Patients\u2019 views about parathyroid transplantation for post-thyroidectomy hypoparathyroidism

Alexander Stevenson,Radu Mihai

doi:10.1007/s00423-018-1693-y

Abstract

BackgroundPermanent hypoparathyroidism (hypoPT) represents the most common postoperative complication associated with total thyroidectomy. Current treatment relies on high-dose calcium and/or vitamin D supplementation, but often this is insufficient and some patients remain symptomatic. Parathyroid allotransplantation is a new therapeutic option described recently in the literature. This study aims to investigate the patients’ acceptability of parathyroid transplantation as a potential new treatment for hypoPT.MethodOnline survey of members of HypoParaUK, a support group for individuals affected by hypoPT.ResultsResponses were received from 252 hypoPT patients. Majority declared to experience severe symptoms despite regular medical treatment. On a severity scale of 0–5, symptoms that were most troublesome were fatigue (3.8), low sense of well-being (3.5), and numbness/tingling (2.9). On a scale of 0–10, on average, their current quality of life (QoL) was 5 ± 3 and they expected this would improve to 7 ± 2 with correction of their hypoPT. Forty-four percent of patients were extremely interested in a potential technique involving intramuscular injection of parathyroid cell suspension compared to just 14% who were interested in the more invasive procedure of implantation of a parathyroid allograft into the forearm. The main concerns expressed were related to the possible need for immunosuppressive therapy.ConclusionPatients with severe symptomatic hypoPT seem interested to consider participation in a clinical trial exploring the feasibility and success rate of parathyroid transplantation.

Highlights

Primary hypoparathyroidism is defined as a low calcium levels in a patient with low/absent parathyroid hormone (PTH) levels
The importance of preserving well-vascularized glands has been reconfirmed by recent studies using indocyanine green fluorescence angiography that showed PTH levels on postoperative day 1 were normal in all patients who had at least one well vascularized parathyroid gland and none of these patients required treatment for hypoPT [3]
Intraoperative infrared imaging has been used to identify parathyroid glands based on their autofluorescence [6] but it is yet to be demonstrated whether routine use of this technique will decrease the risk of postthyroidectomy hypoPT

Summary

Introduction

Primary hypoparathyroidism (hypoPT) is defined as a low calcium levels in a patient with low/absent parathyroid hormone (PTH) levels. Its prevalence was estimated as 37 per 100,000 person-years in the USA and 22 per 100,000 person-years in Denmark [1] Such data are currently lacking in most other countries. The most common cause of hypoPT is injury to the parathyroid glands during bilateral thyroid surgery. The importance of preserving well-vascularized glands has been reconfirmed by recent studies using indocyanine green fluorescence angiography that showed PTH levels on postoperative day 1 were normal in all patients who had at least one well vascularized parathyroid gland and none of these patients required treatment for hypoPT [3]. Inadvertent removal of the parathyroid glands during thyroid surgery is reported to occur in as little as 6% of patients [4] or as high as 25% [2, 5]. Method Online survey of members of HypoParaUK, a support group for individuals affected by hypoPT

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