三发性甲状旁腺功能亢进症合并甲状腺癌及颈部淋巴结结节病1例

Tertiary hyperparathyroidism accompanied with thyroid carcinoma and cervical lymph node sarcoidosis: a case report

继发性甲状旁腺功能亢进是尿毒症规律透析患者几乎必然的并发症,随着致病因素的持续刺激和疾病的发展,部分患者可进展为三发性甲状旁腺功能亢进。甲状腺癌是近年发病率上升最快的恶性肿瘤。目前国内偶可见继发性甲状旁腺功能亢进合并甲状腺癌的报道,但尚无三发性甲状旁腺功能亢进(tertiary hyperparathyroidism,THPT)合并甲状腺癌及颈部淋巴结结节病的报道。

A 63-year-old female with 3 years of hemodialysis and 1 year of joint pain was treated with calcimimetics and other drugs for a long time. The bone and joint pain did not improve, and the serum PTH continued to rise. The left thyroid nodule was found during the preoperative localization examination of parathyroid gland. Preoperative examination showed that PTH 1258.9 ng/L, Ca 2.48 mmol/L, P 2.32 mmol/L, ALB 36.70 g/L, ALP 227.00 IU/L. Cervical ultrasonography showed thyroid nodules in the left lobe(TI-RADS 4 b), parathyroid hyperplasia and enlargement, and abnormal lymph nodes in the Ⅲ region of the left neck. Postoperative pathology:(1)Thyroid papillary carcinoma on the left side, the size of the tumor was about 0.7 cm;(2)There were 3 lymph nodes in Ⅲ region, of which 1 showed metastasis, and 1 consistent with sarcoidosis;(3)4 parathyroid glands showed proliferative lesions, including the formation of pseudotumor-like nodules on the left upper parathyroid gland with hyperparathyroidism and no cancer invasion;(4)There were 6 lymph nodes in the central region, of which 3 showed metastasis;(5)There was 1 prelaryngeal lymph node and showed metastasis;(6)There were 8 lymph nodes in Ⅱ region, of which 1 showed metastasis;(7)There were 21 lymph nodes in Ⅳ region, all of which had no metastasis.