Is Primary Hyperparathyroidism a Risk Factor for Papillary Thyroid Cancer? An Exemplar Study and Literature Review
11 August 2014
04 November 2014
08 December 2014 (eFirst)
Introduction Primary hyperparathyroidism (PHPT) is associated with several cancer types, including papillary thyroid carcinoma (PTC).
Objective To explore further the relation between PHPT and PTC.
Methods By considering patients with PHPT as extra-suspicious for PTC, we studied an exemplar group of patients with PHPT with a small (≤1 cm) thyroid nodule, which was negative in preoperative cytologic examination. During parathyroidectomy, a frozen section biopsy of the thyroid nodule confirmed PTC, as did the final surgical specimen, revealing that the preoperative cytology was false-negative. Additionally, relevant reports retrieved from the English literature addressing thyroid cancer and hyperparathyroidism were reviewed and processed.
Results Four patients with PHPT were studied. Three had a multifocal thyroid disease, and three had neck lymph node metastasis. Processing previous report data supported an association between PHPT and PTC. Although thyroid nodularity among patients with PHPT was similar to the general population, PTC incidence was higher. This was true also for patients with secondary hyperparathyroidism.
Conclusions This study emphasized that PHPT should be considered as a noteworthy risk factor for PTC. Fine needle aspiration of a thyroid nodule is the most valuable diagnostic procedure for thyroid cancer. Yet, false-negative results were reported in up to 10% of cases, especially in small, subcentimeter nodules. In line with our data and the literature, patients with PHPT should have both a detailed ultrasound addressing the thyroid and cytology of any thyroid nodule, including small subcentimeter lesions. Moreover, surgical flexibility, allowing intraoperative thyroid nodule sampling, should be considered even for “innocent” nodules.
- 1 Morita SY, Somervell H, Umbricht CB, Dackiw AP, Zeiger MA. Evaluation for concomitant thyroid nodules and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Surgery 2008; 144 (6) 862-866 , discussion 866–868
- 2 Attie JN, Vardhan R. Association of hyperparathyroidism with nonmedullary thyroid carcinoma: review of 31 cases. Head Neck 1993; 15 (1) 20-23
- 3 Murray SE, Sippel RS, Chen H. Incidence of concomitant hyperparathyroidism in patients with thyroid disease requiring surgery. J Surg Res 2012; 178 (1) 264-267
- 4 Sanai T, Okamura K, Inoue T, Abe T, Tsuruya K, Node K. Ultrasonographic detection of thyroid nodules in hemodialysis patients in Japan. Ther Apher Dial 2010; 14 (3) 323-327
- 5 Nilsson IL, Zedenius J, Yin L, Ekbom A. The association between primary hyperparathyroidism and malignancy: nationwide cohort analysis on cancer incidence after parathyroidectomy. Endocr Relat Cancer 2007; 14 (1) 135-140
- 6 Pickard AL, Gridley G, Mellemkjae L , et al. Hyperparathyroidism and subsequent cancer risk in Denmark. Cancer 2002; 95 (8) 1611-1617
- 7 Cibas ES, Ali SZ ; NCI Thyroid FNA State of the Science Conference. The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2009; 132 (5) 658-665
- 8 Cooper DS, Doherty GM, Haugen BR , et al; American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19 (11) 1167-1214
- 9 Masatsugu T, Yamashita H, Noguchi S , et al. Significant clinical differences in primary hyperparathyroidism between patients with and those without concomitant thyroid disease. Surg Today 2005; 35 (5) 351-356
- 10 Ogawa T, Kammori M, Tsuji E , et al. Preoperative evaluation of thyroid pathology in patients with primary hyperparathyroidism. Thyroid 2007; 17 (1) 59-62
- 11 Cinamon U, Turcotte RE. Primary hyperparathyroidism and malignancy: “studies by nature.”. Bone 2006; 39 (2) 420-423
- 12 Strichartz SD, Giuliano AE. The operative management of coexisting thyroid and parathyroid disease. Arch Surg 1990; 125 (10) 1327-1331
- 13 Rivo Vázquez A, Rivo Vázquez JE, Cáceres Alvarado N , et al. [Hyperparathyroidism, goiter and well-differentiated thyroid carcinoma. A common association with diagnostic implications]. Cir Esp 2007; 82 (1) 32-36
- 14 Arciero CA, Shiue ZS, Gates JD , et al. Preoperative thyroid ultrasound is indicated in patients undergoing parathyroidectomy for primary hyperparathyroidism. J Cancer 2012; 3: 1-6
- 15 Gul K, Ozdemir D, Korukluoglu B , et al. Preoperative and postoperative evaluation of thyroid disease in patients undergoing surgical treatment of primary hyperparathyroidism. Endocr Pract 2010; 16 (1) 7-13
- 16 Adami S, Marcocci C, Gatti D. Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 2002; 17 (Suppl. 02) N18-N23
- 17 Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 2006; 295 (18) 2164-2167
- 18 Cancer Research UK. Thyroid cancer—UK incidence statistics. Trends over time. Available at: http://info.cancerresearchuk.org/cancerstats/types/thyroid/incidence . Accessed August 27, 2014
- 19 National Cancer Institute of Canada. Canadian Cancer Statistics 2009. Time trends in incidence and mortality. Available at: www.cancer.ca
- 20 Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013; 2013 (13) 965212
- 21 Aschebrook-Kilfoy B, Ward MH, Sabra MM, Devesa SS. Thyroid cancer incidence patterns in the United States by histologic type, 1992–2006. Thyroid 2011; 21 (2) 125-134
- 22 Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008; 22 (6) 901-911
- 23 Hambleton C, Kandil E. Appropriate and accurate diagnosis of thyroid nodules: a review of thyroid fine-needle aspiration. Int J Clin Exp Med 2013; 6 (6) 413-422
- 24 Mehanna R, Murphy M, McCarthy J , et al. False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. Laryngoscope 2013; 123 (5) 1305-1309
- 25 Shrestha M, Crothers BA, Burch HB. The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution. Thyroid 2012; 22 (12) 1251-1256
- 26 Roti E, Rossi R, Trasforini G , et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab 2006; 91 (6) 2171-2178
- 27 Maisonneuve P, Agodoa L, Gellert R , et al. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 1999; 354 (9173) 93-99
- 28 Cengiz K. Increased incidence of neoplasia in chronic renal failure (20-year experience). Int Urol Nephrol 2002; 33 (1) 121-126
- 29 Miki H, Oshimo K, Inoue H , et al. Thyroid carcinoma in patients with secondary hyperparathyroidism. J Surg Oncol 1992; 49 (3) 168-171
- 30 Yoon JH, Kwak JY, Kim EK , et al. How to approach thyroid nodules with indeterminate cytology. Ann Surg Oncol 2010; 17 (8) 2147-2155