Coincidence of hot thyroid nodules and primary hyperparathyroidism

Hyperthyroidism is frequently associated with hypercalcemia, which usually subsides after successful treatment of hyperthyroidism. Moreover, thyroid n odules are frequently detected by preoperative thyroid ultrasound in patien ts with primary hyperparathyroidism. Sensitised by the observation of a patient with coexisting hyperthyroidism and hyperparathyroidism we prospectively evaluated thyroid nodules in euthy roid patients with hyperparathyroidism by thyroid scintigraphy. Whereas the first patient with hyperparathyroidism was hyperthyroid the sub sequent four patients with hyperparathyroidism and thyroid nodules had norm al fT3 and fT4. Two patients had hypercalcemia and nephroureterolithiasis. Three patients suffered from hypercalcemia and bone pain due to osteoporosi s. In the hyperthyroid patient hypercalcemia persisted after euthyroidism w as achieved intact parathyroid hormone was found to be elevated. Subsequent ly, thyroid nodules, detected by preoperative ultrasound in four euthyroid patients with primary hyperparathyroidism, were identified as compensated h ot nodules by thyroid scintigraphy. All patients underwent combined subtota l thyroidectomy and parathyroid resection. Histology showed hyperplastic pa rathyroid glands in one patient and a single parathyroid adenoma in four ca ses. Postoperatively calcium and PTH levels returned to normal and TSH leve ls increased in all patients. Persistence of hypercalcemia after successful treatment of hyperthyroidism should be reason for the determination of parathyroid hormone. Thyroid nodu les detected by preoperative ultrasound in patients with hyperparathyroidis m living in areas of iodine deficiency should be further evaluated by scint igraphy even if TSH is normal. In the case of hot thyroid nodules both para thyroid and partial thyroid resection should be performed.