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Mousa AH, Rahman M, Alsadeq HR, Albukhari ZZ, Ibrahim AS, Khaled I. An atypical concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma: First case reported in Saudi Arabia. Int J Surg Case Rep 2023; 106:108199. [PMID: 37094415 PMCID: PMC10149331 DOI: 10.1016/j.ijscr.2023.108199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most frequent endocrine cancer and most common thyroid cancer. The concurrent occurrence of both tumors however is a very rare occasional finding. Surgical treatment via excision is the only definitive. Our study aims to highlight a rare occurrence of concurrent parathyroid adenoma and micropapillary thyroid carcinoma. CASE PRESENTATION We describe a 36-year-old female who presented to the outpatient clinic with a left thyroid nodule. Both a Tc-99m-MIBI parathyroid scan and Tc-99m thyroid scan were performed. A left total thyroidectomy was performed then subsequently the parathyroid adenoma was localized. Intra-operative parathyroid hormone decreased by >50 % from 531.5 pg/ml iPTH Stat to 39.8 pg/ml iPTH Stat which is diagnostic for proper localization. Two specimens were sent for histopathological evaluation. Histopathological evaluation of the first specimen confirmed the diagnosis of parathyroid adenoma. Histopathological evaluation of the second specimen revealed that the presence of papillary microcarcinoma of a size of 0.8 cm and pathologic staging to be pT1a, pNx, pMx. CONCLUSION To our knowledge, this is the first case of concurrent occurrence of parathyroid adenoma and micropapillary thyroid carcinoma reported in the Kingdom of Saudi Arabia. Intraoperatively, management was done by via excision and confirmation of the parathyroid localization was done via intraoperative parathyroid hormone level measurement. We recommend more extensive studies to identify any possible patterns or predictors of finding these two concurrent tumors.
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Affiliation(s)
- Ahmed Hafez Mousa
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia.
| | - Moshiur Rahman
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Hussain Raeid Alsadeq
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Zain Zuhair Albukhari
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Abdullatif Sheikh Ibrahim
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Islam Khaled
- Department of Surgery, Saudi German Hospitals, Jeddah, Saudi Arabia; Department of Surgery, Faculty of Medicine, Suez Canal University Hospitals, Ismailia, Egypt
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Ben Nacef I, Khelifi D, Kalthoum M, Rojbi I, Riahi I, Mekni S, Ben Salah M, Mchirgui N, Khiari K. Synchronous parathyroid carcinoma and papillary thyroid carcinoma. Clin Case Rep 2022; 10:e06369. [PMID: 36188029 PMCID: PMC9508800 DOI: 10.1002/ccr3.6369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 12/04/2022] Open
Abstract
The simultaneous occurrence of parathyroid carcinoma and nonmedullary thyroid carcinoma is unusual. We report the case of 60-year-old woman who was found to have concurrent parathyroid carcinoma with severe clinical manifestations of primary hyperparthyroidism in addition to an incidental papillary thyroid carcinoma. Parathyroid hormone level was 569 pg/ml (normal range 10-65), and the serum calcium concentration was 13.83 mg/dl (normal range, 8.8-10.4). Preoperative investigation found a large 3 cm anterior cervical nodule suggestive of parathyroid adenoma. Total thyroidectomy and left parathyroidectomy were performed, and the final anatomopathological examination of the operative specimen concluded the coexistence of papillary microcarcinoma and parathyroid carcinoma. Although parathyroid carcinoma is an uncommon cause of hypercalcemia, it should be considered when severe hypercalcemia is observed, and in case of coexistence of thyroid nodules. The possibility of both malignancies must also be considered since parathyroid and nonmedullary thyroid carcinoma rare cases have previously been reported.
