Complication Of Parathyroidectomy Research Articles

A Novel Risk Score to Predict Hungry Bone Syndrome After Parathyroidectomy for Renal Hyperparathyroidism

ObjectiveHungry bone syndrome (HBS) is a known complication of parathyroidectomy. Patients with renal hyperparathyroidism are particularly vulnerable to HBS because of their prolonged exposure to electrolyte abnormalities and elevated parathyroid hormone (PTH). However, in-depth characterization of predictive factors for HBS in these patients is lacking. MethodsA retrospective analysis was performed of patients with renal hyperparathyroidism who underwent parathyroidectomy at a single institution from 2011-2021. Patient demographics, clinical characteristics, and biochemical data were collected and analyzed. Boruta and binary logistic regression analyses were used to develop a scoring system. ResultsThirty-three patients were identified; 16 (48%) developed HBS. Patients with HBS had significantly higher preoperative levels of serum PTH (mean difference [MS] = 2167.2 pg/mL, P <.001), phosphorus (MD = 3.5 mg/dl, P <.001), and alkaline phosphatase (ALP) (MD = 344.2 U/L, P =.002) and significantly lower levels of preoperative serum calcium (MD = −0.96 mg/dL, P =.004). Stepwise regression analysis identified elevated ALP (>150 U/L) and markedly elevated PTH (>1000 pg/mL) as positive predictors of HBS. A two-point scoring system with these 2 variables had overall diagnostic accuracy of 96.8% (sensitivity 100% and specificity 94.1%) with 1 point conferring 93.8% positive predictive value and 2 points conferring 100% positive predictive value. ConclusionPreoperative serum PTH and ALP are significantly associated with HBS in patients with renal hyperparathyroidism undergoing parathyroidectomy for renal hyperparathyroidism. A scoring system with these 2 variables may be of clinical utility in predicting patients at high risk of HBS.

Hypocalcemia after parathyroidectomy in patients taking proton pump inhibitors

PurposeLong-term use of proton pump inhibitors is associated with metabolic derangements, including hypocalcemia. Hypocalcemia is also a known complication of parathyroidectomy. We sought to determine the rate of hypocalcemia following parathyroidectomy in patients on proton pump inhibitors. Materials and methodsThe TriNetX Research Network was queried to identify patients with a history of primary hyperparathyroidism treated with parathyroidectomy between 2012 and 2022. The incidence of short-term (0–6 months following parathyroidectomy) and permanent (6–12 months following parathyroidectomy) postoperative hypocalcemia was compared between patients using proton pump inhibitors and those who were not. ResultsOf 34,595 total patients, 19.5 % (n = 6753) were taking proton pump inhibitors prior to surgery. Patients taking proton pump inhibitors were significantly more likely to experience both short-term (RR, 95 % CI, P) (1.5, 1.4–1.6, P < 0.001) and permanent (1.8, 1.6–2.1, P < 0.001) hypocalcemia, and were also more likely to be evaluated in the emergency department after surgery (1.5, 1.4–1.7, P < 0.001). ConclusionsOur study is the first to indicate an increased risk of hypocalcemia after parathyroidectomy in patients on proton pump inhibitors.

461 A Retrospective Audit of the Success Rate and Complications of Parathyroidectomy in Primary Hyperparathyroidism

Abstract Aim Primary hyperparathyroidism (pHPT) is a clinical disorder which presents with hypercalcaemia. The definitive management for such cases is a Parathyroidectomy. Few centres have reported their success rate for this procedure. We conducted a retrospective review to compare the success rate and complications in Parathyroidectomy at our centre. Method After approval from the ethical committee, data was collected from the case files of the patients. Inclusion criteria was a Parathyroidectomy performed for pHPT between 2013 and 2020 at our institute. The Data included the demographics with pre- and post-operative Calcium / Parathyroid hormone levels to calculate the success rate. The procedure was defined as successful if the calcium levels returned to normal ranges (&amp;lt;2.6 mmol/L) according to NICE guidelines. Results 246 pHPT patients with a mean age of 61 years were included. 222 patients (90.24%) had their calcium level return to normal indicating a successful procedure. 24 cases (9.75%) had persistence or recurrence of hypercalcaemia indicating a failure of the surgery. The rate of success was significantly higher (96.84%) in the last 2 years (2019 – 2020) of the audit suggesting an improvement in outcomes. Five patients (2.03%) out of the 246 had complications related to the surgery. Two patients reported post-operative cord paresis, two had a post-operative neck haematoma and one experienced hypocalcaemia from hungry bone syndrome. Conclusions The surgical outcomes especially in the last 2 years are comparable to other specialized centres mentioned in the review. This Audit helps us demonstrate the improvement in the surgical results over the years at our centre.

