Coexistent Thyroid Pathologies and High Rate of Papillary Cancer in Patients with Primary Hyperparathyroidism: Controversies About Minimal Invasive Parathyroid Surgery

Abstract

Thyroid carcinoma and benign thyroid diseases associated with primary hyperparathyroidism (PHPT) may cause difficulties in the diagnosis, localization and therapy of PHPT. In this study, we analysed coexistent thyroid pathologies in 51 patients who underwent neck exploration with a diagnosis of PHPT between 1999--2002. Five hundred thirteen patients who underwent thyroidectomy for nodular thyroid disease without a parathyroid pathology in histopathological examination served as controls. In patients with PHPT there were 43 cases (84.3%) of coexistent thyroid pathology. Nine patients (17.6 %) had coexistent papillary thyroid cancer. Nine patients (17.6 %) had lymphocytic thyroiditis, two (3.9%) had benign thyroid adenoma and 24 (47%) had nodular hyperplasia. In one patient (2%), there was intrathyroidal metastasis from a parathyroid cancer. One patient had coexistent lymphocytic thyroiditis and multifocal papillary cancer. One of the two cases with thyroid adenomas was Hürthle cell type. In the control group only 28 patients (5.5%) had thyroid malignancy (27 papillary cancer and one follicular cancer). In conclusion, the coexistent thyroid pathologies are highly prevalent in patients with PHPT and pre- and intra-operative thyroid examination should be performed to avoid overlooking important thyroid pathologies.

Papillary Thyroid Carcinoma with Primary Hyperparathyroidism: A Report of Two Cases and a Brief Literature Review

“…Additionally, the number of multicentric tumors metastasizing to the lymph nodes was relatively small (5,6,11). However, papillary carcinomas without microcarcinoma were more frequent in small series such as those of Kosem et al (13) and Ogawa et al (12). The cause of the association between thyroid disease and primary pHPT remains unclear.…”

A Rare Co-Occurrence of Parathyroid and Papillary Thyroid Carcinoma

“…Co-occurring thyroid pathologies are common in patients with PHPT, with rates reported to range from 17% to 84% in patients undergoing neck exploration for PHPT [3][4][5][6][7][8][9]. In contrast, the synchronous occurrence of parathyroid and differentiated thyroid carcinoma is a rare situation.…”

Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

“…These wide variations are attributed to association with the different methods of examination, the surgical indications, and the patient selection process. The characters of thyroid pathology associated with PHPT from these literatures are shown in Table 4 (Bentrem et al, 2002;Kosem et al, 2004;Masatsugu et al, 2005;Sidhu and Campbell, 2000).…”

“…Number [T/P (%)] Nodular goiter Thyroiditis Adenoma Carcinoma Graves ' Sidhu and Campbell (2000), Australia 26/65 (40.0%) 17 (26.2%) 3 (4.6%) 3 (4.6%) 3 (4.6%) Bentrem et al(2002), USA 103/580 (17.8%) 49 (8.4%) 8 (1.4%) 31 (5.3%) 12 (2.1%) Kosem et al(2004), Turkey 43/51 (84.3%) 24 (47.0%) 9 (17.6%) 2 (3.9%) 9 (17.6%) Masatsugu et al(2005) T: Thyroid diseases; P: Hyperparathyroidism the syndrome of multiple endocrine adenomas, resulting from the presence of the abnormal gene responsible for this syndrome (Prinz et al, 1982;van der Schaar and Mulder, 1985). For patients with PHPT, surgical removal of an enlarged parathyroid gland is thought to be a curative treatment.…”

“…Synchronous thyroid pathology found in patients presenting PHPT has been observed (Kosem et al, 2004;Sidhu and Campbell, 2000). This coexistence can present a challenge in the clinical decision making and management for these patients.…”