Endocrine Abstracts

Premilinary: The incidence of thyroid disease in cases operated for hyperparathyroidism is 2.5–17.6%. The coexistence of thyroid and parathyroid nodules makes FNAB difficult in technique but also in cytology diagnosis. Scintigraphy, unless performed with Tc SESTA MIBI, might give unclear informations.

Material: From series of 36 operaed cases with renal secondary and tertiary hyperparathiroidism, we identified four cases with concomitant thyroid papillary carcinoma.

Method: Preoperative evaluation in all cases: clinical, 2 B ultrasound, Power Doppler, and real-time elastography with qualitative and computer assisted quantitative measurement of tissue elasticity with high accuracy linear probe, Hitachi E 7500 Device, Hitachi, Inc., Japan. Histopathology evaluation was performed in all cases. FNAB was performed in cases with associated thyroid nodules.

Results: Histopathology evaluation confirmed the association of thyroid carcinoma (papillary carcinoma) and parathyroid nodular hyperplasia in four cases. These cases consist of three women (aged 57 and 61), and two men (40 and 42 years), with end stage renal disease, in choric hemodialysis program for mean period of 4.65±1.15 years.

Preoperative imaging showed proper localization of the hyperthophic/hyperplasic parathyroid glands but also proper description on the thyroid nodular disease. Ueno score 3 and 4 was observed in all four cases of thyroid cancer. The qualitative suspicion was confirmed by an increased strain ratio in suspicious thyroid nodules, compared with unsuspicious thyroid and parathyroid nodules.

FNAB was impossible in one cases (para-carotidian nodular position). Citological results: two Bethesda 4, one unclear diagnostic. Total thyroidectomy was proposed in all the four cases.

Histopathological report confirmed the thyroid cancer suspicion.

Conclusion: Elastography brings important data in respect to different types of nodular aspects described by conventional ultrasound. It may be used in differentiation of difficult cases with nodular intra and extra-thyroidal masses, where FNAB can not be easily used.