Outcome of Parathyroidectomy for Renal Hyperparathyroidism: A Single Center Experience

Background: Renal hyperparathyroidism (HPTH) is a common complication of chronic kidney disease and is known to cause significant morbidity in these patients. There has been substantial debate on the best possible treatment of this condition. Surgical treatment is now considered to be of vital importance as its efficacy is well documented. The present study reported the outcome of parathyroidectomy in King Chulalongkorn Memorial Hospital, a university hospital in Bangkok, Thailand. Objective: To determine surgical outcomes, including success rate and perioperative complications of parathyroidectomy in patients with renal HPTH. Materials and Methods: The data was collected by retrospective review of patients’ records between June 2014 and May 2019. One hundred ten patients were enrolled. Their demographic data, laboratory results, and outcomes were collected and categorized. Results: Among 110 patients, men accounted for 48.6%. The mean age was 49.5 years (SD 13.3). The most frequent operation was total parathyroidectomy with autotransplantation (TPTX+AT). All four glands were identified and excised in 84.5% of all patients. The mean preoperative serum intact parathyroid hormone (iPTH) level was 1,938 pg per dL with a range of 171 to 5,000 pg per dL. Postoperative hypocalcemia requiring intravenous calcium supplement was present in 70%. Postoperative cardiovascular complication occurrences were 16.4%, with one mortality due to myocardial infarction. In addition, one patient suffered unilateral recurrent laryngeal nerve injury, while two had stroke. The overall success rate of treatment was 81.1%, with 7.3% and 8.2% of patients that had persistently high PTH and recurrence of HPTH, respectively. Conclusion: Parathyroidectomy is an essential choice of treatment in patients with renal HPTH. Further validation of correlations with other factors is now being processed, and more data are needed. Keywords: Secondary hyperparathyroidism; Tertiary hyperparathyroidism; Chronic kidney disease mineral bone disease; Parathyroidectomy

Clinical study on the status of transient thyrotoxicosis after surgery for secondary hyperparathyroidism patients with end-stage renal disease and normal thyroid function

ObjectiveSecondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), and part of SHPT patients need receive parathyroidectomy (PTX). However, as an important postoperative complication of SHPT, thyrotoxicosis has received little attention. Therefore, in this article, we aimed to study the status of transient thyrotoxicosis after PTX for SHPT patients with ESRD and normal thyroid function.MethodsA total of 24 SHPT patients with preoperative normal thyroid function, normal thyroglobulin (Tg) and normal thyroid antibodies receiving PTX were enrolled from the Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, from January 2017 to January 2019. Tg, high sensitivity thyrotropin stimulating hormone (sTSH), triiodothyronine (T3), free triiodothyronine (fT3), thyroxine (T4) and free thyroxine (fT4) were evaluated the day before PTX and on day 1, 3 and 5 after PTX. Besides, all enrolled patients were evaluated whether there are symptoms associated with thyrotoxicosis.ResultsAmong the 24 SHPT patients, 1 case (4.2%), 8 cases (33.3%) and 13 cases (54.2%) had suffered thyrotoxicosis at the first, third and fifth day after surgery, respectively. Serum FT4 level increased significantly from pre-operation (0.68 ± 0.15 ng/dl, normal range 0.59–1.25 ng/dl) to the third day after operation (1.91 ± 0.97 ng/dl, p<0.001) and then gradually decline. The frequencies of serum sTSH lower than the normal level gradually increased from the first day (8.3%) to fifth day (66.7%) after surgery.ConclusionTransient thyrotoxicosis is a common postoperative complication of parathyroidectomy for SHPT patients with ESRD and normal thyroid function, and it is necessary for clinicians to evaluate the perioperative thyroid function to make early diagnosis and appropriate prevention and treatment of thyrotoxicosis.

"Hungry Bone" Syndrome after Parathyroidectomy: Up-To-Date

The hungry bone syndrome is considered in literature as being a complication following parathyroidectomy and it refers to the rapidly installed, severe, prolonged, and in most cases clinically manifested hypocalcaemia, which is sometimes accompanied by hypophosphatemia and hypomagnesemia. It appears due to the rapid demineralization of the dystrophic bone as a result of the sudden drop in the seric level of the parathyroid hormone. The prevalence of this complication is reported in literature with different variations, the number reported ranging from 4-95% depending on the type of affection - i.e. primary hyperparathyroidism or renal secondary hyperparathyroidism, but also on the geographical areas where the respective reports have been filled. The high preoperatory level of calcaemia, seric parathyroid hormone and alkalyne phophatase correlate statistically with the risk of postoperatory hungry bone syndrome appearance; the elderly patients present a higher risk for this complication, increasingly because this category of patients is oftenly associated with D hypovitaminosis and insufficient intake of nutritional calcium. The syndrome semiology is one of a hypocalcaemia and the curative treatment is initially a symptomatic one of fighting the severe postparathyroidectomy hypocalcaemia and only later a patogenic one, aiming to remineralize the distrofic bone. The purpose of this review is to describe the main epidemiologic, physiopathologic and clinical aspects of hungry bone syndrome but also of presenting prevention and treatment methods for this complication of parathyroidectomy.

