Hiperparatiroidismo, bocio y carcinoma tiroideo bien diferenciado: una relación frecuente con implicaciones diagnósticas / Hyperparathyroidism, goiter and well-differentiated thyroid carcinoma. A common association with diagnostic implications

RESUMEN

Objetivo. Estudiar la enfermedad tiroidea encontrada en pacientes intervenidos por hiperparatiroidismo (HPT) comparando la frecuencia de carcinomas tiroideos bien diferenciados entre los distintos tipos de HPT. Pacientes y método. Revisión retrospectiva de las historias clínicas de 124 pacientes intervenidos de HPT de manera consecutiva en nuestro servicio por un mismo cirujano entre enero de 1998 y junio de 2006. Resultados. Se trata de 105 (84,7%) mujeres y 19 (15,3%) varones, con una media de edad de 59,7 ± 15,66 años. De ellos, 115 (92,7%) presentan HPT primario (HPTP) y 9 (7,3%), HPT renal (HPTR). En 3 (2,6%) HPTP y en ninguno de los HPTR hay antecedente de radioterapia cervical. En 43 (34,7%) pacientes se realizó simultáneamente algún tipo de cirugía del tiroides, 40 (34,8%) de los HPTP y 3 (33,3%) de los HPTR (p = 1,00). Entre los 115 pacientes intervenidos por HPTP, encontramos 6 (5,2%) carcinomas papilares y entre los 9 afectos de HPTR, 2 (22,2%), sin diferencias estadísticamente significativas entre ambos grupos (p = 0,105). Conclusiones. La afección tiroidea es frecuente en pacientes intervenidos por HPT, pero no más que en series de autopsias. No se encuentran diferencias significativas en la prevalencia de carcinoma papilar de tiroides entre los HPT primario y renal. La radioterapia cervical no parece ser en la actualidad un factor clínicamente relevante en el desarrollo de carcinoma papilar de tiroides en los pacientes afectos de HPTP. La prevalencia de enfermedad tiroidea en la población general justifica la realización de una ecografía preoperatoria de forma sistemática (AU)

ABSTRACT

Objective. To analyze thyroid gland disease incidentally found in patients undergoing surgery for hyperparathyroidism and to compare the frequency of nonmedullary thyroid carcinoma among different hyperparathyroidism varieties. Patients and method. We retrospectively reviewed 124 clinical records of patients who underwent surgery for hyperparathyroidism by a single surgeon from January 1998 to June 2006. Results. There were 105 women (84.7%) and 19 men (15.3%). The mean age was 59.7 ± 15.66 years old. Of these, 115 (92.7%) were diagnosed with primary hyperparathyroidism and 9 (7.3%) with renal hyperparathyroidism. In the primary hyperparathyroidism group, 3 patients (2.6%) had received neck irradiation compared with none in the renal hyperparathyroidism group. Thyroid gland surgery was performed simultaneously in 43 patients (34.7%), 40 (34.8%) of them belonging to the first group and three (33.3%) to the second group (p = 1.00). Among the 115 patients operated on for primary hyperparathyroidism, 6 papillary thyroid carcinomas (5.2%) were found and 2 (22.2%) were found among the 9 patients with renal hyperparathyroidism, but this difference was not statistically significant (p = 0.105). Conclusions. An incidental finding of thyroid disease in patients undergoing surgery for hyperparathyroidism is fairly frequent but no more so than that found in autopsy series. No statistically significant differences were found between primary and renal hyperparathyroidism in the prevalence of papillary thyroid carcinoma. Currently, neck irradiation does not seem to be a clinically significant factor in this issue. The high prevalence of thyroid disease in the general population warrants systematic neck ultrasound before hyperparathyroidism surgery (AU)