RESUMO
Obesity's role in thyroid cancer development is still debated, as well as its association with aggressive histopathological subtypes (AHSs). To clarify the link between Body Mass Index (BMI) and AHS of differentiated thyroid carcinoma (DTC), we evaluated patients who underwent thyroidectomy for DTC from 2020 to 2022 at four European referral centres for endocrine surgery. Based on BMI, patients were classified as normal-underweight, overweight, or obese. AHSs were defined according to 2022 WHO guidelines. Among 3868 patients included, 34.5% were overweight and 19.6% obese. Histological diagnoses were: 93.6% papillary (PTC), 4.8% follicular (FTC), and 1.6% Hürthle cell (HCC) thyroid carcinoma. Obese and overweight patients with PTC had a higher rate of AHSs (p = 0.03), bilateral, multifocal tumours (p = 0.014, 0.049), and larger nodal metastases (p = 0.017). In a multivariate analysis, BMI was an independent predictor of AHS of PTC, irrespective of gender (p = 0.028). In younger patients (<55 years old) with PTC > 1 cm, BMI predicted a higher ATA risk class (p = 0.036). Overweight and obese patients with FTC had larger tumours (p = 0.036). No difference was found in terms of AHS of FTC and HCC based on BMI category. Overweight and obese patients with PTC appear to be at an increased risk for AHS and aggressive clinico-pathological characteristics.
RESUMO
Background: Atypical parathyroid tumors (APTs) are rare entities. We report the case of a patient with multiple APT presenting with extrapyramidal symptoms and a delayed hypercalcemic crisis. Case Description: A 72-year-old man presented to a tertiary referral center's emergency room (ER) following two episodes of temporary loss of consciousness. He had a history of ideomotor sluggishness, lethargy, extrapyramidal symptoms and dysphagia, which started 6 months prior. Serum calcium levels at presentation were normal. Four days later the patient developed a rapidly evolving respiratory failure requiring orotracheal intubation, severe hypercalcemia (up to 19.8 mg/dL) and increased serum parathyroid hormone (PTH) (151 pmol/L). A neck ultrasound (US) showed two lesions posteroinferiorly to the right and left thyroid lobe. Since hypercalcemia proved to be refractory to medical therapy, the patient underwent urgent bilateral neck exploration with subtotal parathyroidectomy for suspect parathyroid carcinoma (PC). Histopathological examination showed three nodular lesions consistent with a diagnosis of APT in each excised parathyroid. Four months after surgery, the patient is alive and well with no signs of recurrence. Neurological follow-up visits documented the absence of extrapyramidal signs. Conclusions: Our patient showed an unusual presentation of primary hyperparathyroidism (PHPT) sustained by multiple concurrent APTs. A low suspicion threshold should be maintained to avoid delay in diagnosis. The present case adds to the body of literature on APTs, contributing to a greater understanding of this rare disease.
