Hyperparathyroidism in a pregnant woman with previous thyroid carcinoma. Case report and review of the literature.
A 29 year old woman, primipara, at 26 weeks' gestation had been undergone, five years before, a total thyroidectomy owing to a mixed papillary-follicular carcinoma of thyroid. After thyroidectomy the patient was placed on suppressive thyroxine treatment. Since she was 22 years old she suffered from recurrent renal colics and cholelithiasis. For these reasons she underwent, at the age of 27, an operation to remove bilateral renal calculi and a cholecystectomy owing to gall-stones. During her pregnancy biochemical determinations revealed slight and persistent hypercalcemia, hypophosphatemia, elevated urine calcium besides elevated serum parathyroid hormone (PTH) levels. Thus a diagnosis of primary hyperparathyroidism was taken into consideration. It was considered, but temporarily delayed, the surgical exploration of the neck. A strict clinic overseeing of the patient, which allowed her to carry out the pregnancy happily, was undertaken. Any thyroid carcinoma repercussion on pregnancy was not noted. A left inferior parathyroid adenoma was removed five months after the woman's delivery. The child psychosomatic development, at one year of age, was absolutely normal. A review of the literature indicates that when a pregnancy is complicated by hyperparathyroidism its prognosis is improved by parathyroidectomy, if possible during the second trimester. In patients with asymptomatic hypercalcemia and/or in late pregnancy surgical treatment may be postponed until after delivery. It is also demonstrated that thyroid carcinoma is not aggravated by pregnancy and that the latter can develop without any worry for mother and fetus.
Lucisano
F
F
Second Department of Obstetrics and Gynecology, University of Bari, Italy.
Ceci
O
O
D'Agostino
G
G
Loizzo
M R
MR
Tartagni
M
M
Diaferia
A
A
D000230:Adenocarcinoma / Q000473:pathology*; D000236:Adenoma / Q000473:pathology; D000328:Adult; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000473:pathology*; D007231:Infant, Newborn; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000473:pathology; D010280:Parathyroid Glands / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000473:pathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology*; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000473:pathology*