THYROID CANCER IN AN ADOLESCENT WITH CRITICAL SYSTEMIC OSTEOPOROSIS

Abstract

Despite the low incidence of thyroid cancer (PCOS) in children, each case of primary hyperparathyroidism should be analyzed in detail for the presence of a malignant process, especially at too high levels of parathyroid hormone (PTH) and calcium ionized (Ca++) blood. in combination with severe symptoms, which are more often manifested in the form of systemic osteoporosis and fractures of the tubular bones, expressed by the formation of stones in the kidneys and gallbladder. Biochemical measures for primary hyperparathyroidism, both in benign and malignant parathyroid tumors, in addition to elevated PTH and hypercalcemia, are: hypophosphatemia, hypercalciuria (although Ca in the urine may be low in combination with vitamin D deficiency). To determine the genetic cause of hyperparathyroidism, it is possible to perform a genetic research using a target multicancer panel (with analysis of more than 80 genes, including MEN genes). In this case, a mutation of MAX c.25G> T (p.Val9Leu) was detected, which was classified as unclearly significant (VUS). Mutations in the MAX gene have been associated with the development of hereditary pheochromocytoma-paraganglioma, but have not been described in patients with isolated primary hyperparathyroidism, confirming the lack of association between the genetic aspect and the existing parathyroid tumor. One of the causes of parathyroid cancer is operative, with the subsequent dynamic supervision and control of indicators of PTH and Ca++ of blood plasma in combination with imaging methods of research. Increase in the level of the last above reference values in the postoperative period, in this case PTH - 152 pg/ml, which is corrected by alfacalcidol or calcitriol both as monotherapy and in combination with cholecalciferol, lack of topical imaging, do not always indicate persistent disease. In such cases, an additional method of diagnosing the possible persistence of the disease may be PET/CT (with 11C-choline), which allows to differentiate the accumulation of the drug in atypical sites of the surgical operation.