Incidental finding of papillary thyroid carcinoma with BRAF^V600Emutation in a patient with coexistent primary hyperparathyroidism and Graves’ hyperthyroidism

Abstract

SUMMARYThe simultaneous occurrence of hyperthyroidism and hyperparathyroidism was previously reported to be rare, but it was recognised more and more clearly by effective evaluations. Recent studies also mentioned the coexistence of parathyroid adenoma and papillary thyroid carcinoma (PTC). The potential mechanism is still unknown. We report a case of a 46-year-old man coexisted with primary hyperparathyroidism, Graves' hyperthyroidism and occult PTC. The patient had a 6-month history of polyphagia and irritability. Blood examinations showed elevated serum calcium and parathyroid hormone levels. Serum phosphate was lower. Thyroid function evaluation indicted Graves' hyperthyroidism. Ultrasound showed a solitary hyperchoic thyroid nodule in the right gland. Parathyroid radioisotope scanning found a mild enhancement of 99mTc absorption in the lower part of the right parathyroid gland. A surgical exploration was carried out and the parathyroid adenoma resection was performed. An occult micro-PTC with BRAF V600E mutation was also detected. BACKGROUND

Incidental thyroid carcinomas. A retrospective study

“…The incidence of carcinomas in the cervicomediastinal goiter compared with benign thyroid cervical-mediastinum disease, is around 12.1% (50,51). The association with parathyroid diseases (52)(53)(54)(55)(56) and lymphocytic thyroiditis (57, 58) is also described.…”

Coexistence of Graves’ disease and primary hyperparathyroidism: a case description

“…U n t i l n o w, t h e m e c h a n i s m o f c o e x i s t e n t hyperparathyroidism and hyperthyroidism is still unclear. Some researchers believe the occurrence of this association is just a coincidence, whereas others have advocated that serum calcium level, growth factor, and genetic factors may be involved (4,5,12,13). Further studies are needed to investigate the mechanism between the two disorders and their association.…”

“…The development of examination methods has made the diagnosis of concurrent GD and PHPT much easier; however, the link between the two disorders remain unclarified. Some researchers have observed that concomitant GD and PHPT is associated with multiple endocrine neoplasia (MEN) (5,6).…”

Coexistence of a large functioning parathyroid cyst with papillary thyroid carcinoma: A case report and review of the literature

“…NMTC may be rarely incidentally discovered after synchronous parathyroidectomy and thyroidectomy or after FNAB of a suspicious thyroid nodule in a patient with PHPT (with a reported incidence of 2–13%) [ 4 , 5 , 15 ]. The most common type is PTC, manifesting usually as a unifocal microcarcinoma, located in the right thyroid lobe, being more common in women [ 4 , 5 , 15 ]. By contrast, patients with follicular NMTC present with larger tumors, with frequent extrathyroidal growth and lower pre-operative PTH levels than in those with PTC [ 5 ].…”

“…Parathyroid cysts constitute a rare cause of primary hyperparathyroidism (PHPT) [ [1] , [2] , [3] ]. PHPT may also rarely coexist with non-medullary thyroid carcinoma (NMTC) [ 4 , 5 ]. Whether NMTC has a different clinical course in cases of PHPT is unknown.…”