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Concomitant multiple parthyroid adenomas and non medullary thyroid carcinoma with a review of the literature

Appetecchia Marialuisa, Massaro Rosalba

CaseRepClinPractRev 2005; 6:85-90

ID: 428817

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Background: We report here a case of a 75-year-old woman with primary hyperparathyroidism and a papillary thyroid carcinoma and the results of a literature review.Case Report: The patient presented high parathyroid hormone levels (276 pg/dl) and high serum calcium levels (13 mg/dl). A chest radiography was normal, however a neck ultrasonography displayed a bilateral multinodular goiter with a prevalent solid nodule in the inferior pole of the left lobe (10 mm) and a solid nodule (8 mm) in the superior pole of the right lobe. Dual-phase 99 m-Tc-SestaMIBI scintiscan showed an increased uptake in the inferior pole of the right lobe. The patient did not perform any further evaluations until October 2003, when she was operated on elsewhere for upper right parathyroidectomy and ipsilateral lobo-isthmectomy. Histological examination found a right upper parathyroid adenoma and a well differentiated papillary carcinoma of the right thyroid lobe. In January 2004, a completion thyroidectomy with a central neck lymph node dissection and an inferior left parathyroidectomy was performed. Histological examination found a benign goiter and a parathyroid adenoma. The patient was then submitted to radioiodine treatment. The first report of an association between hyperparathyroidism and well differentiated non medullary thyroid carcinoma was made by Hellstrom in 1954. Since then a further 355 reports have been described including our own. Conclusions: During preoperative diagnostic investigations for primary hyperparathyroidism (PHPT), it should be mandatory to take into account the presence of a thyroid disease, in order to perform the right treatment.

Keywords: Primary hyperthyroidism, non medullary thyroid cancer, Parathyroidectomy, coexistence thyroid and parathyroid, thyroid neoplasm