World Journal of Surgery

, Volume 36, Issue 3, pp 607–611

Breast Radiation Correlates with Side of Parathyroid Adenoma

  • Monica L. Woll
  • Haggi Mazeh
  • Bethany M. Anderson
  • Herbert Chen
  • Rebecca S. Sippel



Prior head and neck irradiation is a known risk factor for hyperparathyroidism. It is not clear whether irradiation for breast cancer, which may expose the neck to radiation, is also a risk factor for hyperparathyroidism. The present study analyzes the association between the side of radiation to the chest following breast surgery and the side of subsequent parathyroid adenoma development.


We analyzed a prospective database of 1,428 consecutive patients who underwent parathyroidectomy at our institution between November 2000 and August 2010. Patients who had previously undergone breast surgery were identified. Patients with multigland disease were excluded. Patients with bilateral breast surgery were counted as having had two separate procedures; one on each side. Patients who had radiation therapy following breast surgery (RadRx) were compared to those who had breast surgery without radiation treatment (No RadRx).


A total of 146 breast procedures were performed in 121 patients. Forty procedures were in the RadRx group versus 106 cases in the No RadRx group. Patients with radiation therapy were older (68 ± 1.8 years versus 63 ± 1.2 years; P = 0.02) and had higher preoperative calcium levels (11.3 ± 0.1 mg/dl versus 10.9 ± 0.1 mg/dl; P = 0.001). However, there was no significant difference in either parathyroid hormone (PTH) level or gland weight. The latency period between breast irradiation and parathyroid surgery was 8 ± 0.9 years. Interestingly, the side of radiation therapy was associated with the side of the parathyroid adenoma in 76% of cases, compared to only 44% in those who had breast surgery without radiation exposure (P = 0.0004).


The present study demonstrates that, similar to prior head and neck radiation, prior breast irradiation correlates with the development of parathyroid disease. Specifically, there is a strong correlation between the side of the radiation therapy and the side of a subsequent parathyroid adenoma. Breast irradiation should therefore be considered a risk factor for the development of parathyroid adenomas.


  1. 1.
    Duffy BJ Jr, Fitzgerald PJ (1950) Cancer of the thyroid in children: a report of 28 cases. J Clin Endocrinol Metab 10:1296–1308PubMedCrossRefGoogle Scholar
  2. 2.
    Rosen IB, Strawbridge HG, Bain J (1975) A case of hyperparathyroidism associated with radiation to the head and neck area. Cancer 36:1111–1114PubMedCrossRefGoogle Scholar
  3. 3.
    Beard CM, Heath H III, O’Fallon WM et al (1989) Therapeutic radiation and hyperparathyroidism. A case-control study in Rochester, Minn. Arch Intern Med 149:1887–1890PubMedCrossRefGoogle Scholar
  4. 4.
    Cohen J, Gierlowski TC, Schneider AB (1990) A prospective study of hyperparathyroidism in individuals exposed to radiation in childhood. JAMA 264:581–584PubMedCrossRefGoogle Scholar
  5. 5.
    Schneider AB, Shore-Freedman E, Weinstein RA (1986) Radiation-induced thyroid and other head and neck tumors: occurrence of multiple tumors and analysis of risk factors. J Clin Endocrinol Metab 63:107–112PubMedCrossRefGoogle Scholar
  6. 6.
    Schneider AB, Favus MJ, Stachura ME et al (1977) Salivary gland neoplasms as a late consequence of head and neck irradiation. Ann Intern Med 87:160–164PubMedGoogle Scholar
  7. 7.
    Block MA, Miller MJ, Horn RC Jr (1969) Carcinoma of the thyroid after external radiation to the neck in adults. Am J Surg 118:764–769PubMedCrossRefGoogle Scholar
  8. 8.
    Martin H, Strong E, Spiro RH (1970) Radiation-induced skin cancer of the head and neck. Cancer 25:61–71PubMedCrossRefGoogle Scholar
  9. 9.
    Clark DE (1955) Association of irradiation with cancer of the thyroid in children and adolescents. J Am Med Assoc 159:1007–1009PubMedCrossRefGoogle Scholar
  10. 10.
    Shapiro CL, Recht A (2001) Side effects of adjuvant treatment of breast cancer. N Engl J Med 344:1997–2008PubMedCrossRefGoogle Scholar
  11. 11.
    Buchholz TA (2009) Radiation therapy for early-stage breast cancer after breast-conserving surgery. N Engl J Med 360:63–70PubMedCrossRefGoogle Scholar
  12. 12.
    Staffurth J (2010) A review of the clinical evidence for intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol) 22:643–657CrossRefGoogle Scholar
  13. 13.
    Shigematsu N, Takeda A, Sanuki N et al (2006) Radiation therapy after breast-conserving surgery. Radiat Med 24:388–404PubMedCrossRefGoogle Scholar
  14. 14.
    Galper S, Recht A, Silver B et al (1999) Factors associated with regional nodal failure in patients with early stage breast cancer with 0–3 positive axillary nodes following tangential irradiation alone. Int J Radiat Oncol Biol Phys 45:1157–1166PubMedCrossRefGoogle Scholar
  15. 15.
    Stephen AE, Chen KT, Milas M et al (2004) The coming of age of radiation-induced hyperparathyroidism: evolving patterns of thyroid and parathyroid disease after head and neck irradiation. Surgery 136:1143–1153PubMedCrossRefGoogle Scholar
  16. 16.
    Tezelman S, Rodriguez JM, Shen W et al (1995) Primary hyperparathyroidism in patients who have received radiation therapy and in patients who have not received radiation therapy. J Am Coll Surg 180:81–87PubMedGoogle Scholar
  17. 17.
    Tisell LE, Carlsson S, Lindberg S et al (1976) Autonomous hyperparathyroidism: a possible late complication of neck radiotherapy. Acta Chir Scand 142:367–373PubMedGoogle Scholar
  18. 18.
    Kalaghchi B, Brietze SA, Drake AJ 3rd et al (2003) Effects of prior neck radiation therapy on clinical features of primary hyperparathyroidism and associated thyroid tumors. Endocr Pract 9:353–362PubMedGoogle Scholar
  19. 19.
    Holten I, Christiansen C (1984) Unchanged parathyroid function following irradiation for malignancies of the head and neck. Cancer 53:874–877PubMedCrossRefGoogle Scholar
  20. 20.
    Obedian E, Fischer DB, Haffty BG (2000) Second malignancies after treatment of early-stage breast cancer: lumpectomy and radiation therapy versus mastectomy. J Clin Oncol 18:2406–2412PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Monica L. Woll
    • 1
  • Haggi Mazeh
    • 1
  • Bethany M. Anderson
    • 2
  • Herbert Chen
    • 1
  • Rebecca S. Sippel
    • 1
  1. 1.Department of SurgerySection of Endocrine SurgeryMadisonUSA
  2. 2.Department of Human OncologyUniversity of WisconsinMadisonUSA

Personalised recommendations