World Journal of Surgery

, Volume 43, Issue 5, pp 1243–1248 | Cite as

Does Primary Hyperparathyroidism Have an Association with Thyroid Papillary Cancer? A Retrospective Cohort Study

  • Kenan ÇetinEmail author
  • Hasan E. Sıkar
  • Şule Temizkan
  • Cem B. Ofluoğlu
  • Ayşenur Özderya
  • Kadriye Aydın
  • Aylin E. Gül
  • Hasan F. Küçük
Original Scientific Report



To investigate the relationship between primary hyperparathyroidism (pHPT) and papillary thyroid cancer (PTC).


The perioperative findings of 275 patients with pHPT who underwent surgery between January 2014 and December 2017 were retrospectively reviewed. Thirty-one patients were diagnosed with pHPT and PTC concurrently. Pathology results and demographic findings of these patients were compared with 186 patients who underwent thyroidectomy and diagnosed with PTC at the same time interval.


The co-occurrence of pHPT and PTC was 11.3% (31/275). The median ages of the pHPT, pHPT + PTC, and PTC groups were 55, 57, and 50 years old, respectively (p < 0.001). The diameter of tumor was smaller in the pHPT + PTC group [median 7 mm (range 0.5–25 mm) vs. 15 mm (range 1–100 mm)], with higher rates of microcarcinomas (p < 0.001), than the patients in the PTC group. Examination of tumor morphology showed higher rates of tumor capsule invasion and multicentricity in the pHPT + PTC group than those in the isolated PTC group (p = 0.02, p = 0.04, respectively).


The pHPT + PTC group had significantly smaller tumor diameter than the PTC group. This result may support the idea that pHPT leads to overdiagnosis of PTC. However, observation of high rates of tumor capsule invasion and multicentricity in the pHPT + PTC group may suggest an associative etiology with more aggressive PTC.


Compliance with ethical standards

Conflict of interest

None of the authors have any financial or other relationship leading to a conflict of interest.

Ethical approval

All procedures performed in studies involving human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study protocol was approved by Dr. Lutfi Kirdar Kartal Research and Training Hospital in affiliation with University of Medical Sciences’ ethics committee.

Informed consent

Informed consent was not obtained from participants due to retrospective design of the study.