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Affiliation(s)
- Ibtissem Ben Nacef
- Department of EndocrinologyUniversity Hospital of Charles Nicolle TunisTunisTunisia
| | - Dayssem Khelifi
- Department of EndocrinologyUniversity Hospital of Charles Nicolle TunisTunisTunisia
| | - Mehdi Kalthoum
- Department of EndocrinologyUniversity Hospital of Charles Nicolle TunisTunisTunisia
| | - Imen Rojbi
- Department of EndocrinologyUniversity Hospital of Charles Nicolle TunisTunisTunisia
| | - Ines Riahi
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity Hospital of Charles NicolleTunisTunisia
| | - Sabrine Mekni
- Department of EndocrinologyUniversity Hospital of Charles Nicolle TunisTunisTunisia
| | - Mamia Ben Salah
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity Hospital of Charles NicolleTunisTunisia
| | - Nadia Mchirgui
- Department of EndocrinologyUniversity Hospital of Charles Nicolle TunisTunisTunisia
| | - Karima Khiari
- Department of EndocrinologyUniversity Hospital of Charles Nicolle TunisTunisTunisia
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Wang Y, Cai S, Liu H, Zhao RN, Lai XJ, Lv K, Jiang YX, Li JC. Parathyroid disorder and concomitant thyroid cancer in patients with multiple endocrine neoplasia type 1: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e27098. [PMID: 34516500 PMCID: PMC8428741 DOI: 10.1097/md.0000000000027098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 08/12/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to determine the rates and characteristics of parathyroid disorder and thyroid cancer in patients with multiple endocrine neoplasia type 1 vs sporadic primary hyperparathyroidism (SPHP) undergoing parathyroidectomy.Patients with multiple endocrine neoplasia type 1-associated primary hyperparathyroidism (MPHP) or SPHP who underwent initial or reoperative parathyroid exploration from 1999 to 2019 were identified via a clinical database. The data for MPHP patients (n = 15) were compared to those of a selected 2:1 age- and sex-matched SPHP cohort (n = 30) who all underwent thyroidectomy for concurrent thyroid nodules.Compared with that of the SPHP group, the parathyroid hormone level of the MPHP group was much higher (470.67 ± 490.74 pg/mL vs 217.77 ± 165.60 pg/mL, P = .001). Multiglandular parathyroid disease (6/15 [40%] vs 3/30 [10%], P = .026) and more hyperplasia (7/15 [46.7%] vs 5/30 [16.7%], P = .039) were found in the MPHP group, and more parathyroid lesions presented as a round shape (long/short meridian < 2) by ultrasound (16/20 [80%] vs 8/31 [25.8%], P < .001). Regarding thyroid nodules, there was no difference in the rate of histologic thyroid cancer, but more thyroid cancer was found in the last 5 years among the MPHP cases (5/9 [55.6%] vs 3/18 [16.7%], P = .052).Multiglandular parathyroid disease and hyperplasia were more frequent in the MPHP cohort than in the SPHP cohort, and the parathyroid lesions usually presented with a round shape on ultrasonography. More concurrent thyroid cancer was found in MPHP than SPHP patients over the previous 5 years.
