Background: The association of hyperparathyroidism (HPT) with thyroid disease has long been known, but the mechanisms underlying such an association have not yet been clari®ed. Objective: To elucidate the main factors determining this combination of endocrine diseases, in a retrospective multicenter study. Methods: We retrospectively reviewed all patients referred for parathyroid scintigraphy in the period 1990±1999. A total of 487 patients in the age range 17±65 years were selected for the analysis (339 women and 148 men); group A included 241 patients with primary and group B 246 patients with secondary HPT. Results: A total of 124/241 patients in group A (51.5%), but only 92/246 patients in group B (38.2%) had thyroid disorders (notably nodular goiter) associated with HPT P 0X0035X Thyroid disorders were evenly distributed throughout the entire 17±65 years age range in group A, but 17± 40-year-old patients in group B had signi®cantly fewer thyroid disorders than the older patients of the same group (15.5% compared with 43.3%, P , 0X002), as expected in a general population. In patients with primary HPT there was no difference in the prevalence of thyroid disease between women and men, whereas the ratio of women to men in secondary HPT patients with thyroid disease was about 3:1.Conclusions: These results demonstrate an increased prevalence of nodular goiter in patients with primary rather than secondary HPT, and are consistent with a possible role of increased endogenous calcium concentrations (a hallmark of primary, but not of secondary, HPT) as a goitrogenic factor in patients with HPT.
Rarely may a non-hyperfunctioning thyroid nodule present as "hot" at Technetium-99m pertechnetate (99mTcO4-) and "cold" at radioiodine scintigraphy at late acquisitions. We report the case of a hyperthyroid female patient whose 99mTcO4- scintigraphy showed two "hot" nodules, whereas Iodide-131 (131I-) revealed a lack of indicator uptake by the larger, and intense uptake by the smaller nodule. The patient underwent surgery: histology demonstrated that the larger nodule, mismatched at pertechnetate vs iodine scintigraphy, was a papillary carcinoma. Our suggestion is to perform thyroid scintigraphy with radioiodine in hyperthyroid patients with more than one nodule concentrating pertechnetate, especially when an ultrasonographic pattern possibly suspect for malignancy is present.
Our results, unlike the good results of previous trials, are very poor. Therefore we do not recommend this combination for routine treatment of advanced melanoma.
Acute-onset primary hyperparathyroidism in a previously asymptomatic individual is uncommon. We herein report the case of a 61-yr old woman who underwent bone scintigraphy for severe, rapidly worsening, diffuse bone pain, associated with weight loss, anxiety and confusion. The patient was asymptomatic until a few days before presentation. A marked redistribution of the tracer was observed, with poor bone uptake and relevant accumulation in liver, kidneys, lungs and spleen. Blood chemistry unequivocally allowed the diagnosis of primary hyperparathyroidism due to multiple parathyroid adenomas, as suggested by parathyroid scan. Unfortunately, the patient critically worsened and surgery was made impossible. She died despite intensive critical care. Autopsy confirmed both massive intraparenchymal calcium deposition in the kidneys, lungs, liver and spleen, as well as multiple parathyroid adenomas. One may speculate that some adaptation of the organism to progressively increasing blood calcium levels and to slowly increasing intraparenchymal calcium salt deposition occurred, until critically high concentrations were attained.
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