Mustafa ÇALIŞKAN, Hasret CENGİZ, Taner DEMİRCİ

Primer Hiperparatiroidili Hastalarda Nodüler Guatr ve Papiller Tiroid Kanseri Birlikteliğinin Değerlendirilmesi

Amaç: Primer hiperparatiroidi ve diferansiye tiroid karsinomu en sık görülen endokrinolojik hastalıklardır. İlk tanımlanmış olduğu 1950’li yıllardan bu yana primer hiperparatiroidili hastalarda nodüler guatr ve diferansiye tiroid karsinomu varlığı birçok çalışmada incelenmiş ve kanser insidansında bir artış olduğu saptanmıştır. Bu çalışmada, primer hiperparatiroidili hastalardaki nodüler guatr ve diferansiye tiroid kanseri birlikteliğinin araştırılması amaçlandı. Gereç ve Yöntemler: Bu çalışmaya hastanemizde 2012 ve 2015 yılları arasında paratiroid cerrahisi yapılmış olan toplam 172 hasta dahil edildi. Hastaların demografik, klinik ve cerrahi verileri geriye dönük olarak incelendi. Bulgular: Hastaların yaş ortalaması 54,3±11,3 yıl olup %85,5’i (n=147) kadın idi. Hastaların preoperatif değerlendirmesinde %61,0 (n=105) oranında nodüler guatr izlenmiştir. Hastaların 125’ine (%72,7) sadece paratiroidektomi uygulanırken 32’sine (%18,6) eş zamanlı total tiroidektomi ve 15’ine (%8,7) ise eş zamanlı lobektomi uygulanmıştır. Histopatolojik olarak değerlendirilen paratiroid dokularının %94,8’i (n=163) adenom olarak yorumlanırken, %2,9’u (n=5) paratiroid hiperplazisi ve %2,3’ü (n=4) paratiroid karsinomu olarak yorumlanmıştır. Histopatolojik olarak tiroid karsinomu saptanan (n=30) hastalar ile benign saptanan (n=17) hastalar klinik ve laboratuvar özellikleri yönünden karşılaştırılmış olup hiçbir parametrede anlamlı bir farklılık izlenmemiştir. Sonuç: Primer hiperparatiroidili hastalarda tiroid nodülaritesinde anlamlı bir artış olmamakla birlikte, bu çalışmada literatürle uyumlu şekilde diferansiye tiroid kanseri insidansında anlamlı bir artış saptanmıştır. Bu bulgu da bu hasta grubunda preoperatif olarak yapılan tiroid dokusu değerlendirmesinin önemini vurgulamaktadır.

Anahtar Kelimeler:

Primer hiperparatiroidi, nodüler guatr, tiroid kanseri

Evaluation of Nodular Goiter and Papillary Thyroid Cancer Coincidence in Patients with Primary Hyperparathyroidism

Aim: Primary hyperparathyroidism and differentiated thyroid carcinoma are the most common endocrinological diseases. Since its first definition in the 1950s, nodular goiter and differentiated thyroid carcinoma in patients with primary hyperparathyroidism have been examined in many studies and an increase in cancer incidence has been found. In this study, we aimed to investigate the co-incidence of nodular goiter and differentiated thyroid cancer in patients with primary hyperparathyroidism. Material and Methods: One hundred seventy-two patients who underwent parathyroid surgery in our hospital between 2012 and 2015 were included in this study. Demographic, clinic, and surgical data of the patients were reviewed retrospectively. Results: The mean age of the patients was 54.3±11.3 years and 85.5% (n=147) of them were female. Nodular goiter was observed at a rate of 61.0% (n=105) in preoperative evaluation. Parathyroidectomy was performed in 125 (72.7%) and simultaneous total thyroidectomy was performed in 32 (18.6%) and lobectomy in 15 (8.7%) of the patients. Histopathologically, 94.8% (n=163) were interpreted as adenoma, 2.9% (n=5) as parathyroid hyperplasia, and 2.3% (n=4) as parathyroid carcinoma. Patients with papillary thyroid carcinoma (n=30) and benign (n=17) histopathologically were compared in terms of clinical and laboratory characteristics, and no significant difference was observed in any parameter. Conclusion: There was no significant increase in thyroid nodularity, but a significant increase was found in differentiated thyroid carcinoma incidence in patients with primary hyperparathyroidism in this study in accordance with the literature. This finding highlights the importance of preoperative thyroid evaluation in this patient group.

Keywords:

