Thyroid carcinoma found at parathyroidectomy

Burmeister, Lynn A.; Sandberg, Marc I.; Carty, Sally E.; Watson, Charles G.

doi:10.1002/(sici)1097-0142(19970415)79:8<1611::aid-cncr26>3.0.co;2-#

Cited by 51 publications

(23 citation statements)

References 41 publications

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“…In addition, hyperthyroidism could worsen some PHPT features, such as hypercalcemia and osteoporosis [10]. Moreover, the prevalence of thyroid cancer seems to be higher in patients with PHPT, with thyroid malignancy reported in 2 to 12% of PHPT surgical patients [13,14].…”

Section: Discussionmentioning

confidence: 99%

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Surgical Approach to Primary Hyperparathyroidism in Patients with Concomitant Thyroid Diseases: A Retrospective Single Center Study

Castellano

Benso

Attanasio

et al. 2020

International Journal of Endocrinology

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Background. Primary hyperparathyroidism (PHPT) and thyroid diseases are a frequent concomitant occurrence, but the surgical approach to associated disease is still debated. Methods. We retrospectively evaluated a series of PHPT patients focusing on thyroid disease and surgery. Results. Among 238 PHPT patients undergoing parathyroidectomy (PTX) between 2002 and 2017, 128 were affected also by a benign thyroid disease, namely, goiter in 118 (76 multinodular (MNG) and 42 uninodular (UNG)), autoimmune thyroiditis in 10, and hyperthyroidism in 21. Surgical approach was unilateral neck exploration (UNE) in 59 patients and bilateral neck exploration (BNE) in 69. The PHPT cure rate was 94%. On comparing patients submitted to PTX only and PTX plus thyroidectomy (TX), in the latter MNG and hyperthyroidism were more frequent, and surgical time and length of stay were longer. No difference in surgical complications was found between patients undergoing UNE and BNE. Conclusion. PHPT patients with a concomitant thyroid disease underwent double surgery in almost two-thirds of the cases, mostly by BNE. The main factors driving the decision to perform concomitant PTX and TX were the presence of thyroid nodular disease with the nodule site ipsilateral to the presurgically localized parathyroid adenoma.

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Section: Discussionmentioning

confidence: 99%

“…Nodular goiter complications are a common occurrence in endemic goiter areas [20], so that a simultaneous surgery could avoid costs and risks associated with neck reexploration. Finally, this approach can detect unsuspected occult thyroid cancers that are more prevalent in PHPT patients than in general population [13,14].…”

Section: Discussionmentioning

confidence: 99%

Surgical Approach to Primary Hyperparathyroidism in Patients with Concomitant Thyroid Diseases: A Retrospective Single Center Study

Castellano

Benso

Attanasio

et al. 2020

International Journal of Endocrinology

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“…In a retrospective study of 824 patients who had undergone cervical exploration for hyperparathyroidism in which at least a thyroid lobectomy was carried out, thyroid carcinoma was detected in 18 patients (8.6%) with primary hyperparathyroidism [2]. …”

Section: Discussionmentioning

confidence: 99%

“…Burmeister et al additionally compared the incidence of thyroid carcinoma among groups of primary, secondary and tertiary hyperparathyroidism patients and found that the prevalence of thyroid carcinoma in a population of patients undergoing parathyroidectomy for hyperparathyroidism was the same irrespective of whether the patients had primary, secondary or tertiary hyperparathyroidism [2]. They concluded that the detection of thyroid carcinoma at the time of parathyroidectomy is related to risk factors that are probably not associated with hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%

Synchronous parathyroid adenoma and thyroid papillary carcinoma: a case report

et al. 2009

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A 51-year-old female patient presented with atypical chest pain, laryngo-oesophageal reflux, increased levels of serum calcium and parathyroid hormone. Ultrasonography showed a multinodular goiter with a prominent solid nodule in the lower left thyroid lobe and a solid hypoechoic nodule outside this area.Tc99m-sestamibi parathyroid scintigraphy was performed to investigate a primary hyperparathyroidism, revealing an area with increased uptake in the lower left thyroid lobe and another area with marked uptake lower than this level. Thyroid scintigraphy with 99mTc showed a cold nodule of the left lower pole. FNA of the thyroid nodule was positive for papillary carcinoma later verified by postoperative histopathology.This case underlines the need for a clinical high index of suspicion for synchronous hyperparathyroidism and thyroid cancer.

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“…The rate of incidentally detected thyroid pathology in patients with pHPT has been reported to range from 17%-84% [9-13]. The frequency of malignant thyroid lesions in population with pHPT ranges from 2% to 12% [9,11,14,15]. …”

Section: Introductionmentioning

confidence: 99%

Impact of concomitant thyroid pathology on preoperative workup for primary hyperparathyroidism

et al. 2009

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Background The former standard surgical treatment in patients with primary hyperparathyroidism (pHPT) has been bilateral cervical exploration. New localization techniques and the possibility of intraoperative measurement of intact parathormone (iPTH) permit a focused, minimally invasive parathyroidectomy (MIP). The introduction of MIP without complete neck exploration leads to the potential risk of missing thyroid pathology. The aim of the present study is to evaluate the value of MIP in respect to coexisting thyroid findings and their impact on preoperative workup for primary hyperparathyroidism. Methods This is a prospective study including 30 consecutive patients with pHPT (median age 65 years; 17 females, 13 males). In all patients preoperative localization was performed by ultrasonography and 99m Tc-MIBI scintigraphy-Intraoperative iPTH monitoring was routinely done. Results Ten patients (33%) had a concurrent thyroid finding requiring additional thyroid surgery, and two patients (7%) with negative localization results underwent bilateral neck exploration. Therefore, MIP was attempted in 18 (60%) patients. The conversion rate to a four gland exploration was 6% (1/18). The sensitivities of 99m Tc-MIBI scanning and ultrasonography were 83.3% and 76.6%, respectively. The respective accuracy rates were 83.3% and 76.6%. Of note, the combination of the two modalities did not improve the sensitivity and accuracy in our patient population. During a median follow-up of 40 months, none of the patients developed persistent or recurrent hypocalcaemia, resulting in a 100% cure rate. Conclusion Coexisting thyroid pathology is relatively frequent in patients with pHPT in our region. Among patients having pHPT without any thyroid pathology, the adenoma localization is correct with either ultrasonography or 99m Tc-MIBI scintigraphy in the majority of cases. MIP with iPTH monitoring are highly successful in this group of patients and this operative technique should be the method of choice.

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Thyroid carcinoma found at parathyroidectomy

Cited by 51 publications

References 41 publications

Surgical Approach to Primary Hyperparathyroidism in Patients with Concomitant Thyroid Diseases: A Retrospective Single Center Study

Surgical Approach to Primary Hyperparathyroidism in Patients with Concomitant Thyroid Diseases: A Retrospective Single Center Study

Synchronous parathyroid adenoma and thyroid papillary carcinoma: a case report

Impact of concomitant thyroid pathology on preoperative workup for primary hyperparathyroidism

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