Parathyromatosis coexisting with papillary thyroid microcarcinoma

Area of Science:

• Endocrinology
• Surgical Pathology
• Oncology

Background:

• Recurrent primary hyperparathyroidism can present with non-specific symptoms.
• Parathyromatosis is a rare condition characterized by multiple parathyroid tissue implants, often leading to persistent or recurrent hyperparathyroidism.
• Papillary thyroid microcarcinoma is a small, well-differentiated thyroid cancer, frequently discovered incidentally.

Observation:

• A 56-year-old woman with recurrent hyperparathyroidism underwent surgery.
• Intraoperative findings revealed parathyroid tissue consistent with parathyromatosis and a small focus of papillary thyroid carcinoma.
• The patient underwent a thyroid lobectomy and remained symptom-free post-operatively.

Findings:

• This case describes the fortuitous discovery of parathyromatosis coexisting with papillary thyroid microcarcinoma.
• The preoperative diagnosis of both conditions, especially the thyroid microcarcinoma, is challenging and rarely anticipated.
• Surgical management involved an en bloc thyroid lobectomy, which proved beneficial for the incidentally found thyroid lesion.

Implications:

• The coexistence of parathyromatosis and papillary thyroid microcarcinoma is a rare, likely coincidental, finding.
• Comprehensive preoperative and intraoperative assessments are crucial for identifying potential coexisting thyroid lesions in patients with hyperparathyroidism.
• Surgical strategies should encompass thyroid lobectomy when such incidental findings occur to ensure complete management.