8317 Biochemical Adequacy And Renal Complications In Long-Term Management Of Patients With Postsurgical Hypoparathyroidism

Abstract

Abstract Disclosure: A. Hong: None. J. Park: None. W. Choi: None. J. Yoon: None. H. Kim: None. H. Kang: None. Background: Hypoparathyroidism (HypoPT) most commonly develops after neck surgery, particularly thyroid surgery. Permanent postsurgical HypoPT necessitates calcium and active vitamin D supplementation for 12 months or more due to irreversible parathyroid damage following surgery. This study investigated the biochemical adequacy of conventional therapy (i.e., active vitamin D and/or calcium) in patients with permanent postsurgical HypoPT based on recent guidelines and assessed the incidence of renal complications. Materials and Methods: The study included 62 adult patients with permanent postsurgical HypoPT who underwent total thyroidectomy for papillary thyroid cancer at Chonnam National University Hwasun Hospital. Biochemical parameters, including albumin-adjusted serum total calcium, ionized calcium, phosphate, creatinine, parathyroid hormone, magnesium, 25-hydroxyvitamin D (25[OH]D), and 24-h urine calcium, were measured. Renal ultrasound and KUB X-ray were performed for all patients. Results: The mean age of the patients was 55.5 ± 12.4 years, with 48 (77.4%) being female. The median follow-up duration after surgery was 10.6 years (interquartile range 9.0-15.5 years). At the time of evaluation, all patients were treated with calcitriol. Additional treatment, including calcium carbonate or cholecalciferol, was received by 43 (69.4%), and 28 (45.2%) were given thiazide diuretics. Thirty-seven (59.7%) patients had values below the recommended serum calcium (albumin-adjusted or ionized) concentration, while three (4.8%) had values above the upper normal limit of serum phosphate level. Serum 25(OH)D levels were maintained within the normal range (30-50 ng/mL) in 27 (43.5%) patients, and 47 (75.8%) patients met normal serum magnesium levels. Hypercalciuria, defined as >7.5 mmol/day in men and >6.25 mmol/day in women, was observed in 12 (19.4%) patients. Nephrolithiasis and nephrocalcinosis were present in 2 (3.2%) patients each. No patient had chronic kidney disease (CKD), defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Conclusion: Conventional management for permanent postsurgical HypoPT appears suboptimal for certain patients. However, the incidence of renal complications, such as hypercalciuria, nephrolithiasis/nephrocalcinosis, and CKD, was not commonly observed in a real-world setting during the 10 years of follow-up. This observation may be associated with a higher prescription rate of thiazide diuretics. Presentation: 6/2/2024