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      Simultaneous intrathyroidal parathyroid adenomas and multifocal papillary thyroid carcinoma in a patient with kidney transplantation: a case report

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          Abstract

          Background

          Persistent hyperparathyroidism after kidney transplantation has been associated with adverse outcomes. Parathyroidectomy is the definitive treatment approach, but the success of parathyroidectomy relies on the accurate preoperative localization of the culprit parathyroid lesions. Simultaneous intrathyroidal parathyroid adenomas and multifocal papillary thyroid carcinoma present important diagnostic challenges. Here, we describe a patient with kidney transplantation who underwent successful surgery after being evaluated with functional and structural imaging.

          Case presentation

          A 53-year-old man presented with potentially malignant multifocal thyroid nodules by ultrasonography 2 years after kidney transplantation. The patient had hypercalcaemia and persistent hyperparathyroidism. Thyroid papillary carcinoma was confirmed in the left thyroid nodules by fine-needle aspiration biopsy. The right superior thyroid hypoechoic nodule was 1.2 cm in size and showed marked uptake of the tracer 99mTcO 4-sestamibi during single-photon emission computed tomography/computed tomography (SPECT/CT); additionally, a cystic parathyroid lesion without tracer uptake was present behind the left superior pole of the thyroid. The histological examination demonstrated the coexistence of right intrathyroidal parathyroid adenomas, left cystic parathyroid nodular hyperplasia and multifocal papillary thyroid carcinoma. At the 6-month follow-up, the serum calcium levels were within the normal range, and the patient’s kidney function remained stable.

          Conclusions

          Simultaneous intrathyroidal parathyroid adenomas and multifocal papillary thyroid carcinoma in a patient with kidney transplantation is a rare clinical scenario. Physicians must be aware that the combination of functional (SPECT/CT) and structural (ultrasonography) imaging is highly successful in diagnosing patients with coexistent intrathyroidal parathyroid adenomas and papillary thyroid carcinoma.

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          Most cited references25

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          Current Status of Kidney Transplant Outcomes: Dying to Survive

          Jeffrey Wang, Melissa A Skeans, Ajay Israni (2016)
          Article 0 comments Cited 71 times – based on 0 reviews     Review now
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            Persistent hyperparathyroidism is a major risk factor for fractures in the five years after kidney transplantation.

            P Perrin, S. Caillard, R Javier … (2013)
            The risk of fractures after kidney transplantation is high. Hyperparathyroidism frequently persists after successful kidney transplantation and contributes to bone loss, but its impact on fracture has not been demonstrated. This longitudinal study was designed to evaluate hyperparathyroidism and its associations with mineral disorders and fractures in the 5 posttransplant years. We retrospectively analyzed 143 consecutive patients who underwent kidney transplantation between August 2004 and April 2006. The biochemical parameters were determined at transplantation and at 3, 12 and 60 months posttransplantation, and fractures were recorded. The median intact parathyroid hormone (PTH) level was 334 ng/L (interquartile 151-642) at the time of transplantation and 123 ng/L (interquartile 75-224) at 3 months. Thirty fractures occurred in 22 patients. The receiver operating characteristic (ROC) curve analysis for PTH at 3 months (area under the ROC curve = 0.711, p = 0.002) showed that a good threshold for predicting fractures was 130 ng/L (sensitivity = 81%, specificity = 57%). In a multivariable analysis, independent risk factors for fracture were PTH >130 ng/L at 3 months (adjusted hazard ratio [AHR] = 7.5, 95% CI 2.18-25.50), and pretransplant osteopenia (AHR = 2.7, 95% CI 1.07-7.26). In summary, this study demonstrates for the first time that persistent hyperparathyroidism is an independent risk factor for fractures after kidney transplantation.
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              Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism.

              Hege Pihlstrøm, Dag Olav Dahle, Geir Mjøen … (2015)
              Hyperparathyroidism is reported in 10% to 66% of renal transplant recipients (RTR). The influence of persisting hyperparathyroidism on long-term clinical outcomes in RTR has not been examined in a large prospective study.
              Article 0 comments Cited 40 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jun Yang: yangjun-zy-hz@zju.edu.cn
                Jun Zhang: 1505156@zju.edu.cn
                Jian-li Bi: bjl19630@163.com
                Wan-wen Weng: kifetwww@163.com
                Meng-jie Dong: dmjlzf2016@zju.edu.cn
                Journal
                Journal ID (nlm-ta): BMC Nephrol
                Journal ID (iso-abbrev): BMC Nephrol
                Title: BMC Nephrology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2369
                Publication date (Electronic): 9 November 2019
                Publication date PMC-release: 9 November 2019
                Publication date Collection: 2019
                Volume: 20
                Electronic Location Identifier: 405
                Affiliations
                ISNI 0000 0004 1759 700X, GRID grid.13402.34, Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, , Zhejiang University, ; 310003 Hangzhou, People’s Republic of China
                Article
                Publisher ID: 1600
                DOI: 10.1186/s12882-019-1600-y
                PMC ID: 6842198
                PubMed ID: 31706276
                SO-VID: 15d00b58-a35b-43f6-aace-cb50d8f5f47d
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 21 August 2019
                Date accepted : 23 October 2019
                Funding
                Funded by: the Science and Technology Panning Project of Zhejiang Province, China
                Award ID: 2017KY061
                Award Recipient :
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Nephrology
                Keywords: intrathyroidal parathyroid adenomas,hyperparathyroidism,papillary thyroid carcinoma,kidney transplantation
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: intrathyroidal parathyroid adenomas, hyperparathyroidism, papillary thyroid carcinoma, kidney transplantation

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