  1. 1.
    Heath DA (1989) Primary hyperparathyroidism Clinical presentation and factors influencing clinical management. Endocrinol Metab Clin North Am 18:631–646CrossRefGoogle Scholar
  2. 2.
    Fraser ED (2009) Hyperparathyroidism. Lancet 374:145–158CrossRefGoogle Scholar
  3. 3.
    Wilhelm SM, Wang TS, Ruan DT et al (2016) The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 151(10):959–968CrossRefGoogle Scholar
  4. 4.
    Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26(1):1–133CrossRefGoogle Scholar
  5. 5.
    Noone AM, Howlader N, Krapcho M et al (2018) SEER cancer statistics review, 1975–2015, National Cancer Institute., based on November 2017 SEER data submission, posted to the SEER web site, April 2018. Accessed 26 Sept 2018
  6. 6.
    Vaccarella S, Dal Maso L, Laversanne M et al (2015) The impact of diagnostic changes on the rise in thyroid cancer incidence: a population based study in selected high-resource countries. Thyroid 25:1127–1136CrossRefGoogle Scholar
  7. 7.
    Davies L, Morris LG, Haymart M et al (2015) American Association of Clinical Endocrinologists and American College of Endocrinology disease state clinical review: the increasing incidence of thyroid cancer. Endocr Pract 21:686–696CrossRefGoogle Scholar
  8. 8.
    La Vecchia C, Malvezzi M, Bosetti C et al (2015) Thyroid cancer mortality and incidence: a global overview. Int J Cancer 136:2187–2195CrossRefGoogle Scholar
  9. 9.
    Wang TS, Sosa JA (2018) Thyroid surgery for differentiated thyroid cancer—recent advances and future directions. Nat Rev Endocrinol 14(11):670–683CrossRefGoogle Scholar
  10. 10.
    Kitahara CM, Sosa JA (2016) The changing incidence of thyroid cancer. Nat Rev Endocrinol 12(11):646–653CrossRefGoogle Scholar
  11. 11.
    Ogburn PL, Black BM (1956) Primary hyperparathyroidism and papillary adenocarcinoma of the thyroid: report of four cases. Proc Staff Meet Mayo Clin 31:295–298Google Scholar
  12. 12.
    Linos DA, van Heerden JA, Edis AJ (1982) Primary hyperparathyroidism and non-medullary thyroid cancer. Am J Surg 143:301–303CrossRefGoogle Scholar
  13. 13.
    Burmeister LA, Sandberg M, Carty SE (1997) Thyroid carcinoma found at parathyroidectomy: association with primary, secondary, and tertiary hyperparathyroidism. Cancer 79:1611–1616CrossRefGoogle Scholar
  14. 14.
    Krause UC, Friedrich JH, Olbricht T, Metz K (1996) Association of primary hyperparathyroidism and non-medullary thyroid cancer. Eur J Surg (Acta Chir) 162:685–689Google Scholar
  15. 15.
    Nishiyama RH, Farhi D, Thompson NW (1979) Radiation exposure and the simultaneous occurrence of primary hyperparathyroidism and thyroid nodules. Surg Clin North Am 59:65–75CrossRefGoogle Scholar
  16. 16.
    Bentrem DJ, Angelos P, Talamonti MS (2002) Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperparathyroidism? Thyroid 12:1109–1112CrossRefGoogle Scholar
  17. 17.
    Attie JN, Vardhan R (1993) Association of hyperparathyroidism with nonmedullary thyroid carcinoma: review of 31 cases. Head Neck 15:20–23CrossRefGoogle Scholar
  18. 18.
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): thyroid carcinoma. Version 1.2018. National Comprehensive Cancer Network. Accessed 10 June 2018
  19. 19.
    Hughes DT, Haymart MR, Miller BS, Gauger PG, Doherty GM (2011) The most commonly occurring papillary thyroid cancer in the United States is now a micro-carcinoma in a patient older than 45 years. Thyroid 21(3):231–236CrossRefGoogle Scholar
  20. 20.
    Morita SY, Somervell H, Umbricht CB, Dackiw AP, Zeiger MA (2008) Evaluation for concomitant thyroid nodules and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Surgery 144(6):862–866CrossRefGoogle Scholar
  21. 21.
    Murray SE, Sippel RS, Chen H (2012) Incidence of concomitant hyperparathyroidism in patients with thyroid disease requiring surgery. J Surg Res 178:264–267CrossRefGoogle Scholar
  22. 22.
    Dean DS, Gharib H (2008) Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 22:901–911CrossRefGoogle Scholar
  23. 23.
    Nilsson IL, Zedenius J, Yin L, Ekbom A (2007) The association between primary hyperparathyroidism and malignancy: nationwide cohort analysis on cancer incidence after parathyroidectomy. Endocr Relat Cancer 14:135–140CrossRefGoogle Scholar
  24. 24.
    Pickard AL, Gridley G, Mellemkjae L et al (2002) Hyperparathyroidism and subsequent cancer risk in Denmark. Cancer 95:1611–1617CrossRefGoogle Scholar
  25. 25.
    Cinamon U, Levy D, Marom T (2015) Is primary hyperparathyroidism a risk factor for papillary thyroid cancer? An exemplar study and literature review. Int Arch Otorhinolaryngol 19:42–45Google Scholar
  26. 26.
    Beebeejaun M, Chinnasamy E, Wilson P, Sharma A, Beharry N, Bano G (2017) Papillary carcinoma of the thyroid in patients with primary hyperparathyroidism: is there a link? Med Hypotheses 103:100–104CrossRefGoogle Scholar
  27. 27.
    Huber BC, Grabmaier U, Brunner S (2014) Impact of parathyroid hormone on bone marrow derived stem cell mobilization and migration. World J Stem Cells 6:637–643CrossRefGoogle Scholar
  28. 28.
    Veselý D, Astl J, Matucha P, Sterzl I, Betka J (2003) Serum levels of angiogenic growth factors in patients with thyroid gland tumors and parathyroid adenoma. Neuro Endocrinol Lett 24:417–419Google Scholar
  29. 29.
    Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L (2016) Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med 18(375):614–617CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of General SurgeryUniversity of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research HospitalIstanbulTurkey
  2. 2.Department of Endocrinology, Faculty of MedicineYeditepe UniversityIstanbulTurkey
  3. 3.Department of EndocrinologyUniversity of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research HospitalIstanbulTurkey
  4. 4.Department of PathologyUniversity of Health Sciences, Kartal Dr. Lutfi Kirdar Training and Research HospitalIstanbulTurkey

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