Endocrine Abstracts

Background: Concomitent occurrence of primary (PHPt) or renal (RHPt) hyperparathyroidism and papillary thyroid microcarcinoma (PTMc) is rarely described in literature.

Patients and methods: Between 1986 and 2010 sixtythree subjects undewent operations for PHTp (n=20) or RHTp (n=43) in our clinic. In three cases (4.7%) a synchronous PTMc was intraoperatively discovered.

Results: First case, female – 56 years old presented with recurrent hyperparathyroidism 6 years after an ‘extra muros’extirpation of a right sided inferior adenoma. At operation multiple gray-tan micronodules of 2–5 mm was discovered on the thyroid surface. Biopsy revealed benign parathyroid tissue leading to a diagnosis of parathyromatosis. A right thyroid lobectomy was done. At the paraffine examination a minute foci of PTMc was identified. Any postoperative therapy was recommended. At two years postoperatively she presents a simptomless course.

In two cases of RHPt, one male and one female of 48 and 50 years respectively, in both of whom a near-total parathyroidectomy together with a Dunhill operation was done due to the presence of a bilateral nodular goitre and also of a hard nodule of 5 mm in diameter.

Pathology precised existence of a PTMc classified as PT1.

The patients was guided to complementary therapy and both are alive without recurrences at 7 and 4 years respectively.

Discussions and conclusions: Coexistence between PHPt or RHPt with PTMc is coincidental but can be encountered in endemic goitre areas. The diagnosis of these lesions is rarely affirmed before surgery being established by serendipity or better by a careful intra- or postoperative exploration. Surgical treatment must be adapted to the gravely lesion: thyroid carcinoma.