Concomitant Graves’ disease and primary hyperparathyroidism: clinical implications and preoperative localization of parathyroid adenoma by fine needle biopsy
A 53-year old female patient, who presented with retrosternal pain, which could be ascribed to reflux oesophagitis and gastritis, furthermore stated recurrent palpitations, sweating and the feeling of uneasiness. In routine laboratory investigation hyperthyroidism and hypercalcaemia were detected. Further testing revealed elevated TSH receptor antibodies and a parathyroid hormone level within the normal range. Scintigraphically a homogeneous, but increased uptake was found. In ultrasonography guided fine needle aspiration biopsy of a nodule parathyroid hormone was verifiable by immunochemical means. Under thyrostatic treatment with carbimazole the patient became euthyroid, simultaneous a decrease of serum calcium levels could be observed. Parathyroid hormone level remained in normal range. After confirmation of Graves’ disease and adenoma of the parathyroid gland parathyroidectomy in combination with near total resection of the thyroid gland was performed. In conclusions concomitant Graves’ disease and primary hyperparathyroidism is rare, but should be considered in case of persisting hypercalcaemia after the patient became euthyroid again, when parathyroid hormone level is in normal range or elevated. Thus a potentially required second operation can be avoided. By ultrasonography guided fine needle aspiration biopsy and immunochemical processing adenomas of parathyroid glands can be localized preoperatively.
- Department 3 of Internal Medicine and Endocrinology, Klinikum München-Neuperlach, 81737, München, Germany
- Department of Pathology, Klinikum München-Neuperlach, 81737, München, Germany
- Department 3 of Internal Medicine and Endocrinology, Klinikum München-Neuperlach, 81737, München, Germany, email@example.com
-  H.C. Lam, L.T. Ho, K.T. Tang and K.N. Ching: “Primary hyperparathyroidism and coexisting hyperthyroidism - review of the literature”, Zhonghua Yi Xue Za Zhi Vol. 43(2), (1989), pp. 105–112.
-  A.G. Bondeson, L. Bondeson and N.W. Thompson: “Hyperparathyroidism after treatment with radioactive iodine: not only a coincidence?”, Surgery, Vol. 106(6), (1989), pp. 1025–1027.
-  J.D. Baxter and P.K. Bondy: “Hypercalcemia of thyrotoxicosis”, Ann. Intern. Med., Vol. 65, (1966), pp. 429–442.
-  R. Arem, M.A. Lim-Abrahan and L.E. Mallette: “Concomitant Graves’ disease and primary hyperparathyroidism. Influence of hyperthyroidism on serum calcium and parathyroid hormone”, Am.J.Med., Vol. 80(4), (1986), pp. 693–698. http://dx.doi.org/10.1016/0002-9343(86)90827-2[Crossref]
-  M.P. MacFarlane, D.L. Fraker, T.H. Shawker, J.A. Norton, J.L. Doppmann, R.A. Chang, M.C. Skarulis, S.J. Marx, A.M. Spiegel and H.R. Alexander: “Use of preoperative fine-needle aspiration in patients undergoing reoperation for primary hyperparathyroidism”, Surgery, Vol. 116(6), (1994), pp. 959–964.
-  F. Liu, D.R. Gnepp and L.R. Pisharodi: “Fine needle aspiration of parathyroid lesions”, Acta Cytol., Vol. 48(2), (2004), pp. 133–136. [Crossref][PubMed]
-  J.F. Noble and J.E. Borge: “Hyperthyroidism complicated by hyperparathyroidism: report of a case”, Arch. Intern. Med., Vol. 58, (1936), pp. 846–859.
-  G.R. Mundy, J.L. Shapiro, J.G. Bandelin, E.M. Canalis and L.G. Raisz: “Direct stimulation of bone resorption by thyroid hormones”, J. Clin. Invest., Vol. 58, (1976), pp.529–534. http://dx.doi.org/10.1172/JCI108497[Crossref]
-  I. Mosekild, F. Melsen, J.P. Bagger, O. Myhre-Jensen and N. Schwartz Sorensen: “Bone changes in hyperthyroidism: interrelationships between bone morphometry, thyroid function and calcium phosphorus metabolism”, Acta Endocrinol., Vol. 85, (1977), pp. 515–525.
-  I. Mosekilde and S. Christensen: “Decreased parathyroid function in hyperthyroidism: interrelationships between serum parathyroid function, calcium, phosphorus metabolism and thyroid function”, Acta Endocrinol., Vol. 84, (1977), pp. 566–575.
-  H. Xiao, B. Yu, S. Wang and G. Chen: “Concomitant Graves’ disease and primary hyperparathyroidism: the first case report in mainland of China and literature review”, Chin. Med. J., Vol. 115(6), (2002), pp. 939–941.