Lever E G, Refetoff S, Straus F H, Nguyen M, Kaplan E L
Surgery. 1983 Dec;94(6):893-900.
A high prevalence of non-C cell, thyroid gland disease associated with primary hyperparathyroidism (HPT) has been reported in 11 uncontrolled studies. Yet experimental evidence linking these thyroid and parathyroid gland lesions is lacking. To test the hypothesis that the coexistence of these lesions is significant, we analyzed 124 consecutive cases of parathyroidectomy (110 women, mean age 53.5 +/- 12.7 years). Patients in the group with HPT who had visible or palpable thyroid disease at the time of operation were age-, sex-, and race-matched with autopsy controls. There was no statistical difference in the prevalence of total macroscopic thyroid lesions between the autopsy control group (46.4%) and the group of patients with HPT (54%, P = 0.8). Microscopic lesions in the absence of macroscopic abnormalities were found in an additional 26% of the autopsy control patients. Since in the surgical group, only those with macroscopic abnormalities underwent thyroid biopsy, no accurate calculation can be made of the microscopic lesions in those 55 patients with HPT who did not have macroscopic abnormalities. There was no difference in the prevalence of autoimmune or thyroid nodular disease between the two groups except for the presence of seven macroscopic nonmedullary thyroid carcinomas in the HPT group and none in the autopsy control group (P less than 0.001). One microscopic carcinoma was found in the autopsy group, however. An increased prevalence of parathyroid adenomas in nonmedullary thyroid disease has been suggested by other studies. We were unable to confirm this association. In fact, the incidence of parathyroid adenomas found unsuspectedly in 229 consecutive thyroidectomies was 0.43%. Thus with the exception of macroscopic, nonmedullary carcinomas, there was no evidence that thyroid disease accompanies HPT. Furthermore, parathyroid adenomas were not more frequent in surgical thyroid disease. Lesions of the thyroid and parathyroid glands are prevalent in middle-age women. This probably is the major factor that accounts for their coexistence.
在11项非对照研究中，已有报告称与原发性甲状旁腺功能亢进症（HPT）相关的非C细胞甲状腺疾病患病率较高。然而，缺乏将这些甲状腺和甲状旁腺病变联系起来的实验证据。为了检验这些病变共存具有显著性这一假设，我们分析了124例连续的甲状旁腺切除术病例（110名女性，平均年龄53.5±12.7岁）。手术时患有可见或可触及甲状腺疾病的HPT组患者在年龄、性别和种族上与尸检对照组匹配。尸检对照组（46.4%）和HPT患者组（54%，P = 0.8）之间总的宏观甲状腺病变患病率无统计学差异。另外26%的尸检对照患者发现了无宏观异常的微观病变。由于在手术组中，只有那些有宏观异常的患者接受了甲状腺活检，所以无法准确计算出那55例无宏观异常的HPT患者中的微观病变情况。除了HPT组有7例宏观非髓样甲状腺癌而尸检对照组无（P＜0.001）外，两组之间自身免疫性或甲状腺结节性疾病的患病率无差异。然而，在尸检组中发现了1例微观癌。其他研究提示非髓样甲状腺疾病中甲状旁腺腺瘤的患病率增加。我们无法证实这种关联。事实上，在229例连续甲状腺切除术中意外发现的甲状旁腺腺瘤发生率为0.43%。因此，除了宏观非髓样癌外，没有证据表明甲状腺疾病与HPT相伴。此外，甲状旁腺腺瘤在手术性甲状腺疾病中并不更常见。甲状腺和甲状旁腺的病变在中年女性中很普遍。这可能是它们共存的主要因素。
