Normocalcemic, subclinical, asymptomatic primary hyperparathyroidism in patients with goiter or papillary thyroid cancer--preliminary report. Normocalcemic primary hyperparathyroidism and thyroid pathology

Abstract

The aim of the prospective study was the evaluation of primary, subclinical, normocalcemic hyperparathyroidism (PHPT) incidence in patients, operated on because of non-toxic (NTG), toxic (TG) goiter and papillary thyroid cancer (PTC).

Material and methods: The study was performed in the group of 196 patients operated on NTG (115 patients), TG (43 patients) and PTC (38 patients). All patients had never been operated because of goiter. No patient had clinical symptoms of PHPT. Calcium concentration (Ca), phosphorus concentration (P) and alkaline phosphatase activity (ALP) in blood serum were measured in all patients a day before operation. When those parameters were out of range, parathormone concentration (PTH) in blood serum was measured. In the case of elevated PTH concentration PHPT was diagnosed. Furthermore, in order to exclude renal failure and insufficiency tests for creatinine and urea concentrations in blood serum and urinalysis were performed.

Results: There was no case of increased Ca concentration among 158 patients with benign goiter. The values of at least one measured parameters (P or ALP) were abnormal in 47 out of 158 patients with benign goiter (29.7%). Increased PTH concentration (mean 101.5 pg/ml) was in 16 of 47 patients (10.1% of 158 patients). Normocalcemic PHPT was diagnosed in 12 (10.4%) NTG patients and 4 (9.3%) TG patients. In patients with PTC hypercalcemia was not affirmed. In 7 (18.42%) cases of 38 PTC patients P concentration and ALP activity were abnormal. Increased PTH concentration (84.85 pg/ml) was found in one female with PTC with normal values of P and ALP. Incidence of PHPT was observed in 2.63% of PTC patients.

Conclusions: 1. There was no significant difference of PHPT incidence between various type of goiter. 2. In our study coexistence of PTC and normocalcemic, asymptomatic PHPT is rare.