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Affiliation(s)
- Ying Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Sheng Cai
- Department of Health Management, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - He Liu
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Rui-Na Zhao
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Xing-Jian Lai
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Ke Lv
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Yu-Xin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Jian-Chu Li
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
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Lu R, Zhao W, Yin L, Guo R, Wei B, Jin M, Zhou X, Zhang C, Lv X. Efficacy of ultrasonography and Tc-99m MIBI SPECT/CT in preoperative localization of parathyroid adenomas causing primary hyperthyroidism. BMC Med Imaging 2021; 21:87. [PMID: 34020602 PMCID: PMC8139103 DOI: 10.1186/s12880-021-00616-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Primary hyperparathyroidism (PHPT) results from an excess of parathyroid hormone (PTH) produced from an overactive parathyroid gland. The study aimed to explore the sonographic features of parathyroid adenomas and assess the diagnostic performance of ultrasonography (US) and Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid adenomas. Methods A total of 107 patients were enrolled in this retrospective study who had PHPT and underwent parathyroidectomy. Of the 107 patients, 97 performed US and Tc-99m MIBI SPECT/CT examinations for preoperative localization of parathyroid nodules. The sensitivity and accuracy of each modality were calculated. Results In this study, residual parathyroid sign and polar vascular sign were identified as characteristic US features of parathyroid adenomas. These manifestations were closely related to the size of the abnormal parathyroid lesions. Among the 108 parathyroid nodules from 97 patients with PHPT, the sensitivity and accuracy of US for locating the parathyroid nodules were significantly higher than those of Tc-99m MIBI SPECT/CT (93.0% vs. 63.0% and 88.0% vs. 63.0% respectively; 2=26.224, 18.227 respectively, P<0.001). The differences between US+Tc-99m MIBI SPECT/CT and Tc-99m MIBI SPECT/CT-alone were statistically significant (2=33.410, 21.587 respectively, P<0.001), yet there were no significant differences in the sensitivity or accuracy between US+Tc-99m MIBI SPECT/CT and US-alone (2=0.866, 0.187 respectively, P=0.352 and 0.665). Conclusions US shows significantly better sensitivity and accuracy for localization of parathyroid adenomas than Tc-99m MIBI SPECT/CT. However, US combined with Tc-99m MIBI SPECT/CT is of great clinical value in the preoperative localization of parathyroid nodules in patients with PHPT.
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Affiliation(s)
- Ruigang Lu
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Wei Zhao
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Li Yin
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Bojun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Xiang Zhou
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China
| | - Chun Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiuzhang Lv
- Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chao Yang District, Beijing, 100020, China.
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Li Q, Xu XZ, Shi JH. Synchronous parathyroid adenoma, papillary thyroid carcinoma and thyroid adenoma in pregnancy: A case report. World J Clin Cases 2020; 8:5426-5431. [PMID: 33269280 PMCID: PMC7674750 DOI: 10.12998/wjcc.v8.i21.5426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer, but this relationship is infrequent in pregnant patients with primary hyperparathyroidism (PHPT).
CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy. She was diagnosed with parathyroidoma, papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically. Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy. The healthy infant was delivered at the 40th week of pregnancy. The mother had no evidence of recurrence over three years of follow-up.
CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.
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Affiliation(s)
- Qiang Li
- Department of Breast and Thyroid Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu Province, China
| | - Xiao-Zhang Xu
- Department of Breast and Thyroid Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu Province, China
| | - Jian-Hua Shi
- Department of Breast and Thyroid Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu Province, China
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 281] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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Preda C, Branisteanu D, Armasu I, Danila R, Velicescu C, Ciobanu D, Covic A, Grigorovici A. Coexistent papillary thyroid carcinoma diagnosed in surgically treated patients for primary versus secondary hyperparathyroidism: same incidence, different characteristics. BMC Surg 2019; 19:94. [PMID: 31311533 PMCID: PMC6636032 DOI: 10.1186/s12893-019-0556-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coexistence of hyperparathyroidism and thyroid cancer presents important diagnostic and management challenges. With minimally invasive parathyroid surgery trending, preoperative thyroid imaging becomes more important as concomitant thyroid and parathyroid lesions are reported. The aim of the study was to evaluate the rate of thyroid cancer in patients operated for either primary (PHPT) or secondary hyperparathyroidism (SHPT). METHODS Our retrospective study included PHPT and SHPT patients submitted to parathyroidectomy and, when indicated, concomitant thyroid surgery between 2010 and 2017. RESULTS Parathyroidectomy was performed in 217 patients: 140 (64.5%) for PHPT and 77 (35.5%) for SHPT. Concomitant thyroid surgery was performed in 75 patients with PHPT (53.6%), and 19 papillary thyroid carcinomas (PTC) were found, accounting for 13.6% from all cases with PHPT and 25.3% from PHPT cases with concomitant thyroid surgery. Thirty-one of operated SHPT patients (40.3%) also underwent thyroid surgery and 9 PTC cases were diagnosed (11.7% of all SHPT patients and 29% of patients with concomitant thyroid surgery). We found differences between PHPT and SHPT patients (p < 0.001) with respect to age (54.6 ± 13y versus 48.8 ± 12y), female-to-male ratio (8:1 versus ~ 1:1), surgical technique (single gland parathyroidectomy in 82.8% PHPT cases; versus subtotal parathyroidectomy in 85.7% SHPT cases) and presurgical PTH (357.51 ± 38.11 pg/ml versus 1020 ± 161.38 pg/ml). Morphopathological particularities, TNM classification and multifocality incidence of PTC were similar in the two groups. All PTC from patients with SHPT were thyroid microcarcinomas (TMC, i.e. tumors with a diameter smaller than 1 cm), whereas seven out of the 19 cases with PTC and PHPT were larger than 1 cm. CONCLUSIONS PTC was frequently and similarly associated with both PHPT and SHPT irrespective of presurgical PTH levels. Thyroid tumors above 1 cm were found only in patients with PHPT. Investigators should focus also on associated thyroid nodular pathology in patients with PHPT.
