Serum Calcium and Risk of Nonmedullary Thyroid Cancer in Patients with Primary Hyperparathyroidism

Xue, Ying; Ye, Zheng-qin; Zhou, Hongwen; Shi, Baomin; Yi, Xianghua; Zhang, Ke‐Qin

doi:10.12659/msm.898138

Cited by 11 publications

(34 citation statements)

References 30 publications

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“…These reasons could explain the higher incidence of PTC in PHPT patients than in general population [ 22 ]; however, they were inadequate to explain the stronger invasive ability of PTC in asymptomatic PHPT patients whose serum calcium and PTH were lower as we observed; and, for the 1,25-hydroxy vitamin D, although we could not test it in our hospital, previous study showed that the 1,25-hydroxy vitamin D level was lower in asymptomatic PHPT patients when compared to symptomatic PHPT patients [ 35 ]. Moreover, both previous studies and the present study showed a lower PTH and serum calcium level in the PHPT patients with concomitant PTC when compared with PHPT patients with benign thyroid lesion [ 19 , 36 ]. We therefore hypothesized that elevated PTH and calcium could promote the development of PTC; however, this effect may not be dose-dependent.…”

Section: Discussionsupporting

confidence: 68%

“…In 2007, Zheng et al were the first to report 1 case of PTC among 22 PHPT patients who had synchronous thyroid and parathyroid surgery [ 18 ]. Xue et al found 12 PTC cases among 155 surgically treated PHPT patients in 2016 [ 19 ]. More recently, Yu et al have reported that the prevalence of PTC in thyroidectomized PHPT patients was 43.14% (22/51) in 2019.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Guo

Sang

et al. 2021

International Journal of Endocrinology

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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.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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

Liu

Guo

Sang

et al. 2021

International Journal of Endocrinology

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“…The majority of the reported studies were made in patients with PHPT in different stages of evolution [15, 16]. In the present study, in which we included patients with symptomatic PHPT, we found a prevalence of CPT in 20%.…”

Section: Discussionsupporting

confidence: 57%

“…PTC occurs in 7 to 15% of cases and is related to risk factors as age, sex, radiation exposition, family history, among others [13]. It calls to attention that, in patients with PHPT, the prevalence of thyroid nodular disease is similar that in general population; nevertheless, CPT is more frequent than in general population [15, 16]. The high concurrence of these two diseases in the same patients may not be a coincidence; a lot of factors may connect PHTP with CPT.…”

Section: Discussionmentioning

confidence: 99%

“…Xue Y et al found that, from 155 patients with PHPT, 7.7% were ill with concomitant PTC; they found lower calcium concentrations as predictor of nonmedullary thyroid cancer in patients with PHPT [16, 17]. Gul K et al found that, from 60 patients with PHPT, 9 patients (15%) had PTC in a concomitant; they recommend the evaluation of the thyroid with ultrasonography and FNAB [17].…”

Section: Discussionmentioning

confidence: 99%

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Symptomatic Primary Hyperparathyroidism as a Risk Factor for Differentiated Thyroid Cancer

Vargas‐Ortega

Balcázar-Hernández

González-Virla

et al. 2018

Journal of Thyroid Research

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Background The primary hyperparathyroidism (PHPT) is a common disease for the endocrinologist. The concomitant thyroid disease and differentiated thyroid cancer (DTC) appear to be more frequent in patients with PHPT than in the general population. The aim of this study was to characterize patients with symptomatic PHPT with and without DTC and analyze frequency and risk factors. Methods We consecutively studied patients with symptomatic PHPT diagnosed and treated at our center between 2013 and 2015. Patients with subclinical and syndromic forms of PHPT were excluded. Clinical and biochemical characteristics of patients with and without DTC were compared and risk factors were determined. All patients were studied with thyroid ultrasound and thyroid gammagraphy with TC-MIBI. Two expert surgeons performed all the surgical procedures. Results In 59 patients included, we found 12 cases of PTC (20.3%). The final histopathological report of the PTC was 7 cases of follicular variant, 2 cases of oncocytic variant, 2 cases of classic variant, and 1 case of columnar cells variant of PTC. Patients with thyroid cancer were older than patients without thyroid cancer (62 ± 9.5 versus 52 ± 15.8, p = 0.03). Higher preoperative levels of iPTH were associated with PTC (p=0.03) [OR 5.16 (95% CI: 1.08-24.7)]. Conclusion PTC is frequent in patients with symptomatic PHPT. Thyroid nodules in patients with symptomatic PHPT must be studied before parathyroidectomy. In symptomatic PHPT, higher level concentration of parathormone (PTH) was associated with higher risk of DTC.

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Risk of Malignant Neoplasm in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

Charoenngam,

Rittiphairoj,

Wannaphut

et al. 2024

Calcif Tissue Int

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This study aimed to evaluate the prevalence and risk of malignant neoplasm in primary hyperparathyroidism (PHPT) patients. Potentially eligible studies were retrieved from PubMed and Embase databases from inception to November 2023 using search strategy consisting of terms for “Primary hyperparathyroidism” and “Malignant neoplasm”. Eligible study must report prevalence of malignant neoplasm among patients with PHPT or compare the risk of malignant neoplasm between patients with PHPT and comparators. Point estimates with standard errors were extracted from each study and combined using the generic inverse variance method.A total of 11,926 articles were identified. After two rounds of systematic review, 50 studies were included. The meta-analysis revealed that pooled prevalence rates of overall cancer was 0.19 (95%CI: 0.13–0.25; I2 94%). The two most prevalent types of malignancy among patients with PHPT ware papillary thyroid cancer (pooled prevalence: 0.07; 95%CI: 0.06–0.08; I2 85%) and breast cancer (pooled prevalence: 0.05; 95%CI: 0.03–0.07; I2 87%). Subgroup analysis of studies focusing on patients undergoing parathyroidectomy reported a fourfold higher prevalence of papillary thyroid cancer than the remaining studies (0.08 versus 0.02). The meta-analysis of cohort studies found a significant association between PHPT and overall cancer with the pooled risk ratio of 1.28 (95%CI: 1.23–1.33; I2 66.9%).We found that the pooled prevalence of malignant neoplasm in PHPT was 19%, with papillary thyroid cancer and breast cancer being the most prevalent types. The meta-analysis of cohort studies showed that patient with PHPT carried an approximately 28% increased risk of malignancy.

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Serum Calcium and Risk of Nonmedullary Thyroid Cancer in Patients with Primary Hyperparathyroidism

Cited by 11 publications

References 30 publications

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

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

Symptomatic Primary Hyperparathyroidism as a Risk Factor for Differentiated Thyroid Cancer

Risk of Malignant Neoplasm in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

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