A Case of Papillary Carcinoma of the Thyroid Associated with Parathyroid Adenoma without Hyperparathyroidism.

Abstract

A rare occurrence of the association of parathyroid adenoma in a case of thyroid papillary carcinoma is described. The patient was incidentally found to have parathyroid adenoma which was preoperatively diagnosed to be a metastatic lymph node. Analysis of her serum obtained before operation showed an elevation of serum parathyroid hormone (PTH) concentration without hypercalcemia. Since the association of hyperparathyroidism is high in patients with thyroid diseases, examination of not only serum levels of calcium and PTH but also careful interpretation of computed tomography (CT) and/or nuclear magnetic imaging (MRI) is necessary in the diagnosis of co-existing asymptomatic hyperparathyroidism. (Internal Medicine 31: 459-462, 1992) Key words: serum PTH, normal serum calcium, computed tomography (CT), nuclear magnetic imaging (MRI) Intr oductionIt has been reported that thyroid disease is common in patients with hyperparathyroidism, and vice versa (1). Parathyroid adenoma is clinically recognized in patients presenting with either hypercalcemia or it may be a part of multiple endocrine neoplasia (MEN) type I and type Ha (2). There have also been sporadic reports of the coexistence of hyperparathyroidism and nonmedullary thyroid carcinoma (3-8). Thus, the presence of hyper parathyroidism has to be kept in mind in patients with thyroid carcinoma. In such cases, hypercalcemia is a virtually inevitable laboratory finding and therefore, is an important laboratory finding in the diagnosis of hyperparathyroidism. Except for such conditions, it is very rare to find parathyroid adenoma. We have recently encountered a case of nonmedullary thyroid carcinoma (papillary carcinoma) associated with parathyroid adenoma which was initially diagnosed to be a metastatic lymph node of thyroid malignancy. She had neither radiologic abnormalities such as subperi osteal bone resorption nor symptoms associated with hyperparathyroidism. Since the elevated concentration of PTH normalized after operation, we speculate that the patient had asymptomatic hyperparathyroidism, namely parathyroid adenoma with the preclinical stage of hyperparathyroidism. Materials and MethodsSerum concentrations of free T3 (FT3) and free T4 (FT4) were measured by analog method radioimmuno assay (RIA) kits (Amerlex FT3 and FT4, Amersham International, Tokyo,.7pg/ml and 0.80-2.10ng/dl, respectively. Serum TSH levels were measured by an immunoradiometric assay (IRMA) kit (Spac TSH, Daiichi Isotope Lab, Tokyo, with normal range of 0.1-5.0/^U/ml). Titers of anti-thyroglobulin (Tg) and anti-microsomal antibodies were measured by hemagglutination kits (Serodia-ATG, Serodia-AMC, Fujirebio Inc., Tokyo). Titers of serum anti-TSH receptor antibodies (TRAb) were measured using a commercially available radioreceptor assay kit (Baxter, Tokyo, normal range less than 10%). Serum calcitonin was measured by a double antibody RIA kit (Calcitonin kit Daiichi, Daiichi Isotope Lab, Tokyo, normal range, less that 100pg/ml) and an IRMA kit ELSA-hCT, CSI diagnostic, Osaka, normal r...

Coexistence of parathyroid adenoma and papillary thyroid carcinoma

“…As different from the previous studies, the thyroid carcinoma was diagnosed prior to the diagnosis of primary hyperparathyroidism, and primary hyperparathyroidism was postoperatively diagnosed in the pathology specimens. To our knowledge, there is only one similar case report [6]. …”

Coexistence of parathyroid adenoma and papillary thyroid carcinoma: Experience of a single center

“…Boyun eksplorasyonu ve tiroid lobektomisi yapılan 824 vakalık bir çalışmada tiroid karsinomu olan hastaların %2,6'sında primer hiperparatiroidizme rastlanmıştır. Bu çalışmada dikkat çekici başka bir durum da böyle büyük bir seride tiroid ve paratiroid karsinomunun birlikteliğinin görülmemiş olmasıdır [18]. Kliniğimizde bu çalışma süresince maligniteye bağlı 416 tiroid cerrahisi yapılmış olup bu hastaların 8 (%1,9)'inde PHPT saptanmıştır.…”

“…Papiller tiroid karsinomlu hastalarda paratiroid adenomları operasyon öncesi dönemde metastatik lenf nodu olarak düşünülebilir. Tiroid hastalıklı hastalarda hiperparatiroidizm birlikteliği sıktır, bu hastalarda sadece serum Ca ve PTH düzeyine bakmak yeterli olmayabilir, aynı zamanda yavaş ilerleyen asemptomatik hiperparatirodizm tanısı için Bilgisayarlı Tomografi ve Manyetik Rezonans Görüntülemeleri de yardımcı olabilir [18]. Ayrıca günümüzde 99Tc-MIBI sintigrafisi adenom lokalizasyonu belirlemede en yüksek sensitiviteye sahip tanı yöntemidir; ayrıca bu yöntemin bir diğer avantajı da ektopik dokuların da tanımlanabilmesidir.…”