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Affiliation(s)
- Cristina Preda
- Faculty of Medicine, Department of Endocrinology, "Gr igore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Dumitru Branisteanu
- Faculty of Medicine, Department of Endocrinology, "Gr igore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania.
| | - Ioana Armasu
- Department of Morphofunctional Sciences, "Grigore T. Popa" University of Medicine, Iasi, Romania
| | - Radu Danila
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Cristian Velicescu
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Delia Ciobanu
- Faculty of Medicine, Department of Morphopathology, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
| | - Adrian Covic
- Faculty of Medicine, Department of Nephrology, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania.,Academy of Romanian Scientists, Bucuresti, Romania
| | - Alexandru Grigorovici
- Faculty of Medicine, Department of Surgery, "Grigore T Popa" University of Medicine and Pharmacy, 16 Universitatii Str, 700115, Iasi, Romania
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Panarese A, D'Andrea V, Pontone S, Favoriti P, Pironi D, Arcieri S, Filippini A, Sorrenti S. Management of concomitant hyperparathyroidism and thyroid diseases in the elderly patients: a retrospective cohort study. Aging Clin Exp Res 2017; 29:29-33. [PMID: 27832469 DOI: 10.1007/s40520-016-0665-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Thyroid disease and hyperparathyroidism are the most common endocrine disorders. The incidence of thyroid disease in patients with hyperparathyroidism ranges in the different series from 17 to 84%, and thyroid cancer occurs with an incidence ranging from 2 to 15%. AIM The aim of our study was to analyze the management of elderly patients with concomitant thyroid and parathyroid disease in order to define the best surgical therapeutic strategy and avoid reoperations associated with a higher risk of complications. METHODS All consecutive patients (64 patients, age range 60-75 years), undergoing surgery for hyperparathyroidism, from January 2011 to June 2014, were retrospectively evaluated. Enrolled patients were divided into two study groups of patients affected by hyperparathyroidism with or without a concomitant thyroid disease. RESULTS Out of 64 patients enrolled in our study (24 men, age range 60-75 years), affected by hyperparathyroidism, 34 had an associated thyroid disease and were treated with total thyroidectomy and parathyroidectomy. The group, who underwent parathyroidectomy associated with thyroidectomy, had no greater complications than the group receiving only parathyroidectomy. CONCLUSIONS Thyroid disease must be excluded in patients affected by hyperparathyroidism. It is difficult to determine whether hyperparathyroidism can be considered a risk factor for thyroid disease, but an accurate preoperative study is essential for a surgery able to treat both thyroid and parathyroid disease. In this way, we avoid the elderly patient, with associated morbidity and increased surgical risk, to undergo a reoperation for thyroid disease, burdened with major complications.
