Endocrine Abstracts

Introduction

The association between parathyroid and thyroid diseases is not uncommon; however concurrent presence of parathyroid adenoma and thyroid cancer is rare (1). As a natural consequence, preoperative imaging studies for diagnosis and localization of parathyroid adenomas may result with the detection of thyroid incidentalomas and most of these thyroid nodules should be evaluated by fine-needle aspiration biopsy before parathyroid surgery (1). We have recently encountered a case of papillary thyroid carcinoma (PTC) associated with primary hyperparathyroidism (PHPT).

Methods

We describe the clinical findings, thyroid and parathyroid function tests, and imaging data of a patient presenting with hypercalcemia and thyroid nodule.

Results

A 56-year-old female with chronic epigastric pain, was referred to our department after discovery of hypercalcemia. In the routine laboratory tests, we noticed to a serum calcium of 11.1 mg/dl [8.2–10.2]. Further evaluation, confirmed a low serum phosphorus and a high serum parathyroid hormone (126 pg/ml), low vitamin D while renal functions tests, and thyroid test levels was within normal range. Patients had not history of treatment with calcium or vitamin D supplements. Cercival ultrasound showed 4 parathyroid glands increased in size and a 3.5 cm thyroid nodule in the lower right pole classified EU-TIRADS 5. 99 Tc-sestamibi scanning revealed features of parathyroid adenoma adjoining the lower pole of right thyroid lobe. A conducted aspiration biopsy of thyroid nodule was indicative of PTC. The patient was referred to the otorhinolaryngology department for surgery.

Conclusion

Concomitant PTC and PHPT are rare. The underlying mechanisms are not yet established and may be coincidental. Goitrogenic and carcinogenic factors have been implicated in the pathogenesis with no conclusive evidence. Shared embryological origin, genes and transcription factors, high parathyroid hormone (PTH), low vitamin D and hypercalcemia could result in high levels of angiogenic growth factors (2).

Bibliographie

1- Çetin K, Sıkar HE, Temizkan Ş, Ofluoğlu CB, Özderya A, Aydın K, Gül AE, Küçük HF. Does Primary Hyperparathyroidism Have an Association with Thyroid Papillary Cancer? A Retrospective Cohort Study. World J Surg. 2019 May;43(5):1243–1248.

2- Beebeejaun M, Chinnasamy E, Wilson P, Sharma A, Beharry N, Bano G. Papillary carcinoma of the thyroid in patients with primary hyperparathyroidism: Is there a link? Med Hypotheses. 2017 Jun;103:100–104.