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Query: UMLS:C0221002 (primary hyperparathyroidism)
 4,921 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The coexistence of parathyroid adenomas and thyroid cancer in a substantial number of patients with primary hyperparathyroidism has led to speculation implicating ionizing radiation as a possible cause. Experience with a group of 40 individuals harboring both tumors was reviewed and evidence of roentgen ray exposure to the head and neck was found in only one of these patients. Association of parathyroid adenomas and thyroid carcinoma cannot be explained on the basis of prior irradiation to the neck.
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PMID:Coexistent parathyroid adenomas and thyroid carcinoma. Can radiation be blamed? 63 93

To the best of our knowledge this is the first report of two cases with concomitant secondary hyperparathyroidism and thyroid cancer. Despite previously published reports of a possible association between primary hyperparathyroidism and non-medullary thyroid cancer, we believe that such an association is coincidental. Nevertheless, increased awareness of the possibility of encountering and treating both diseases at the same time is advisable.
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PMID:Secondary hyperparathyroidism and thyroid cancer. 383 70

Computerized axial tomography (CAT) was used to study 39 patients with known thyroid disease and 14 patients with primary hyperparathyroidism. In all, CAT was performed only when information that was required for diagnosis or therapy was not available from other less expensive techniques. The greatest value was found in the evaluation of cryptic symptoms or structures in the neck after surgery for thyroid cancer, the assessment of the extent of thyroid cancer, the localization of aberrant thyroid tissue, the etiology of unexplained recurrent laryngeal nerve paralysis and the identification and delineation of mediastinal goiter. In six of 14 patients undergoing neck exploration for primary hyperparathyroidism CAT correctly localized the site of the enlarged parathyroid glands including one mediastinal parathyroid adenoma and one patient with two parathyroid adenomas.
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PMID:Computerized axial tomography in the diagnosis and management of thyroid and parathyroid disorders. 654 39

Of 2,058 patients who had surgically proven primary hyperparathyroidism at the Mayo Clinic from 1965 through 1979, 51 or 2.5 percent had associated nonmedullary thyroid carcinoma. A history of radiation exposure to the head and neck was obtained in 14 of 43 patients questioned. Thyroid disease consisted of grade 1 papillary adenocarcinoma in 48 cases and pure follicular adenocarcinoma in 3 cases. The parathyroid disease included 41 single adenomas and 5 cases of parathyroid hyperplasia; 5 patients had 2 adenomas. At follow-up, none of the patients had evidence of metastatic thyroid carcinoma. Ten patients were receiving calcium or vitamin D supplementation for protracted hypocalcemia presumably due to the increased insult to the parathyroids from combined bilateral thyroidectomy and parathyroidectomy. More consecutive thyroidectomy, along with parathyroid autotransplantation when indicated, will provide definitive treatment of the thyroid cancer and at the same time minimize the risk of postoperative hypoparathyroidism.
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PMID:Primary hyperparathyroidism and nonmedullary thyroid cancer. 706 49

Several causative factors for thyroid cancer have been identified, the most important of which is low-dose ionizing radiation. Although the prognosis for patients with differentiated thyroid cancer is generally good, the literature continues to present new information concerning clinical, pathologic, and molecular factors that allow for identification of high-risk subgroups. Molecular biology techniques now enable clinicians to identify patients with benign disease or a family history of thyroid cancer who will develop a malignancy. Despite these advances in tumor biology, however, controversy continues regarding the surgical procedures that should be performed for the various types of thyroid cancer. Although parathyroid cancer is a very rare but lethal form of neoplasia, benign parathyroid disease is much more common. Recent molecular studies have revealed fascinating differences among the various clinical manifestations of primary hyperparathyroidism.
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PMID:Diagnosis and management of thyroid and parathyroid hyperplasia and neoplasia. 769 63

Nonmedullary thyroid carcinoma is known to occur in association with primary hyperparathyroidism. A combination of secondary, uremic, hyperparathyroidism and non-medullary thyroid carcinoma is rare and was hitherto reported in only 12 cases. We report another three patients with this parathyroid/thyroid disease combination, suggesting that it may represent not merely a coincidence. A number of factors active in secondary hyperparathyroidism may play a role in the induction and/or promotion of the thyroid cancer. These include parathyroid endocrinopathy, goiterogenic effect of prolonged hypercalcemia, and uremia. During surgery on the parathyroid glands, associated thyroid lesions demand special considerations.
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PMID:Secondary hyperparathyroidism and nonmedullary thyroid cancer. 774 92

