Synchronous Primary Hyperparathyroidism, Follicular Thyroid Carcinoma, and Papillary Thyroid Carcinoma: A Rare Case and Its Clinical Lessons

Thyroid nodules affect up to 50% of adults globally, and primary hyperparathyroidism (pHPT)—a condition where overactive parathyroid glands raise blood calcium levels—touches millions more. But what happens when these two common issues collide with two types of thyroid cancer? A 2019 case report from Shanghai Jiao Tong University Affiliated Sixth People’s Hospital highlights a rare, important scenario that could change how doctors screen for overlapping endocrine conditions.

The Patient’s Story: A Silent but Complex Diagnosis

A 66-year-old woman arrived at the hospital after a routine blood test showed high calcium (2.80 mmol/L, vs. the normal 2.08–2.60 mmol/L). Further tests revealed elevated parathyroid hormone (PTH)—a key sign of pHPT. Unlike many patients with pHPT, she had no symptoms like fatigue or nausea.

Doctors used SPECT/CT imaging (a combination of 3D scans and radioactive tracers) to find a right-sided parathyroid adenoma—a non-cancerous tumor causing the hormone overproduction. An ultrasound also detected bilateral solid thyroid nodules. To check for cancer, they performed a fine-needle aspiration (FNAC)—a quick, low-risk test where a thin needle takes cell samples from the nodules. The results suggested lymphocytic thyroiditis (inflammation), a follicular neoplasm, and papillary hyperplasia (cell overgrowth)—enough to recommend surgery.

Surgery Reveals a Rare Triple Diagnosis

The patient underwent a right parathyroidectomy (removal of the affected parathyroid gland) and bilateral total thyroidectomy (removal of the entire thyroid). Pathologists examined the tissue and found:

A parathyroid adenoma (the source of her pHPT).
Right-sided follicular thyroid carcinoma (1.2×1.0×1.0 cm) with tiny capsule invasion.
Right-sided papillary microcarcinoma (0.5×0.4×0.3 cm)—a small, slow-growing cancer.

She recovered well: her calcium levels dropped to normal (2.2 mmol/L) within days, and she was discharged 4 days post-surgery.

Why This Case Matters: A First-of-Its-Kind Finding

To the authors’ knowledge, this was the first reported case of pHPT coexisting with both follicular and papillary thyroid carcinoma. While pHPT and nonmedullary thyroid carcinoma (NMTC)—the most common type of thyroid cancer—have been linked since 1956, this case adds a new dimension: two distinct thyroid cancers occurring alongside a parathyroid adenoma.

Studies confirm the overlap isn’t random: the co-morbidity rate of pHPT and NMTC is higher than the chance of either condition alone (Lehwald et al., 2013). For doctors, this means:

Patients with pHPT should get thyroid ultrasounds to check for nodules.
Patients with thyroid nodules should be screened for pHPT (via calcium and PTH tests).

Simple, low-cost tools like ultrasound can catch these issues early—avoiding missed cancers and repeat surgeries.

The Takeaway: Screening Saves Lives

This case underscores a critical lesson: endocrine conditions rarely exist in isolation. For patients with pHPT or thyroid nodules, thorough testing is key. The team behind the report—Dong-Jun Dai, Dan-Feng Peng, Ming-Gao Guo, Jun Yin, Yu-Qian Bao, and Jian Zhou from Shanghai Jiao Tong University Affiliated Sixth People’s Hospital—emphasizes that careful pre-surgical evaluation can turn a complex diagnosis into a manageable one.

The patient’s story also highlights the importance of collaborative care: endocrinologists, surgeons, and pathologists working together to connect the dots between symptoms, tests, and treatment.

Original Study Citation: Dai DJ, Peng DF, Guo MG, Yin J, Bao YQ, Zhou J. Synchronous primary hyperparathyroidism, follicular thyroid carcinoma and papillary thyroid carcinoma. Chinese Medical Journal 2019;132:240–241.

DOI: doi.org/10.1097/CM9.0000000000000018

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