Arg2:E87 R75 MODIFY Arg1:T143 Arg2:E87 R76 SUB_PROCEDURE Arg1:E87 Arg2:E86 R77 SUB_PROCEDURE Arg1:E88 Arg2:E86 T144 Sign_symptom 3641 3650 recovered E89 Sign_symptom:T144 T145 Date 3697 3704 3 years E90 Date:T145 T146 Therapeutic_procedure 3722 3729 surgery E91 Therapeutic_procedure:T146 T147 Outcome 3743 3768 continues to do very well E92 Outcome:T147 T148 Clinical_event 3776 3787 followed up E93 Clinical_event:T148 T149 Frequency 3788 3802 every 3 months R78 MODIFY Arg1:T149 Arg2:E93 T150 Diagnostic_procedure 3820 3823 PTH E94 Diagnostic_procedure:T150 T151 Diagnostic_procedure 3828 3835 calcium E95 Diagnostic_procedure:T151 T152 Detailed_description 3814 3819 serum R79 MODIFY Arg1:T152 Arg2:E94 T153 Diagnostic_procedure 3917 3928 blood tests E96 Diagnostic_procedure:T153 T154 Diagnostic_procedure 3954 3957 PTH E97 Diagnostic_procedure:T154 T155 Lab_value 3934 3953 marginally elevated E98 Lab_value:T155 T156 Frequency 3893 3902 Sometimes R80 MODIFY Arg1:T156 Arg2:E98 R81 MODIFY Arg1:E98 Arg2:E97 T157 Sign_symptom 3987 3998 eucalcaemic E99 Sign_symptom:T157 T158 Diagnostic_procedure 4013 4026 nuclear scans E100 Diagnostic_procedure:T158 T159 Diagnostic_procedure 4031 4034 PET E101 Diagnostic_procedure:T159 T160 Lab_value 4056 4064 negative E102 Lab_value:T160 R82 MODIFY Arg1:E102 Arg2:E101 R83 MODIFY Arg1:E102 Arg2:E100 T161 Frequency 4108 4122 every 3 months T162 Clinical_event 4098 4107 monitored E103 Clinical_event:T162 R84 MODIFY Arg1:T161 Arg2:E103 R85 SUB_PROCEDURE Arg1:E97 Arg2:E96 R86 SUB_PROCEDURE Arg1:E48 Arg2:E60 * OVERLAP E48 E65 E66 E67 E68 E69 E70 T163 Detailed_description 2581 2590 scattered R87 MODIFY Arg1:T163 Arg2:E70 T164 Diagnostic_procedure 2646 2655 pathology E104 Diagnostic_procedure:T164 R88 BEFORE Arg1:E70 Arg2:E104 * OVERLAP E104 E71 E72 E73 E74 E75 E76 E77 E83 E49 R89 BEFORE Arg1:E49 Arg2:E51 * OVERLAP E51 E52 E53 E54 E55 R90 BEFORE Arg1:E55 Arg2:E86 R91 BEFORE Arg1:E86 Arg2:E89 R92 BEFORE Arg1:E89 Arg2:E90 R93 AFTER Arg1:E90 Arg2:E91 R94 BEFORE Arg1:E91 Arg2:E92 * OVERLAP E92 E93 E94 E95 E4 E96 E99 E100 E101 E103