Studies on the Small Thyroid Carcinoma in the Dialysis Patients with Hyperparathyroidism

Abstract

For twenty long-term hemodialysis patients with medically uncontrolled hyperparathyroidism, subtotal parathyroidectomy (PTX) was performed and histological examination was done for 17 out of them, suspected of thyroid disease from operative findings. Thyroid carcinomas were found in 5 out of 17 patients by biopsied specimens of thyroids. Histological findings of carcinomas were follicular (2 cases) and papillary types (3 cases). In all cases, carcinomas were in occult state and the sizes of carcinomas of 4 cases were small being a diameter less than 10 mm. Among others, findings of follicular adenoma (2 cases) and chronic thyroiditis (1 case) were obtained. The incidence rate of thyroid carcinoma in this report seemed to be rather high as the incidence diagnosed from biopsied specimen at operation. Several factors such as immunological incompetence accompanied by renal failure, metabolic abnormalities of cells induced by parathyroid dysfunction and accelerated aging are considered to be involved as a cause of increased incidence of thyroid carcinoma in hemodialysis patients with hyperparathyroidism.

Thyroid carcinoma found at parathyroidectomy

“…All were papillary carcinomas and all were <1 cm in size, although the 1 patient with history of head and neck irradiation had multiple foci within the gland and lymph node metastases. The prevalence from the study institution was considerably lower than the 15‐36%33‐36 prevalence reported in other populations of patients who were in renal failure at the time of PTX. This may be due to geographic differences, the extent of concomitant thyroidectomy, or the higher number of patients in this study than in the other studies, in which the denominator ranged from 11‐40 patients.…”

“…Specifically, an association between primary hyperparathyroidism (HPT) and well differentiated nonmedullary thyroid carcinoma has been frequently reported 1‐32. In addition, a few reports have suggested an association between secondary HPT and thyroid carcinoma33‐36 and it has been suggested that the incidence of malignancy is higher in patients with renal failure than in the general population 37‐40. Thyroid carcinoma has been reported in patients with renal failure both before and after transplantation 35, 37, 41, 42.…”

Clinicopathological Characteristics of Thyroid Cancer in Patients on Dialysis for End-Stage Renal Disease

“…In contrast, only 2.4% of 123 ESRD patients undergoing surgery for severe secondary HPT in the United Kingdom had thyroid cancer (18). It is striking that all patients had PTC in the previously reported cases of associated renal HPT and thyroid cancer as in our study (17)(18)(19)(20)(21). It is known that the most common thyroid malignancy is PTC, which constitutes 50-90% of differentiated thyroid cancers worldwide (22).…”

Thyroid carcinoma in patients with secondary hyperparathyroidism

“…Some studies have reported that the combination of nonmedullary thyroid carcinoma and primary hyperparathyroidism might be more common than was previously believed [ 1,3-61. However, the association of thyroid carcinoma and secondary hyperparathyroidism is less well known [8,9]. Accordingly, we studied the incidence of thyroid carcinoma in 1 I patients with secondary hyperparathyroidism who were undergoing hemodialysis and treated by parathyroidectomy at Higashi Tokushima National Sanatorium.…”

“…Various explanations have been proposed for the high incidence of association of these diseases. However, there have been few reports of thyroid carcinoma in association with secondary hyperparathyroidism [8,9]. We therefore studied the incidence of thyroid carcinoma in patients with secondary hyperparathyroidism who were undergoing hemodialysis and treated by parathyroidectomy at our hospital.…”