Coexistence of hyperparathyroidism and non-medullary thyroid carcinoma
Leonidas Alevizos, Haridimos Markogiannakis, Panagiotis Kekis, Artemisia Papadima, Frantzeska Sigala, Konstantinos Filis, Konstantinos Toutouzas & Andreas Manouras
Background objective: Medullary thyroid carcinoma and hyperparathyroidism coexistence is well described in the literature. On the other hand, data regarding the coexistence of non-medullary thyroid cancer and hyperparathyroidism are scarce. The aim of this study was to evaluate the occurrence of such coexistence.
Methods: This is a retrospective study of all patients with primary or secondary hyperparathyroidism who underwent parathyroidectomy in our endocrine surgery unit from 2003 to 2006. Thyroid surgery was additionally performed in those cases that preoperative or intraoperative findings were suspicious of thyroid cancer.
Results: Sixty consecutive patients (38 female: 63.3%) were included in our study. Mean age of the patients was 56.3±7.4 years (range: 2680 years). Twenty-nine patients (48.3%) had primary and 31 (51.7) secondary hyperparathyroidism. Total thyroidectomy was performed in 15 cases (25%). Thyroid cancer was found in 7 cases (11.6% of the total study group and 46.6% of the patients with thyroidectomy); in all these cases the final histopathology report was consistent with primary papillary thyroid cancer. One patient with thyroid carcinoma had secondary hyperparathyroidism (3.2%) and 6 primary disease (20.7%). This difference was found to be statistically significant (P=0.04).
Conclusions: Non-medullary thyroid cancer may be identified in a substantial proportion of patients with hyperparathyroidism that preoperative or intraoperative findings suggest thyroid disease. In our study, there was a significant coexistence of papillary thyroid carcinoma and primary hyperparathyroidism. The surgeon should, therefore, not overlook the thyroid gland when medullary carcinoma is excluded and focus merely on the evident parathyroid disease in such a setting.