ASSOCIATION OF PRIMARY HYPERPARATHYROIDISM AND NONMEDULLARY THYROID-CANCER

Objective: To assess the prevalence of differentiated thyroid cancer a mong patients with primary hyperparathyroidism (pHPT) and to describe our experience in its treatment. Design: Retrospective study. Setting: Teaching hospital, Germany. Subjects: 322 patients who were operated on for pHPT from 1979-1993 and a control group of 840 patients operate d on for nodular goitre during the same time period. Interventions: Al l patients with non-occult cancer were treated by complete thyroidecto my and adjuvant radioiodine. Main outcome measures: Prevalence of diff erentiated thyroid cancer, morbidity and mortality. Results: No patien t died. 120 of the 322 patients had simultaneous thyroid resection for either nodular goitre of solitary adenoma; 9 patients had differentia ted thyroid cancer (3% of the whole group, or 8% of the group that had thyroid resections). The prevalence among the control group during th e same time period war 4%, which is not significantly different. There were 4 occult papillary cancers, 3 papillary stage T2N0 tumours, 1 T2 N1 tumour, and 1 follicular tumour. Among the 9 patients with cancer 1 developed transient and 1 permanent paralysis of the laryngeal nerve. Among the 120 patients who had thyroid resections, 45 (38%) developed transient hypocalcaemia and of the 202 operated on for pHPT alone the corresponding figure was 63 (31%). There were 2 postoperative haemorr hages, and 3 wound infections. All patients were alive and free of dis ease after a mean follow up of 62 months. Conclusion: Though the morbi dity of combined thyroid and parathyroid surgery is slightly higher th an after operations for pHPT alone we recommend that the indications s hould not be too rigid because of the benefit that can accrue to patie nts from the diagnosis of an asymptomatic malignant tumour.