Although the pathological relationship between parathyroid and thyroid diseases is common, an association between parathyroid adenoma and thyroid cancer is rare. Concomitant thyroid cancer in patients with primary hyperparathyroidism (pHPT) has been reported at varying frequencies. WE present here a 23-year-old man who had papillary thyroid carcinoma in the right thyroid lobe and a parathyroid adenoma in the left thyroid lobe, which were confirmed surgically. Copyright Â© 2012 Via Medica

Assadi, M.

Farrokhi, S.

Jallalat, S.

Javadi, H.

Mogharrabi, M.

Moshtaghi, D.

Nabipour, I.

Riazi, A.

Semnani, S.

English

Although the pathological relationship between parathyroid and

thyroid diseases is common, an association between parathyroid

adenoma and thyroid cancer is rare. Concomitant thyroid

cancer in patients with primary hyperparathyroidism (pHPT) has

been reported at varying frequencies.

WE present here a 23-year-old man who had papillary thyroid

carcinoma in the right thyroid lobe and a parathyroid adenoma

in the left thyroid lobe, which were confirmed surgically.

KEY words: primary hyperparathyroidism, papillary

thyroid carcinoma, thyroid diseas

Javadi, Hamid

Jallalat, Sara

Farrokh, Shokrollah

Semnani, Shahriar

Mogharrabi, Mehdi

Riazi, Ahmad

Nabipour, Iraj

Moshtagh, Darab

Assadi, Majid

Bushehr University of Medical Sciences Repository

Concurrent papillary thyroid cancer

and parathyroid adenoma as a rare

condition: a case report

Golestan University of Medical Sciences Repository

153Nuclear Medicine Review 2012, 15, 2: 153–15510.5603/NMR.2012.0013Copyright © 2012 Via MedicaISSN 1506–9680www.nmr.viamedica.plCase  reportAbstractAlthough the pathological relationship between parathyroid and thyroid diseases is common, an association between parathy-roid adenoma and thyroid cancer is rare. Concomitant thyroid cancer in patients with primary hyperparathyroidism (pHPT) has been reported at varying frequencies. WE present here a 23-year-old man who had papillary thyroid carcinoma in the right thyroid lobe and a parathyroid adenoma in the left thyroid lobe, which were confirmed surgically. KEY words: primary hyperparathyroidism, papillary thyroid carcinoma, thyroid diseaseNuclear Med Rev 2012; 15, 2: 153–155Concurrent papillary thyroid cancer and parathyroid adenoma as a rare condition: a case report Correspondence to: Majid Assadi, M.D.The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr 3631, IranTel.: 0098–771–2580169 Fax: 0098–771–2541828e-mail: assadipoya@yahoo.com, asadi@bpums.ac.ir IntroductionThe correlation between concurrent thyroid and parathyroid disease was initially described in 1947 [1]. The existence of para-thyroid adenoma resulting in primary hyperparathyroidism (pHPT) and concomitant thyroid papillary cancer is rare [2]. Probably this can be partially explained by different embryologic source of thyroid follicular cells and parathyroid cells. Conversely, the co-existence of parathyroid adenoma and medullary thyroid can-cer (MTC) deriving from parafollicular cells is more common due to similar origin of both cell types. We present here a 23-year-old man who had papillary thyroid carcinoma in the right thyroid lobe and a parathyroid adenoma in the left thyroid lobe, which were confirmed surgically. Case ReportA 23-year-old man with a recent history of papillary carcinoma of the thyroid in the right lobe presented to our nuclear medicine department for 99mTc thyroid scan. Microscopic finding showed papillary thyroid carcinoma (mixed papillary and follicular vari-ant) in the surgical right lobe. The patient’s past medical history was unremarkable. His 99mTc thyroid scan showed normal left lobe and isthmus in terms of shape, size, and uptake (Figure 1). In post-surgical thyroid laboratory findings, he had elevated serum calcium (10.9 mg/dl; normal range: 9–10.5 mg/dl) and low serum phosphate (2.3 mg/dl; normal range: 2.5–4.5 mg/dl). Serum cal-cium