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Affiliation(s)
- Alessandra Panarese
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy.
| | - Vito D'Andrea
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Stefano Pontone
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Pasqualino Favoriti
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Stefano Arcieri
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Rome, V.le Regina Elena n.324, 00161, Rome, Italy
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Emirikçi S, Özçınar B, Öner G, Omarov N, Ağcaoğlu O, Soytaş Y, Aksakal N, Yanar F, Barbaros U, Erbil Y. Thyroid cancer incidence in simultaneous thyroidectomy with parathyroid surgery. ULUSAL CERRAHI DERGISI 2015; 31:214-7. [PMID: 26668529 DOI: 10.5152/ucd.2015.2666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 01/18/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) is often seen in conjunction with an underlying thyroid disorder. Imaging methods that are used to localize the parathyroid adenoma also detect associated thyroid nodules and thyroid cancer. The aim of this study was to detect the rate of thyroid cancer identified while performing parathyroidectomy and thyroidectomy in patients with PHPT. MATERIAL AND METHODS Files of all patients who were operated for PHPT and who underwent simultaneous thyroidectomy were analyzed. Data regarding parathyroid pathology, surgical procedures, indications of thyroid surgery, and pathology results were retrospectively recorded. The indications for thyroid surgery included presence of suspicious thyroid nodules in ultrasonography, increase in size of thyroid nodules in follow-up ultrasound, or presence of suspicious thyroid fine needle aspiration biopsy (FNAB) findings. Rates of thyroid cancer detection were investigated according to definite pathology reports. RESULTS Eighty-three patients who underwent parathyroidectomy with a diagnosis of PHPT with concurrent thyroidectomy in Department of General Surgery, İstanbul University İstanbul Faculty of Medicine were included in the study. Eighteen patients were male (22%) and 65 were female (78%). The median age was 53 (18-70) years. The primary indication for parathyroidectomy was primary hyperparathyroidism in all patients. The thyroid procedures applied in addition to parathyroidectomy were lobectomy + isthmusectomy in 29 patients (35%), bilateral subtotal thyroidectomy in 20 patients (24%), bilateral total thyroidectomy in 23 patients (28%), and total thyroidectomy on one side and near total thyroidectomy to the other side in 11 patients (13%). The only indication for thyroidectomy was the presence of thyroid nodules until 2000 (20 patients, 24%). Indications in the remaining 63 patients included the presence of multiple nodules that cannot be followed up by ultrasonography in 25 patients (30%), presence of a suspicious nodule on ultrasonography in 33 patients (40%), growth in nodule size in 2 patients (2%), and detection of suspicious findings on FNAB in 3 patients (4%). Five patients (6%) were diagnosed with papillary thyroid cancer, four of whom were micropapillary cancer. CONCLUSION Imaging methods performed to localize the pathological parathyroid gland for a diagnosis of PHPT are useful in estimating other accompanying pathologies. Presence of thyroid nodules should be evaluated before all parathyroid procedures, and if the nodule has an indication for surgery, thyroid surgery should be considered at the same operation with parathyroid surgery.
