PRIMARY HYPERPARATHYROIDISM AND PAPILLARY THYROID CARCINOMA CASE REPORT - CLINICAL AND SURGICAL ATTITUDE

Abstract

Differentiated thyroid cancer (DTC), which includes papillary and follicular cancer, comprises the vast majority (>90%) of all thyroid cancers. Papillary carcinoma of the thyroid gland typically presents as a nodule that is firm and solid on thyroid ultrasound, sometimes with internal calcifications. In multinodular goiter, the cancer is usually a dominant nodule - larger, firmer, and/or with ultrasound characteristics more suspicious than other nodules in the gland. Primary hyperparathyroidism results from the excessive secretion of PTH, and typically produces frank hypercalcemia. Primary hyperparathyroidism is caused by a single parathyroid adenoma in about 80% of cases and by primary hyperplasia of the parathyroids in 10% to 15%. Parathyroid carcinoma is a rare cause of hyperparathyroidism, accounting for 1% to 2% of cases. We report the case of a 67-year-old woman who initially presented herself in our department for clinical and therapeutic evaluation in the context of suspicion of hyperparathyroidism, associating high levels of PTH and serum calcium on test results performed in an outpatient clinic. She is subsequently diagnosed with primary hyperparathyroidism by ultrasound detection of a right parathyroid adenoma, as well as a multinodular goiter with numerous nodules with suspicious aspect. While thyroid function evaluated by repeated dosing of TSH, FT4, T3 has been shown to remain within normal limits, PTH values, as well as total serum calcium and ionic calcium, continued to show elevated values. Phosphorus values remained within normal limits. Further investigations including both parathyroid scintigraphy and contrast CT examination of the cervical region and mediastinum. The patient is redirected for surgical cure of the goiter and parathyroid adenoma, resulting in total thyroidectomy and upper right parathyroidectomy. Histopathologically, the diagnosis of multifocal papillary microcarcinoma and upper right parathyroid adenoma is established. In the context of the detection of thyroid neoplastic pathology, the patient is advised to seek further treatment in the form of radioiodine therapy. The patient should present for periodic clinical and therapeutic follow-up according to indications and guidelines.