Endocrine Abstracts

Introduction: Papillary Thyroid Carcinoma (PTC) is the most frequent cancer of the thyroid. PTC may rarely coexist with Primary hyperparathyroidism (PHPT). Furthermore, the association of PTC and graves’ disease (GD) has been described and the existence of a link between these entities has long been investigated, but no clear correlation has been established. We report the case of a female patient who suffered from GD, PTC and PHPT.

Observation: A 34-year-old woman consulted our endocrinology department for palpitations, tremors of the extremities and anxiety. Primary hyperthyroidism was diagnosed (TSH<0.01mUI/l, FT4= 30 pmol/l). It was related to Graves ‘disease considering the presence of positive TSH receptor antibodies at 3.32 IU/ml. The patient was treated with Thiamazole. Furthermore, thyroid Ultrasound revealed a right thyroid nodule measuring 18*10 mm and classified as EU-Tirads 4. Fine needle aspiration was performed revealing malignant thyroid cytopathology (category VI according to the Bethesda system). Hence, surgical treatment was indicated. At the preoperative assessment, hypercalcemia was incidentally discovered (Calcemia= 2,78 mmol/l) and related to a primary hyperparathyroidism (PTH= 60 pg/ml). Cervical ultrasound showed a 7mm left inferior polar parathyroid adenoma, consistent with hyperfixation on parathyroid Scintigraphy. A total thyroidectomy and a left lower parathyroidectomy were performed. the final pathological examination showed a PTC classified as pT2NxMx according to TNM system.

Conclusion: The association of hyperparathyroidism with thyroid pathology has been described in the literature. Further studies are needed to clarify the link between these disorders.