Endocrine Abstracts

Introduction: Co-existence of medullary thyroid carcinoma and primary hyperparathyroidism (PHPT) is well described, however, the association of non-medullary cancer and PHPT is less recognised. Herein, we report two cases of patients with PHPT and papillary thyroid carcinoma (PTC).

Case 1: A 55-year-old woman received a diagnosis of PHPT during investigation of her anemia. (Ca: 11.4 mEq/l, PTH: 256 pg/ml, urinary calcium: 960 mg/day). Thyroid function tests were totally normal. Neck ultrasonography demonstrated multinodular goitre. There were six nodules; one had 20×12 mm diameter and microcalcification. There was a 14×9 mm, hypoechoic, solid lesion compatible with a parathyroid adenoma at the left side. A fine needle aspiration biopsy (FNAB) was performed for the microcalcific nodule. The FNAB was positive for PTC. The patient gone under total thyroidectomy, central lymph node dissection and parathyroidectomy. A parathyroid adenoma and two foci of PTC (2.5 cm and 1.5 cm) with two metastatic lymph nodes were determined.

Case 2: A 60-year-old man presented with back and lombar pain referred for evaluation of PHPT. His laboratory findings confirmed the diagnosis of PHPT: Ca: 15.2 mg/dl, PTH: 1900 pg/ml, urinary calcium: 720 mg/day, serum creatinine: 2.1 mg/dl, alcaline phosphatase: 2142 U/l. Thyroid function tests were normal. Neck ultrasonography showed multinodular goitre. One of 5 nodules was 23×19 mm, hypoechoic, had a satellite nodule and calcification. There was a hypoechoic, solid, 18×17 mm lesion compatible with a parathyroid adenoma at the right side. The FNAB of the nodule was suspicious for PTC. Total thyroidectomy, central lymph node dissection and parathyroidectomy were performed. The pathology report confirmed parathyroid adenoma and a 2 cm of PTC.

Conclusion: These cases represent the probability of concomitant PHPT and PTC. Preoperative evaluation with ultrasonography may be suggested to patients with a diagnosis of PHPT.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.