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Coexistence of thyroid carcinoma and secondary hyperparathyroidism

Koinzidenz von Schilddrüsenkarzinom und sekundärem Hyperparathyreoidismus

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Summary

Background

Reports on the coexistence of secondary hyperparathyroidism (sHPT) and thyroid carcinoma are very rare.

Methods

A case of secondary hyperparathyroidism and concomitant papillary thyroid carcinoma (follicular variant) is described, and compared to data from the literature.

Results

1 out of 26 patients undergoing parathyroidectomy for secondary hyperparathyroidism had papillary thyroid microcarcinoma (follicular variant) associated with regional lymph node metastases. Head and neck were not irradiated during the patient’s case history. Dialysis had been performed for 23 years prior to simultaneous near-total thyroidectomy, total parathyroidectomy and autotransplantation. The prolonged high parathyroid hormone levels, or massive hemosiderin deposits may have caused the development of carcinoma. The incidence rate of occult thyroid microcarcinoma in all autopsies of our geographical region and period was 4.5 per cent.

Conclusions

Careful exploration of the thyroid gland, and liberal indication for biopsy of suspicious thyroid areas is mandatory in each sHPT patient who is operated on, in order to exclude possible thyroid carcinomas.

Zusammenfassung

Grundlagen

In der Literatur gibt es nur wenige Berichte über das gemeinsame Vorkommen von sekundärem Hyperparathyreoidismus (sHPT) und Schilddrüsenkarzinom.

Methodik

Ein Fall von sekundärem Hyperparathyreoidismus mit gleichzeitigem papillärem Schilddrüsenkarzinom (follikuläre Variante) wird beschrieben und mit Literaturdaten verglichen.

Ergebnisse

Unter 26 Patienten, die wegen sHPT operiert wurden, fand sich eine Patientin mit papillärem Mikrokarzinom (follikuläre Variante) und Lymphknotenmetastasen. Anamnestisch wurde keine Bestrahlung der Kopf-Halsregion durchgeführt. Die erhöhten Parathormonwerte und die massiven Hämosiderinablagerungen während der 23 Jahre langen Hämodialyse könnten die Ursache für die Karzinomentstehung sein. Neben einer totalen Parathyroidektomie mit simultaner Autotransplantation wurde eine „near-total” Thyroidektomie durchgeführt. In derselben geographischen Region wurden im gleichen Zeitraum bei 4,5% aller Autopsien Mikrokarzinome der Schilddrüse beobachtet.

Schlußfolgerungen

Bei jeder Halsexploration wegen sHPT ist immer die Schilddrüse sorgfältig nach einem Schilddrüsenkarzinom zu untersuchen und suspekte Schilddrüsenareale sind gegebenenfalls zu biopsieren.

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Lukács, G.L., Ujhelyi, L., Mátyus, J. et al. Coexistence of thyroid carcinoma and secondary hyperparathyroidism. Acta Chir Austriaca 28, 314–315 (1996). https://doi.org/10.1007/BF02629295

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