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[Tertiary hyperparathyroidism accompanied with thyroid carcinoma and cervical lymph node sarcoidosis: a case report]
Summary
A patient with long-term hemodialysis and joint pain was found to have both thyroid papillary carcinoma and parathyroid hyperplasia. Surgery revealed metastatic lymph nodes, indicating complex endocrine and oncologic conditions in this patient.
Area of Science:
- Endocrinology
- Oncology
- Nephrology
Background:
- A 63-year-old female on hemodialysis for 3 years presented with persistent joint pain and rising parathyroid hormone (PTH) levels despite calcimimetic treatment.
- Preoperative evaluation for parathyroid localization revealed a left thyroid nodule and signs of parathyroid hyperplasia.
Observation:
- Elevated serum PTH (1258.9 ng/L), calcium (2.48 mmol/L), phosphorus (2.32 mmol/L), and alkaline phosphatase (227.00 IU/L) were noted.
- Cervical ultrasound identified a left thyroid nodule (TI-RADS 4b), parathyroid hyperplasia, and suspicious lymph nodes in the left neck region.
Findings:
- Pathology confirmed left-sided thyroid papillary carcinoma (0.7 cm) with metastasis in regional lymph nodes (levels II, III, central).
- Four parathyroid glands exhibited proliferative lesions, including a pseudotumor-like nodule on the left upper gland, consistent with tertiary hyperparathyroidism without malignancy.
- Sarcoidosis was incidentally found in one lymph node from the left neck level III.
Implications:
- This case highlights the diagnostic challenge of co-existing thyroid cancer and tertiary hyperparathyroidism in a hemodialysis patient.
- Multidisciplinary management is crucial for addressing both the endocrine and oncologic complexities.
- Further investigation into the interplay between chronic kidney disease, parathyroid disease, and thyroid pathology is warranted.
