Differences in Clinicopathological Characteristics of Papillary Thyroid Carcinoma between Symptomatic and Asymptomatic Patients with Primary Hyperparathyroidism

Abstract

Background. Popularization of cervical ultrasound led to higher detection of papillary thyroid carcinoma (PTC) and primary hyperparathyroidism (PHPT), as well as increasing percentage of asymptomatic PHPT in China. Although the coexistence of PTC and PHPT has been reported, it is unknown whether the clinicopathological features of PTC differ between asymptomatic and symptomatic PHPT patients. Methods. We retrospectively reviewed the medical records of 304 PHPT patients treated in our hospital between January 2009 and July 2020, including 217 females and 87 males with the average age of 53.27 ± 13.54 years. Of the 304 patients, 181 were symptomatic PHPT patients and 123 were asymptomatic PHPT patients. We analyzed the laboratory results, postoperative pathology, and the TNM stage of PTC between asymptomatic and symptomatic PHPT patients. Results. Concurrent thyroid nodules were found in 61.51% of PHPT patients, and the prevalence of PTC in thyroidectomized PHPT patients was 29.89% in our cohort. Lower serum parathyroid hormone (PTH) ( p < 0.05 ) and calcium ( p < 0.05 ) were found in PHPT patients with PTC compared to patients with benign thyroid lesion. Compared with the symptomatic PHPT patients, the asymptomatic PHPT patients showed lower serum calcium ( p < 0.05 ), serum chlorine ( p < 0.05 ), alkaline phosphatase ( p < 0.05 ), PTH ( p < 0.05 ), and bone turnover markers ( p < 0.05 ) but higher prevalence of thyroid nodules (70.73% versus 55.24%, p < 0.05 ) and PTC (15.44% versus 3.87%, p < 0.05 ). All the PTC in symptomatic PHPT patients were papillary microcarcinoma limited to the thyroid, while 68.42% and 15.78% of the PTC in asymptomatic PHPT patients showed microscopic extrathyroidal extension and lymph node metastases, respectively. Moreover, 36.84% (7/19) of the PTC patients in asymptomatic group showed multifocality, which was much higher than 14.29% (1/7) in the symptomatic group; however, no statistical significance was found ( p = 0.24 ). Conclusions. The concomitant PTC in asymptomatic PHPT patients showed a higher rate of microscopic extrathyroidal invasion when compared to symptomatic PHPT patients. So the FNA is essential to the asymptomatic PHPT patients with suspicious thyroid nodules and once the PTC is confirmed, concurrent parathyroidectomy should be performed with thyroidectomy in asymptomatic PHPT patients.

Changes in clinical patterns of Chinese patients with primary hyperparathyroidism in the past 12 years: a single-center experience

“…Some researchers believe that PTC in PHPT cases is overdiagnosed because in PHPT patients with concomitant PTC, the tumor diameter is significantly smaller than in patients with PTC alone ( 39 , 40 ). However, in our previous study, we found that PTC in aPHPT patients showed a higher rate of microscopic extrathyroidal invasion than PTC in the general population ( 41 ). Therefore, the relationship between these two diseases needs further investigation.…”

Papillary thyroid carcinoma prevalence and its predictors in patients with primary hyperparathyroidism

“…Conversely, in another study conducted with a similar population, decreased serum PTH measurements were obtained for patients with both PHPT and PTC in comparison to patients diagnosed with benign thyroid lesions (26). In another study conducted with 155 patients, a significant inverse association was identified between nonmedullary thyroid carcinoma and levels of preoperative serum Ca in cases of PHPT, similarly to the research reported by Liu et al (6,26). Contrary to those findings, our study, conducted with a much larger patient population compared to previous studies, showed that high serum Ca levels and advanced age were independent risk factors for PTC.…”

“…In a study conducted with 318 patients, moderate elevations of serum PTH independently predicted thyroid cancer among patients with PHPT (25). Conversely, in another study conducted with a similar population, decreased serum PTH measurements were obtained for patients with both PHPT and PTC in comparison to patients diagnosed with benign thyroid lesions (26). In another study conducted with 155 patients, a significant inverse association was identified between nonmedullary thyroid carcinoma and levels of preoperative serum Ca in cases of PHPT, similarly to the research reported by Liu et al (6,26).…”

“…In the literature, there are very few studies arguing for a relationship between PHPT and PTC and identifying the risk factors for that relationship, and their results are contradictory (6,25,26). In a study conducted with 318 patients, moderate elevations of serum PTH independently predicted thyroid cancer among patients with PHPT (25).…”

The Nexus of Hyperparathyroidism and Thyroid Carcinoma: Insights into Pathogenesis and Diagnostic Challenges—A Narrative Review

“…Liu and coll. (2021) [ 18 ] Showed the higher prevalence of thyroid nodules in asymptomatic PHPT patients and the occurrence of PTC in a considerable percentage of these patients. The study also observed differences in the pathological features of PTC between the two groups, particularly a higher rate of microscopic extrathyroidal invasion in the concomitant PTC among asymptomatic PHPT patients.…”