ECE2018 Poster Presentations: Calcium and Bone Clinical case reports - Thyroid/Others (12 abstracts)
Concomitant primary hyperparathyroidism with papillary thyroid carcinoma: The role of dual-phase 99mTc-MIBI parathyroid imaging: case report
Adina Anghel 1 , Gabriela Vasiliu 1 , Maria Christina Ungureanu 1, , Cristina Preda 1, , Voichita Mogos 1, , Cipriana Stefanescu 2, , Radu Danila 2, & Letitia Leustean 1,
1‘St Spiridon’ Clinical Emergency Hospital, Department of Endocrinology, Iasi, Romania; 2‘Gr. T. Popa’ University of Medicine and Pharmacy, Iasi, Romania; 3‘St Spiridon’ Emergency Hospital, Department of Nuclear Medicine, Iasi, Romania; 4‘St Spiridon’ Emergency Hospital, Department of General Surgery, Iasi, Romania.
Introduction: Although concomitant primary hyperparathyroidism (PHPT) and papillary thyroid carcinoma (PTC) has been repeatedly reported in medical literature with an incidence of 2.3–4.3%, no causal relationship has been elucidated. In most cases, diagnosis of PTC is mostly incidentally, while PHPT is usually the primary pathology. Recent literature supports the possible role of dual-phase 99mTc-MIBI parathyroid imaging in detecting PTC in patients with PHPT.
Case report: We present the case of a 47-year-old woman, recently diagnosed with nodular goiter and severe osteoporosis. Work up of the patient revealed increased levels of serum calcium and low level of phosphorus, high level of intact parathormone and hypercalciuria, consistent with primary hyperparathyroidism. Neck ultrasound identified a hypoechoic thyroid nodule, with macrocalcifications and intranodular vascularisation. The 99mTcO4 -thyroid scan described no uptake of radiopharmaceutical in the left upper thyroid lobe. The 99mTc-MIBI scan revealed an increased uptake in the left lower thyroid lobe, and also in the left upper thyroid lobe. A diagnosis of PHPT and nodular goiter was established. The patient underwent parathyroidectomy and left thyroid lobectomy. After surgery, PHPT was biochemically cured. Histopathological examination revealed parathyroid adenoma in the left lower parathyroid gland, and papillary carcinoma in the suspect thyroid nodule. The completion of thyroidectomy was performed after 3 months. Patient underwent radioiodine ablation therapy, actually being on suppressive T4 treatment.
Conclusions: Even concurrent parathyroid adenoma and papillary thyroid carcinoma is rare, they may coexist. Prior to undergoing parathyroid surgery for PHPT, it’s indicated to carefully screen for thyroid disease, to avoid a second surgery. Dual-phase 99mTc-MIBI parathyroid imaging may be useful in detecting both parathyroid adenoma and papillary thyroid carcinoma.
Keywords: Primary hyperparathyroidism, papillary thyroid carcinoma, 99mTc-MIBI parathyroid imaging
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