Diabetes: the forgotten complication of parathyroidectomy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Predictive Factors for Postoperative Severe Hypocalcaemia after Parathyroidectomy for Primary Hyperparathyroidism

Hypocalcaemia is a complication of parathyroidectomy. We retrospectively analyzed data on patients who underwent parathyroidectomy for primary hyperparathyroidism (pHPT) to identify predictive factors for severe postoperative hypocalcaemia. Since 2004 we performed 87 parathyroidectomies for pHPT. We divided the patients into two groups: subjects who presented with postoperative hypocalcaemia (group B) or otherwise (group A). We looked for a correlation between several variables and the incidence of postoperative hypocalcaemia. The median calcemia in group B (19 patients) was 6.9 mg/dL on the first postoperative day and 7.6 mg/dL on the third day. We observed hypocalcemia related clinical symptoms in every patient. In all 19 cases the reduction of intraoperative parathyroid hormone above 85 per cent after parathyroidectomy was related to the development of severe postoperative hypocalcaemia (P = 0.042). We found that the reduction of intraoperative parathyroid hormone over 85 per cent after parathyroidectomy can be considered a reliable predictive factor of postoperative hypocalcaemia after parathyroidectomy for primary hyperparathyroidism.

204: Reactive Thyrotoxicosis: Under Diagnosed Complication of Parathyroidectomy in the Dialysis Population

204: Reactive Thyrotoxicosis: Under Diagnosed Complication of Parathyroidectomy in the Dialysis Population

Surgical therapy for primary hyperparathyroidism in patients with previous thyroid surgery

Background: In patients with primary hyperparathyroidism (HPTH) and previous thyroid operations, complications of parathyroidectomy are more frequent than in patients undergoing initial neck surgery. The aim of this study was to investigate the value of preoperative imaging with regard to its influence on the surgical strategy. Methods: We retrospectively analyzed 17 patients with primary HPTH and previous thyroid surgery. Preoperatively 16 patients underwent sonography and/or scintigraphy. Results: Sonography had an overall accuracy to correctly localize enlarged parathyroid glands of 80%, and scintiscanning had overall accuracy of 78.6%. The accuracy of localization was increased up to 84.6% if both diagnostic procedures were applied. In patients with normal thyroid residues the accuracy of sonography was 85.7%, and it was 100% if scintiscanning was used. Conclusions: Preoperative localization techniques in patients with primary HPTH and previous thyroid surgery have high accuracy. This allows for an imaging-directed operative strategy, thus preventing unnecessary bilateral neck explorations, which carry a high risk of recurrent laryngeal nerve injury.

Consequences of long-term hyperparathyroidism

We describe a young woman with long-term untreated hyperparathyroidism with a superimposed vitamin D deficiency and an extremely decreased bone mineral density that was complicated by a vertebral fracture. Despite pretreatment with intravenous pamidronate and short-term vitamin D supplementation, severe and long-standing hypocalcaemia (`hungry bone syndrome') developed after parathyroidectomy. We discuss the consequences of hyperparathyroidism, especially the effects on bone, the complications of parathyroidectomy and the possibilities of preoperative treatment with bisphosphonates.

Rhabdomyolysis

HYPOPHOSPHATEMIA may result in a number of pathologic conditions. Fuller et al1have called attention to the fact that rhabdomyolysis may be precipitated by hypophosphatemia, particularly when accompanied by strenuous muscle work. In our patient, severe hypophosphatemia occurred secondary to parathyroidectomy and calcium replacement, resulting in an episode of rhabdomyolysis. Parathyroidectomy is frequently required by patients receiving longterm hemodialysis for control of renal osteodystrophy. To the best of our knowledge, rhabdomyolysis has not previously been reported as a complication of parathyroidectomy and calcium supplementation. Report of a Case A 33-year-old woman receiving long-term hemodialysis was admitted to the University of Mississippi Medical Center on March 27, 1977, for parathyroidectomy. Membranous glomerulonephritis was diagnosed in 1959, requiring long-term hemodialysis in June 1973. Her course was complicated by severe hypertension, and in October 1973 she underwent a bilateral nephrectomy for uncontrollable hypertension. During the patient's dialysis course, her serum inorganic phosphorus