and phosphate were rechecked, and hypercalcemia and hypophosphatemia were confirmed along with an elevated parathy-roid hormone (PTH: 247 pg/ml; normal range: 15–65 g/ml), indicat-ing primary hyperparathyroidism. Also, the parathyroid 99mTc-MIBI scan demonstrated parathyroid adenoma in the left lower pole of the thyroid (Figure 2). Because of above findings yielded, thyroid left lobectomy was also carried out and surgical cure was obtained. Surgical cure was confirmed by histopathologic verification of the removed abnormal parathyroid tissue, with a decrease of serum calcium and PTH levels to normal ranges.Hamid Javadi1, Sara Jallalat1, Shokrollah Farrokhi2, 3, Shahriar Semnani1, Mehdi Mogharrabi1, Ahmad Riazi3, Iraj Nabipour3, Darab Moshtaghi4, Majid Assadi41Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences (GUOMS), Gorgan, Iran2Department of Immunology and Allergy, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran3The Persian Gulf Tropical and Infectious Diseases Research Centre, Bushehr University of Medical Sciences, Bushehr, Iran4The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran[Received 27 I 2012; Accepted 10 II 2012]154Nuclear Medicine Review 2012, Vol. 15, No. 2www.nmr.viamedica.plCase  reportAbout one month later, the patient was treated with radio-iodine and a post-ablation whole-body scan with 131I revealed just remnant thyroid tissue in thyroid bed (Figure 3). Then, six months post radioiodine therapy, his whole-body scan with 131I depicted negative study. Finally, noteworthy clinical improvement was achieved and he was advised to follow up with regular visits to our department. DiscussionThyroid cancer accompanied with pHPT has been encoun-tered in 3.1% to17% [3] of cases. The reason for this association is controversial. Some researchers have shown this concomitant as coincidental [4], whereas other authors have explained in-Figure 1. The 99mTc thyroid scan showed normal left lobe and isth-mus in terms of shape, size and uptake. The right lobe resected surgi-callyFigure 2. Parathyroid 99mTc-MIBI scan revealed parathyroid adenoma underlying the left lower pole of thyroidFigure 3. The post-ablation whole-body scan with 131I depicted rem-nant functioning thyroid tissue in the thyroid bed. No clear evidence of distant metastasis was noted throughout the body155www.nmr.viamedica.plHamid Javadi et al. Concurrent thyroid cancer and parathyroid adenomaCase  reportcreased endogenous calcium levels or probably growth factors, such as epithelial growth factors and insulin-like growth factors, as goitrogenic factors [3, 5, 6].In a study of 824 patients who had undergone cervical explora-tion leads to thyroid lobectomy, thyroid carcinoma was detected in 2.6% patients with pHPT. But, it is also remarkable that in this large series no synchronous development of thyroid and parathyroid carcinoma was seen [4].In 2009, another patient was described: a 59-year-old man who had presented with severe clinical manifestations of pHPT eight years previously because his serum calcium was 14.4 mg/dl and his PTH serum level was 2.023 pg/ml. The patient was found to have synchronous parathyroid carcinoma on the left side as well as papillary thyroid carcinoma and parathyroid adenoma on the right side [7].In 2011, an extremely rare maternal condition was reported during pregnancy. She was a 23-year-old pregnant woman re-ferred with severe hyperemesis and weight loss at 32 gestational weeks [8]. She was diagnosed with pHPT because of parathyroid adenoma and treated with surgery where a synchronous thyroid papillary carcinoma was detected [8]. Previously reported pa-tients had been considerably older in mean age. Although, concurrent thyroid cancer and parathyroid adenoma is rare, the diagnosis of this coexistence should be considered in pHPT because of the prevention of repeat surgery like in our patient. In term of localization, ultrasonography (US) can improve localization