PHPT is the predominant cause of hypercalcemia and is increasingly prevalent. Substantial differences are found in the incidence and prevalence of PHPT between races.

Parathyroid carcinoma is one of the rarest known malignancies that may occur sporadically or as a part of a genetic syndrome. It accounts for approximately 1% of patients with primary hyperparathyroidism. The majority (90%) of parathyroid cancer tumors are hormonally functional and hypersecrete parathyroid hormone (PTH). Thus, most patients exhibit strong symptomatology of hypercalcemia at presentation. Sometimes, it can be difficult to diagnose parathyroid cancer preoperatively due to clinical features shared with benign causes of hyperparathyroidism. Imaging techniques such as neck ultrasound and 99mTc sestamibi scan can help localize disease, but they are not useful in the assessment of malignancy potential. Fine needle aspiration (FNA) prior to initial operation is not recommended due to technical difficulty in differentiating benign and malignant disease on cytology specimens and the possible associated risk of tumor seeding from the needle track. Complete surgical resection with microscopically negative margins is the recommended treatment and offers the best chance of cure. Persistent or recurrent disease occurs in more than 50% of patients with parathyroid carcinoma. Surgical resection is also the primary mode of therapy for recurrence since it can offer significant palliation for the metabolic derangement caused by hyperparathyroidism and allows hypercalcemia to become more medically manageable. However, reoperation is rarely curative and eventual relapse is likely. Chemotherapy and external beam radiation treatments have been generally ineffective in the treatment of parathyroid carcinoma. Typically, these patients require repeated operations that predispose them to accumulated surgical risks with each intervention. In inoperable cases, few palliative treatment options exist, although treatment with calcimimetics can effectively control hypercalcemia in some patients. Most patients ultimately succumb to complications of hypercalcemia rather than from tumor burden or infiltration.

Parathyroid cancer patients typically have a long survival, which often includes multiple reoperations for recurrence and thus a high rate of surgical complications. Patients in whom there is a high index of suspicion for parathyroid cancer should be referred to a dedicated endocrine surgery center for their initial operation.

Black patients and those with low SES have worse outcomes for thyroid cancer. API and Hispanic patients may have a protective effect on survival despite presenting with more advanced disease.

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To determine whether increasing body mass index (BMI) is associated with more aggressive disease and adverse surgical outcomes in patients with papillary thyroid cancer (PTC). Design: Retrospective review of a prospective database. Setting: Single academic tertiary care center. Patients: A total of 443 patients older than 18 years who underwent total thyroidectomy for PTC from January 1, 2004, through March 31, 2011, were included in the analysis. Patients were organized into 4 BMI (calculated as weight in kilograms divided by height in meters squared) groups: normal (18.5-24.9), overweight (25-29.9), obese (30-39.9), and morbidly obese (Ն40). Main Outcome Measures: Disease stage at presentation, histologic subtype, duration of anesthetic induction and extubation, duration of surgery, surgical complications, length of hospital stay, and American Society of Anesthesiologists (ASA) class. Results: Ages ranged from 18 to 89 years. Greater BMI was associated with more advanced disease stage at presentation (P Ͻ .001) and more aggressive PTC histopathologic subtype (P=.03). Morbidly obese patients presented more frequently with stage III or IV disease (odds ratio, 3.67; PϽ.001). Greater BMI was also associated with longer duration of anesthetic induction (P Ͻ .001), increased length of stay (P Ͻ.001), and higher ASA class (PϽ .001). Duration of surgery was not associated with BMI. There was a trend toward larger tumors with increasing BMI (P=.06). Obese BMI was associated with more preoperative vocal cord paralysis due to local invasion (odds ratio, 9.21; P=.001). Conclusions: Obese patients present with more advanced stage and more aggressive forms of PTC. This finding suggests that obese patients should be screened for thyroid cancer.

Browning of the pADR depot occurred in half of pheo patients and was associated with increased catecholamines and mitochondrial activity. No browning was detected in other fat depots, suggesting that other factors are required to promote browning in these depots.

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