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Affiliation(s)
- Selman Emirikçi
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Beyza Özçınar
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Gizem Öner
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Nail Omarov
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Orhan Ağcaoğlu
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Yiğit Soytaş
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Nihat Aksakal
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Fatih Yanar
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Umut Barbaros
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Yeşim Erbil
- Department of General Surgery, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
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Osman Malik Y, Raza SM, Arunselvan S. Coexisting Tertiary Hyperparathyroidism and Severe Hypothyroidism in an End-Stage Renal Disease Patient on Hemodialysis. Nephrourol Mon 2015; 7:e27191. [PMID: 25883915 PMCID: PMC4393553 DOI: 10.5812/numonthly.27191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/26/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction: Case Presentation: Conclusions:
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Affiliation(s)
- Yahya Osman Malik
- Department of Nephrology, School of Medicine, Wayne State University, Detroit, USA
- Corresponding author: Yahya Osman Malik, Department of Nephrology, School of Medicine, Wayne State University, Detroit, MI, USA. Tel: +1-3137457145, E-mail:
| | - Syed Mohsin Raza
- Department of Nephrology, School of Medicine, Wayne State University, Detroit, USA
| | - Sophia Arunselvan
- Department of Nephrology, School of Medicine, Wayne State University, Detroit, USA
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Lee YS, Nam KH, Chung WY, Chang HS, Park CS. Coexistence of parathyroid adenoma and papillary thyroid carcinoma. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:316-20. [PMID: 22148123 PMCID: PMC3228999 DOI: 10.4174/jkss.2011.81.5.316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/04/2011] [Accepted: 08/09/2011] [Indexed: 11/30/2022]
Abstract
Purpose Although several reports have been published regarding the coexistence of hyperparathyroidism and papillary thyroid carcinomas, concurrence of parathyroid adenoma and papillary thyroid carcinoma is extremely rare. The aim of this study was to describe experiences with concurrent parathyroid adenoma and papillary thyroid carcinoma. Methods Seven patients with concurrent parathyroid adenoma and papillary thyroid carcinoma were identified between January 2006 and December 2007, and their medical records were reviewed retrospectively. Results Of the seven patients identified, three were male and four were female; their mean age was 53.6 years. None of the patients presented with symptomatic hyperparathyroidism preoperatively. On laboratory findings, four patients had mild to moderate hypercalcemia, but serum parathyroid hormone concentrations were high in all patients. Preoperative imaging showed suspicious features of diseased parathyroid glands in four patients; two upon ultrasonography and computed tomography together and two upon ultrasonography only. The coexistence of parathyroid adenoma did not affect the extent of thyroid surgery. Laboratory values after surgery returned to within normal ranges in all patients. Conclusion It is important not only to analyze serum calcium levels but also to carefully interpret imaging studies in order to identify asymptomatic hyperparathyroidism when performing thyroid cancer surgery.
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Affiliation(s)
- Yong Sang Lee
- Thyroid Cancer Center, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Evaluation for concomitant thyroid nodules and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Surgery 2008; 144:862-6; discussion 866-8. [DOI: 10.1016/j.surg.2008.07.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 07/01/2008] [Indexed: 11/22/2022]
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Beus KS, Stack BC. Synchronous thyroid pathology in patients presenting with primary hyperparathyroidism. Am J Otolaryngol 2004; 25:308-12. [PMID: 15334393 DOI: 10.1016/j.amjoto.2004.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Thyroid and parathyroid pathology may coexist; classically, this is described in multiple endocrine neoplasia. Other nonsyndromic scenarios result in pathologies of these endocrine organs coexisting. This can create a challenge in the clinical decision making and management of these patients. It is optimal to deal with both problems in one operative procedure, if surgery is required. METHODS A retrospective review of cases of synchronous thyroid and parathyroid pathology that were managed surgically over a 3-year period by a single endocrine surgeon at a single university medical center. RESULTS Seventeen cases of synchronous thyroid and parathyroid disease were discovered. All required surgical management of thyroid and parathyroid conditions. Reasons included removal of thyroid goiter for access to an adenoma, worrisome thyroid lesions coexistent with a parathyroid adenoma, and an intrathyroid parathyroid adenoma. Cases of incidental discovery of a second endocrine condition while the first was evaluated will be reported. CONCLUSIONS A head and neck endocrine surgeon needs to be aware of the possible coexistence of thyroid and parathyroid pathologies so that, when encountered, they can be safely and efficiently managed in a single procedure.
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Affiliation(s)
- Kirt S Beus
- Division of Otolaryngology-HNS, Pennsylvania State University of Medicine, Hershey, PA 17003, USA
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Abstract
In a woman with myxedema and normal total and ionized plasma calcium levels, persistent hypercalcemia developed when she was treated with thyroxine. A parathyroid adenoma was subsequently removed, with return of plasma calcium levels to normal. Hypothyroidism may therefore be a further cause of "masked" primary hyperparathyroidism. The mechanism of masking is likely to have been mediated by hypomagnesemia.
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