of thyroid nodules, and accurate diagnosis of thyroid nodules is performed by combining fine-needle aspiration (FNA) with sensitivity 89%, specificity 91%, and accuracy 90% [9]. In ad-dition, today the 99mTc-MIBI scan is considered as a localization tool with the greatest sensitivity, and there are advantages, includ-ing the detection of ectopic glands. Therefore, the combination of 99mTc-MIBI, US, and US-FNA (if needed) are recommended as the best diagnostic tool for parathyroid localization of pHPT and concomitant thyroid disease. However, removal of relevant thyroid nodules is suggested during parathyroid surgery. ConclusionsThis case demonstrates the need for clinical alertness of concurrent hyperparathyroidism and thyroid cancer. Therefore, careful thyroid assessment is recommended for all patients with primary hyperparathyroidismReferences1. Kissin M, Bakst H. Co-existing myxedema and hyperparathyroidism; case report. J Clin Endocrinol Metab 1947; 7: 152–158.2. Lee JK, Obrzut SL, Yi ES, Deftos LJ, Bouvet M. Incidental finding of metastatic papillary thyroid carcinoma in a patient with primary hyperparathyroidism. Endocr Pract 2007; 13: 380–383.3. dell’Erba L, Baldari S, Borsato N et al. Retrospective analysis of the association of nodular goiter with primary and secondary hyperpar-athyroidism. Eur J Endocrinol 2001; 145: 429–434.4. Burmeister LA, Sandberg M, Carty SE, Watson CG. Thyroid carcinoma found at parathyroidectomy: association with primary, secondary, and tertiary hyperparathyroidism. Cancer 1997; 79: 1611–1616.5. Maiorano E, Ambrosi A, Giorgino R, Fersini M, Pollice L, Ciampolillo A. Insulin-like growth factor 1 (IGF-1) in multinodular goiters: a possible pathogenetic factor. Pathol Res Pract 1994; 190: 1012–1016.6. McCarty MF. Parathyroid hormone may be a cancer promoter — an ex-planation for the decrease in cancer risk associated with ultraviolet light, calcium, and vitamin D. Med Hypotheses 2000; 54: 475–482.7. Goldfarb M, O’Neal P, Shih JL, Hartzband P, Connolly J, Hasselgren PO. Synchronous parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma in a patient with severe and long-standing hyperparathyroidism. Endocr. Pract. 2009; 15: 463–468.8. Baumann K, Weichert J, Krokowski M, Diedrich K, Banz-Jansen C. Coexistent parathyroid adenoma and thyroid papillary carcinoma in pregnancy. Arch Gynecol Obstet 284: 91–94.9. Koike E, Yamashita H, Noguchi S et al. Effect of combining ultrasonog-raphy and ultrasound-guided fine-needle aspiration biopsy findings for the diagnosis of thyroid nodules. Eur J Surg 2001; 167: 656–661.

Concurrent papillary thyroid cancer and parathyroid adenoma as a rare condition: A case report

Although the pathological relationship between parathyroid andthyroid diseases is common, an association between parathyroidadenoma and thyroid cancer is rare. Concomitant thyroidcancer in patients with primary hyperparathyroidism (pHPT) hasbeen reported at varying frequencies.WE present here a 23-year-old man who had papillary thyroidcarcinoma in the right thyroid lobe and a parathyroid adenomain the left thyroid lobe, which were confirmed surgically.Although the pathological relationship between parathyroid andthyroid diseases is common, an association between parathyroidadenoma and thyroid cancer is rare. Concomitant thyroidcancer in patients with primary hyperparathyroidism (pHPT) hasbeen reported at varying frequencies.WE present here a 23-year-old man who had papillary thyroidcarcinoma in the right thyroid lobe and a parathyroid adenomain the left thyroid lobe, which were confirmed surgically

Farrokhi, Shokrollah

Moshtaghi, Darab

Via Medica Journals

Concurrent papillary thyroid cancer and parathyroid adenoma as a rare condition: a case report

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Concurrent papillary thyroid cancer and parathyroid adenoma as a rare condition: A case report

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