Hiperparatiroidismo primario y cáncer papilar de tiroides

  • Título abreviado Hiperparatiroidismo primario y cáncer papilar
  • Abbreviated title Papillary thyroid cancer and primary hyperparathyroidism
  • Autores J. Bernal Tirapo
    C. Sánchez García
    F.J. Guadarrama González
    P. Yuste García
    E. Ferrero Herrero
  • Categoría Cirugía endocrina
  • Fecha de recepción 29-03-2022
  • ISSN 3020-2655
  • Fecha de aceptación 17-05-2023
  • Páginas 5
  • Número Volumen 1:4

Hiperparatiroidismo primario y cáncer papilar de tiroides: nuestra experiencia en una asociación no tan infrecuente

Papillary thyroid cancer in patients with primary hyperparathyroidism: our experience in a not so uncommon association

Julia Bernal Tirapo*, Carmen Sánchez García*, Francisco Javier Guadarrama González*, Pedro Yuste García*, Eduardo Ferrero Herrero*

* Hospital Universitario 12 de Octubre. Unidad de Cirugía Endocrina. Madrid, España.

DOI: 10.4679/2324
Resumen: 

Introducción: La asociación sincrónica de patología tiroidea con el hiperparatiroidismo primario (HPTP) no es lo habitual, su incidencia oscila del 17.8% al 84.3%, siendo del 2.7% al 9.5% en el caso de cáncer de tiroides bien diferenciado. Material y métodos: se revisan 103 pacientes que fueron sometidos a cirugía paratiroidea. Resultados: 82 mujeres y 21 hombres. Todos tenían diagnóstico preoperatorio de HPTP. La patología tiroidea concomitante fue investigada mediante el examen físico, ecografía y/o Tomografía computarizada. 10 pacientes (9,7%) presentaron cáncer papilar de tiroides. Todos los pacientes eran eutiroideos. El análisis anatomopatológico posterior reveló 6 carcinomas T1a (60%), 1 T1b (10%), 1 T2 (10%), 1 T3 (10%) y 1 T4a (10%). 2 pacientes presentaron metástasis ganglionares cervicales (20%) y en 4 pacientes se detectaron focos de microcarcinoma (40%). El carcinoma fue unifocal en 6 pacientes (60%) y unilateral en 8 pacientes (80%). En la mayoría de los casos se realizó una tiroidectomía total (n=8, 80%), con 2 casos de hemitiroidectomía (20%). En un único caso fue necesario realizar una disección laterocervical. No hubo complicaciones postoperatorias. Discusión: La coexistencia del cáncer papilar de tiroides en pacientes con HPTP puede ser muy frecuente, y esto a menudo causa dificultades en el diagnóstico y tratamiento del HPTP. El examen tiroideo pre e intraoperatorio se debe realizar en todos los pacientes con diagnóstico de HPTP para evitar pasar por alto importantes patologías tiroideas, y del mismo modo en aquellos pacientes con sospecha o diagnóstico de carcinoma tiroideo, se debe realizar un despistaje de HPTP.
Palabras clave: hiperparatiroidismo, cáncer papilar tiroides, sincrónico, despistaje.

Abstract: 

Introduction: Synchronous association of thyroid pathology with primary hyperparathyroidism (PHPT) is not usual, its incidence ranges from 17.8% to 84.3%, being from 2.7% to 9.5% in case of coexistant well-differentiated thyroid cancer. Material and methods: 103 patients who underwent parathyroid surgery were reviewed. Results: 82 women and 21 men. All had preoperative diagnosis of PHPT. Coexistent thyroid pathology was investigated by physical examination, ultrasound or CT scan. 10 patients (9.7%) had papillary thyroid cancer. All patients were euthyroid. The histopathologic exam revealed 6 T1a (60%), 1 T1b (10%), 1 T2 (10%), 1 T3 (10%) and 1 T4a (10%) carcinomas. 2 patients had cervical lymph node metastases (20%) and in 4 microcarcinoma were detected (40%). The carcinoma was unifocal in 6 patients (60%) and unilateral in 8 patients (80%). Total thyroidectomy was performed in most cases (n=8, 80%), with 2 cases of hemithyroidectomy (20%). Laterocervical dissection was necessary in only one case. There were no postoperative complications. Discussion: The coexistence of papillary thyroid cancer in patients with PPH can be very frequent, and this often causes difficulties in the diagnosis and treatment of PHPT. Preoperative and intraoperative thyroid examination should be performed in all patients with a diagnosis of PHPT to avoid overlooking important thyroid pathologies, and likewise in those patients with a suspicion or diagnosis of thyroid carcinoma, screening for PHPT should be performed.
Key words: hyperparathyroidism, papillary thyroid cancer, synchronous, screening.

Bibliografía
      1. Silva BC, Cusano NE, Bilezikian JP. Primary Hyperparathyroidism. Best Pract Res Clin Endocrinol Metab 2018;28:101247.
      2. Fraser ED. Hyperparathyroidism. Lancet 2009;374:145–58. 

      3. Ryan S, Courtney D, Timon C. Coexistent thyroid disease in patients treated for primary hyperparathyroidism: Implications for clinical management. Eur Arch Otorhinolaryngol 2014;272:419-23.
      4. Ricardo VL, Darya B, Elham K. Papillary thyroid carcinoma variants. Head Neck 
Pathol 2011;5:51–6. 

      5. Yazici P, Mihmanli M, Bozdag E, Aygun N, Uludag M. Incidental finding of papillary thyroid carcinoma in the patients with primary hyperparathyroidism. Eurasian J Med 2015;47: 194-8. 

      6. Bentrem DJ, Angelos P, Talamonti MS, Nayar R. Is preoperative investigation of 
the thyroid justified in patients undergoing parathyroidectomy for 
hyperparathyroidism? Thyroid 2002;12:1109–12.
      7. Ogburn PL, Black BM. Primary hyperparathyroidism and papillary adenocarcinoma of the thyroid: report of four cases. Proc Staff Meet Mayo Clin 1956;31:295-8.
      8. Murray SE, Sippel RS, Chen H. Incidence of concomitant hyperparathyroidism in patients with thyroid disease requiring surgery. J Surg Res 2012;178:264–267.
      9. Beebeejaun M, Chinnasamy E, Wilson P, et al. Papillary carcinoma of the thyroid in patients with primary hyperparathyroidism: Is there a link? Medical Hypotheses 2017 (103);100–104.
      10. Çetin K, Sıkar HE, Temizkan Ş, et al. Does Primary Hyperparathyroidism Have an Association with Thyroid Papillary Cancer? A Retrospective Cohort Study. World J Surg. 2019;43(5):1243-1248.
      11. Geara AS, Castellanos MR, Bassil C, et al. Effects of parathyroid hormone on immune function. Clin Dev Immunol 2010;2010:418695.
      12. Kim JR, Kim BH, Kim SM, Oh MY, Kim WJ, Jeon YK, et al. Low serum 25 hydroxyvitamin D is associated with poor clinicopathologic characteristics in female patients with papillary thyroid cancer. Thyroid 2014;24:1618-24.
      13. Wright MC, Jensen K, Mohamed H, et al. Concomitant thyroid disease and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Gland Surg 2017;6:368-74. 

      14. Chaiho Jeong C, Kwon H, Baek H, et al. Association of Hyperparathyroidism and Papillary Thyroid Cancer: A Multicenter Retrospective Study. Endocrinol Metab 2020;35:925-32.:925-932