[A man with thyroid abnormalities: ectopic parathyroid adenoma and multifocal thyroid carcinoma]

Thyroid abnormalities are found in 70% of patients with primary hyperparathyroidism. The simultaneous occurrence of a parathyroid adenoma and non-medullary thyroid carcinoma is rare.A parathyroid adenoma was suspected in a 39-year-old man with hypertension and a previous history of nephrolithiasis on the basis of laboratory results and scintigraphic investigations of the thyroid gland. Histopathological investigation of perioperatively obtained frozen sections of 2 nodules, however, revealed lymph node metastases of a papillary thyroid carcinoma; thyroid carcinoma was confirmed by studying a biopsy of the thyroid gland. Immunohistochemical staining of this biopsy for parathyroid hormone was negative; a parathyroid adenoma could not be confirmed. Total thyroidectomy and exploration of the parathyroid glands followed. Parathyroid hormone and calcium values declined following extirpation of the thyroid gland. Histopathological investigation of the thyroid gland revealed an intrathyroidally situated parathyroid adenoma and a multifocal papillary thyroid carcinoma.The case history emphasises the importance of thorough evaluation of the thyroid gland in patients with primary hyperparathyroidism to reveal or exclude simultaneous presentation of parathyroid adenoma and thyroid carcinoma.