Endocrine Abstracts (2013) 32 P300 | DOI: 10.1530/endoabs.32.P300

High rate of malignant disorders in patients with primary hyperparathyroidism

Stanley Kirana1, Bettina Eggert1, Kirsten Oberwelland2, Guido Schürmann2 & Joachim Feldkamp1

1Department of Internal Medicine, Endocrinology and Diabetology, Klinikum Bielefeld Mitte, Bielefeld, NRW, Germany; 2Department of General and Visceral Surgery, Klinikum Bielefeld Mitte, Bielefeld, NRW, Germany.

Introduction: Some new data suggest a coincidence of differentiated thyroid carcinoma in patients with primary hyperparathyroidism (pHPT).

Methods & design: We performed a retrospective analysis of our patients (n=267) with primary hyperparathyroidism from 2007 until 2011.

Results: Musculoskeletal pain was reported by 34.2% of the patients. Gastrointestinal discomfort was complained by 28.8%, and 21.1% had nephrolithiasis. Out of 267 patients, 223 patients (174 women, 49 men) underwent parathyroidectomy. Fourty-four patients received conservative therapy. In 257 patients ultrasound examination showed uninodular goiter in 38 patients (14.8%) and multinodular goiter was found in 117 patients (45.5%). After surgery, histological specimens from thyroid glands revealed differentiated thyroid cancer in 17 patients (7.62%). Follicular thyroid cancer was seen in two patients (0.90%), papillary thyroid cancer in 14 patients (6.27%), and medullary thyroid carcinoma in one patient (0.45%). Eight patients had C-cell hyperplasia. Including the history of other malignant diseases, 26.1% of the patients had an oncologic disease. Of 223 patients, only 25 patients (11.2%) had no other disease than pHPT. Ninety-one patients (40.8%) suffered from endocrine diseases: multiple endocrine neoplasia type 1: 11 (4.93%), Hashimoto’s thyroiditis: 42 (18.8%), Grave’s disease: 1 (0.45%), Diabetes mellitus type 1 and type 2: 13 (5.8%), polyglandular autoimmune syndrome: 1 (0.5%). One hundred and seventy-four patients (78%) suffered from cardiovascular disease (mostly arterial hypertension), renal disease was found in 66 patients (29.6%) and 81 patients (36.3%) had gastrointestinal disease.

Conclusion: Thyroid cancer is not rare in patients with pHPT. Many of the patients have a history of other malignant diseases. Hashimoto’s thyroiditis is a frequent thyroid disease in this group of patients. It still has to be investigated, if there is a causal relationship between malignancy and hyperparathyroidism.

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