Primary hyperparathyroidism, nodular goiter, thyroid cancer,

PDF

___

Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JE, Rejnmark L, et al. Primary hyperparathyroidism: Review and recommendations on evaluations, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1-19.
Preda C, Branisteanu D, Armasu I, Danila R, Velicescu C, Ciobanu D, et al. Coexistent papillary thyroid carcinoma diagnosed in surgically treated patients for primary versus secondary hyperparathyroidism: same incidence, different characteristics. BMC Surg. 2019;19(1):94.
Vargas-Ortega G, Balcázar-Hernández L, González-Virla B, Ramírez-Rentería C, Nieto-Guzmán O, Garrido-Mendoza AP, et al. Symptomatic primary hyperparathyroidism as a risk factor for differentiated thyroid cancer. J Thyroid Res. 2018;2018:9461079.
Fraser WD. Hyperparathyroidism. Lancet. 2009;374(9684):145-58.
Smit PC, Borel Rinkes IH, van Dalen A, van Vroonhoven TJ. Direct, minimally invasive adenomectomy for primary hyperparathyroidism: an alternative to conventional neck exploration? Ann Surg. 2000;231(4):559-65.
Wright MC, Jensen K, Mohamed H, Drake C, Mohsin K, Monlezun D, et al. Concomitant thyroid disease and primary hyperparathyroidism in patients undergoing parathyroidectomy or thyroidectomy. Gland Surg. 2017;6(4):368-74.
Çalışkan M, Demirci T, Cengiz H. Evaluation of voice quality in primary hyperparathyroidism patients undergoing minimally invasive parathyroid surgery. Cir Cir. 2022;90(S1):45-51.
Del Rio P, Tosi G, Loderer T, Bonati E, Cozzani F, Ruffini L. Preoperatory imaging evaluation in primary hyperparathyroidism and associated thyroid disease. Ann Ital Chir. 2021;92:471-8.
Gates JD, Benavides LC, Shriver CD, Peoples GE, Stojadinovic A. Preoperative thyroid ultrasound in all patients undergoing parathyroidectomy? J Surg Res. 2009;155(2):254-60.
Spanheimer PM, Weigel RJ. Management of patients with primary hyperparathyroidism and concurrent thyroid disease: an evolving field. Ann Surg Oncol. 2012;19(5):1428-9.
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133.
Liu Y, Guo S, Sang S, Liu J, Qi L, Lv B, et al. Differences in clinicopathological characteristics of papillary thyroid carcinoma between symptomatic and asymptomatic patients with primary hyperparathyroidism. Int J Endocrinol. 2021;2021:9917694.
Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, et al. SEER cancer statistics review, 1975-2015. Bethesda, MD: National Cancer Institute; based on November 2017 SEER data submission, posted to the SEER website, April 2018. [Updated: 2018 September 10; Cited: 2023 June 15]. Available from: https://seer.cancer.gov/csr/1975_2015/.
Vaccarella S, Dal Maso L, Laversanne M, Bray F, Plummer M, Franceschi S. The impact of diagnostic changes on the rise in thyroid cancer incidence: a population-based study in selected high-resource countries. Thyroid. 2015;25(10):1127-36.
Ogburn PL, Black BM. Primary hyperparathyroidism and papillary adenocarcinoma of the thyroid; report of four cases. Proc Staff Meet Mayo Clin. 1956;31(10):295-8.
Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341-6.
Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab. 2014;99(10):3561-9.
Çetin K, Sıkar HE, Temizkan Ş, Ofluoğlu CB, Özderya A, Aydın K, et al. Does primary hyperparathyroidism have an association with thyroid papillary cancer? a retrospective cohort study. World J Surg. 2019;43(5):1243-8.
Emirikçi S, Özçınar B, Öner G, Omarov N, Ağcaoğlu O, Soytaş Y, et al. Thyroid cancer incidence in simultaneous thyroidectomy with parathyroid surgery. Ulus Cerrahi Derg. 2015;31(4):214-7.
Hu L, Qian B, Bing K, Mei L, Qu X. Clinical characteristics of primary parathyroid adenoma and its relationship with coexisting papillary thyroid carcinoma: a clinical retrospective study. Gland Surg. 2023;12(5):577-85.
Haciyanli SG, Karaisli S, Suataman B, Karahan F, Haciyanli M. Primary hyperparathyroidism with thyroid cancer: clinicopathologic features. Sisli Etfal Hastan Tip Bul. 2022;56(2):250-5.
Celik M, Guldiken S, Ayturk S, Yilmaz Bulbul B, Tastekin E, Can N, et al. A benign and malignant thyroid gland diseases in the patients with primary hyperparathyroidism. Int J Appl Basic Med Res. 2017;7(2):117-20.
Jeong C, Kwon HI, Baek H, Kim HS, Lim DJ, Baek KH, et al. Association of hyperparathyroidism and papillary thyroid cancer: a multicenter retrospective study. Endocrinol Metab (Seoul). 2020;35(4):925-32.
Weiss DM, Chen H. Role of cervical ultrasound in detecting thyroid pathology in primary hyperparathyroidism. J Surg Res. 2014;190(2):575-8.
Cinamon U, Turcotte RE. Primary hyperparathyroidism and malignancy: "studies by nature". Bone. 2006;39(2):420-3.
Beebeejaun M, Chinnasamy E, Wilson P, Sharma A, Beharry N, Bano G. Papillary carcinoma of the thyroid in patients with primary hyperparathyroidism: is there a link? Med Hypotheses. 2017;103:100-4.
Cinamon U, Levy D, Marom T. Is primary hyperparathyroidism a risk factor for papillary thyroid cancer? An exemplar study and literature review. Int Arch Otorhinolaryngol. 2015;19(1):42-5.
Huber BC, Grabmaier U, Brunner S. Impact of parathyroid hormone on bone marrow-derived stem cell mobilization and migration. World J Stem Cells. 2014;6(5):637-43.
Veselý D, Astl J, Matucha P, Sterzl I, Betka J. Serum levels of angiogenic growth factors in patients with thyroid gland tumors and parathyroid adenoma. Neuro Endocrinol Lett. 2003;24(6):417-9.