With the advent of better thyroid function tests, a tumor marker, and fine-needle aspiration, the role of thyroid imaging studies in the evaluation of the patients with thyroid disease has diminished. Although multimodality thyroid imaging had improved our understanding of thyroid disease, current indications for thyroid imaging are the solitary or dominant thyroid nodule, an upper mediastinal mass, differentiation of hyperthyroidism, detection and staging of postoperative thyroid cancer, neonatal hypothyroidism, thyroid developmental anomalies, and the thyroid mass post-thyroidectomy for benign disease. To provide optimal, cost-effective, care for the thyroid patient, the physician must understand the advantages and disadvantages of each imaging modality--scintigraphy, real-time sonography (RTS), computed tomography, and magnetic resonance--in specific clinical settings. Similarly, preoperative noninvasive localization of hyperfunctioning parathyroid tissue in patients with primary hyperparathyroidism undergoing their initial neck exploration usually is not warranted. In this situation, the best localization procedure is to enlist the services of an experienced parathyroid surgeon. However, if this is not feasible because of local constraints, both sestamibi methoxy isobutyl isonitrile (MIBI) scintigraphy and magnetic resonance imaging (MRI) provide excellent localization (< 90%) of juxta-thyroidal and ectopic parathyroid adenomas. Hyperplastic glands are more difficult to detect because of their smaller size, and tandem studies (MIBI and MRI) should provide higher sensitivity before initial exploration, especially in patients with ectopic glands. In patients with persistent or recurrent disease, multimodality imaging with MIBI, MR, computed tomography and RTS in a sequential fashion is warranted to optimize two-test, site-specific localization.
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PMID:Thyroid and parathyroid imaging. 797 59

The causes, evaluation, and preoperative and postoperative care of primary hyperparathyroidism and thyroid nodules in the elderly patient population have been described. Primary hyperparathyroidism is easily diagnosed and is almost always curable by surgery. Elderly patients with asymptomatic disease are candidates for nonoperative, expectant management. If they become symptomatic, surgery should be performed. Postoperative care of the elderly patient who has undergone parathyroid exploration is potentially complicated by the patient's other medical problems, including cardiac and pulmonary difficulties, variable severity of symptoms of hypocalcemia, and sensitivity to medications. Thyroid nodules in the elderly may present later than in younger patients and are more likely to contain malignant tissue. Tissue diagnosis preoperatively, usually by FNA testing, is mandatory. Anaplastic thyroid carcinoma and thyroid lymphoma are both treated nonoperatively. Thyroid surgery in the elderly is usually well tolerated, although other medical conditions, as mentioned above, may complicate postoperative care. Thyroid carcinoma in the elderly carries a worse prognosis than in younger patients and should always be treated with postoperative adjuvant (radioablative) therapy. Although this does not affect survival (from the thyroid cancer), it does extend the disease-free interval. As the number of elderly patients increases, the frequency with which these disorders are encountered will also rise. It is important to realize that almost all elderly patients can both tolerate and benefit from surgical correction of these two disorders, if appropriate preoperative evaluation is coupled with excellent intraoperative and postoperative care.
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PMID:Endocrine surgical diseases of elderly patients. 810 64

In a series of 948 patients operated on for primary hyperparathyroidism (HPT) by one surgeon (JNA) from 1952 to 1992, there were 242 (26%) instances of coincidental thyroid and parathyroid disease. Of these, 211 had benign thyroid lesions. In the remaining 31 cases HPT was associated with nonmedullary thyroid carcinoma; all were treated by resection of parathyroid adenomas and thyroidectomy. One patient died of unrelated cause (carcinoma of breast) 11 years following surgery. The remaining 30 patients are living and well 2 to 20 (mean 8.2 years) years after surgery; there was no recurrence or thyroid cancer-related mortality in the series. In contrast to prior reports, only six (20%) of our patients had a history of prior radiotherapy. We suggest that during neck exploration for HPT, the entire thyroid gland be evaluated and all palpable nodules resected and submitted to pathologic study.
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PMID:Association of hyperparathyroidism with nonmedullary thyroid carcinoma: review of 31 cases. 841 51

Acute onset of primary hyperparathyroidism is uncommon; neuropsychiatric signs are prominent clinical features in acute hypercalcemia and they can subside after normalization of serum calcium. Radiation therapy is a well-known risk factor for non medullary thyroid cancer, but it induces also parathyroid tumors. Data from the literature show that patients previously treated with neck radiation have an increased risk of primary hyperparathyroidism. Furthermore concomitant thyroid cancer is more frequent in radiation-induced hyperparathyroidism than in sporadic primary hyperparathyroidism. The case of a 63-year-old female patient who at the age of 14 had been irradiated to the neck for goiter and at the age of 50 had been repeatedly hospitalized for psychosis is presented. She was admitted to the hospital for suspected recurrence of psychosis, but clinical findings and urgent biochemical data showed on the contrary that she had a severe hypercalcemic crisis. Serum parathormone concentrations, neck echography and 99mTc-Sestamibi scintigraphy suggested hyperfunction of the right lower parathyroid gland; therefore the patient was operated on. Pathological examination disclosed a parathyroid adenoma but also two foci of follicular cancer in the right thyroid lobe with a metastasis to a lymph node were observed. Neuropsychiatric signs disappeared after normalization of calcemia and 6 months after operation the patient is free from psychiatric symptoms, despite she had stopped neurolectic drugs. It is underlined that patients who had received neck irradiation must be carefully observed because they are at increased risk of primary hyperparathyroidism and concurrent thyroid cancer.
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PMID:[Acute hyperparathyroidism associated with follicular carcinoma in the thyroid: possible role of juvenile cervical irradiation. Description of a case]. 922 12


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