Papillary thyroid carcinoma prevalence and its predictors in patients with primary hyperparathyroidism

Year 2022, Volume: 5 Issue: 5, 1499 - 1504, 25.09.2022

Elif Tutku Durmuş , Ayşegül Atmaca , Mehmet  Kefeli , Ramis Çolak , Buğra Durmuş , Cafer Polat

https://doi.org/10.32322/jhsm.1152567

Abstract

Aim: Papillary thyroid carcinoma (PTC) and primary hyperparathyroidism (PHPT) are among the most common endocrine diseases. Although it has been shown that hyperparathyroidism may be associated with various cancers, the question of whether there is an association between hyperparathyroidism and PTC remains controversial. To evaluate the incidence of concomitant PTC among patients with PHPT and to identify possible risk factors for the development of PTC in these patients.
Material and Method: The data of 543 patients who had been operated on due to PHPT in our institution were reviewed retrospectively. Patients who underwent thyroid surgery in conjunction with parathyroidectomy and patients whose diagnosis of PTC was confirmed histopathologically were compared in terms of their clinical, biochemical, and histopathological features. The prevalence of PTC found in patients with PHPT was compared with national rates to estimate standardized incidence ratios (SIRs).
Results: Of the 456 PHPT patients enrolled in the study, 281 (61.6%) had concomitant thyroid nodules on thyroid ultrasonography, and PTC was detected in 53 (11.6%) patients during their thyroid surgeries. Compared to the general population, the incidence of papillary thyroid cancer was increased in both women and men with PHPT (SIR: 272.2, 95% CI: 201.6-360.0, p<0.001 and SIR: 736.5, 95% CI: 322.1-1457.0, p<0.001, respectively). Patients who were found to have PTC were older than non-PTC patients and had higher serum calcium levels (p=0.026 and p= 0.012, respectively). In multivariate analysis, a high serum calcium level and advanced age were independent predictors of PTC in patients with PHPT (OR: 1.402, 95% CI: 1.046-1.878, p=0.024 and OR: 1.024, 95% CI: 1.001-1.047, p=0.043, respectively).
Conclusion: Our study showed a significant increase in the prevalence of PTC in patients with PHPT compared to the general population in association with both older age and higher levels of serum calcium. Due to their higher levels of risk, such patients should particularly be comprehensively screened for PTC preoperatively, and the indications for thyroid surgery entailing parathyroidectomy should be updated in the current guidelines.

Keywords

Primary hyperparathyroidism, papillary thyroid carcinoma, prevalence, hypercalcemia, advanced age

References

• Bilezikian JP. Primary hyperparathyroidism. J Clin Endocrinol Metab 2018; 103: 3993-4004.
• McCarty M. Parathyroid hormone may be a cancer promoter–an explanation for the decrease in cancer risk associated with ultraviolet light, calcium, and vitamin D. Medical Hypotheses 2000; 54: 475-82.
• 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 Hypothes 2017; 103: 100-4.
• Nilsson I-L, Zedenius J, Yin L, Ekbom A. The association between primary hyperparathyroidism and malignancy: nationwide cohort analysis on cancer incidence after parathyroidectomy. Endocrine-Related Cancer 2007; 14: 135-40.
• Pickard AL, Gridley G, Mellemkjæ L, et al. Hyperparathyroidism and subsequent cancer risk in Denmark. Cancer 2002; 95: 1611-7.
• Xue Y, Ye ZQ, Zhou HW, Shi BM, Yi XH, Zhang KQ. Serum calcium and risk of nonmedullary thyroid cancer in patients with primary hyperparathyroidism. Med Sci Monit 2016; 22: 4482-9.
• Lehwald N, Cupisti K, Krausch M, Ahrazoglu M, Raffel A, Knoefel W. Coincidence of primary hyperparathyroidism and nonmedullary thyroid carcinoma. Hormone Metab Rese 2013; 45: 660-3.
• Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013. JAMA 2017; 317: 1338-48.
• Patel KN, Yip L, Lubitz CC, et al. The American Association of Endocrine Surgeons guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg 2020; 271: 21-93.
• Schmid K. Lymph node and distant metastases of thyroid gland cancer. Metastases in the thyroid glands. Der Pathologe 2015; 36: 171-5.
• Masatsugu T, Yamashita H, Noguchi S, et al. Thyroid evaluation in patients with primary hyperparathyroidism. Endocr J 2005; 52: 177-82.
• 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.
• 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: 862-7.
• Ogawa T, Kammori M, Tsuji E-i, et al. Preoperative evaluation of thyroid pathology in patients with primary hyperparathyroidism. Thyroid 2007; 17: 59-62.
• Erickson LA, Mete O, Juhlin CC, Perren A, Gill AJ. Overview of the 2022 WHO Classification of Parathyroid Tumors. Endocr Pathol 2022; 33: 64-89.
• Haugen BR, Alexander EK, Bible KC, 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: 1-133.
• Baloch ZW, Asa SL, Barletta JA, et al. Overview of the 2022 WHO Classification of Thyroid Neoplasms. Endocr Pathol 2022; 33: 27-63.
• The Public Health Cancer Statistics of the Ministry of Health in Turkey, avaliable at: https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/istatistik/Turkiye_Kanser_Istatistikleri_2017.pdf
• Carling T, Rastad J, Åkerström Gr, Westin G. Vitamin D receptor (VDR) and parathyroid hormone messenger ribonucleic acid levels correspond to polymorphic VDR alleles in human parathyroid tumors. J Clin Endocrinol Metab 1998; 83: 2255-9.
• Giovannucci E. The epidemiology of vitamin D and cancer incidence and mortality: a review (United States). Cancer Causes & Control 2005; 16: 83-95.
• 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: 637.
• Vesely D, Astl J, Matucha P, Sterzl I, Betka J. Serum levels of angiogenic growth factors in patients with thyroid gland tumors and parathyroid adenoma. Neuroendocrinol Letters 2003; 24: 417-9.
• Segiet OA, Michalski M, Brzozowa-Zasada M, et al. Angiogenesis in primary hyperparathyroidism. Ann Diagn Pathol 2015; 19: 91-8.
• Brito JP, Gionfriddo MR, Al Nofal A, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab 2014; 99: 1253-63.
• Li L, Li B, Lv B, et al. Increased thyroid malignancy in patients with primary hyperparathyroidism. Endocrine Connections 2021; 10: 885-93.
• Liu Y, Guo S, Sang S, et al. Differences in clinicopathological characteristics of papillary thyroid carcinoma between symptomatic and asymptomatic patients with primary hyperparathyroidism. Int J Endocrinol 2021; 2021: 9917694.
• Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surgery. 2016; 151: 959-68.
• Carling T, Ocal IT, Udelsman R. Special variants of differentiated thyroid cancer: does it alter the extent of surgery versus well-differentiated thyroid cancer? World J Surg 2007; 31: 916-23.
• 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: 1243-8.
• Jeong C, Kwon HI, Baek H, et al. Association of hyperparathyroidism and papillary thyroid cancer: a multicenter retrospective study. Endocrinol Metab (Seoul) 2020; 35: 925-32.