Decrease In Parathyroid Hormone Research Articles

Nanocarbon tracer applied to explore the relationship between the number of exposed parathyroid glands and parathyroid function

After nanocarbon tracer was applied to thyroidectomy, we aimed to investigate the risk factors of hypoparathyroidism and the relationship between the number of exposed parathyroid glands and parathyroid function. This study retrospectively collected clinical data of patients who underwent thyroidectomy at Haining People’s Hospital from January 2019 to December 2022. Levels of parathyroid hormone (PTH) and blood calcium were observed before surgery, 1 day after surgery, and one month after surgery to assess the occurrence of postoperative parathyroid hypofunction. Patients were grouped based on their postoperative PTH levels. Furthermore, basic patient data and surgical data were collected to analyze the risk factors associated with hypoparathyroidism after thyroidectomy using single factor analysis. ANOVA analysis was used to compare the correlation between intraoperative parathyroid exposure and postoperative PTH and blood calcium levels. This study involved 80 patients. On the first day after surgery, the serum PTH and blood calcium levels of patients decreased, and 59 patients (73.75%) had normal serum PTH level after surgery, which was the normal group. Twenty-one patients (26.25%) developed hypoparathyroidism after operation and were divided into hypoparathyroidism group. Single factor analysis showed that the main risk factors of postoperative hypoparathyroidism were lesion location, lymph node dissection, nano carbon, number of lymph node metastasis, intraoperative parathyroid exposure, and inaccurate parathyroidectomy. ANOVA analysis showed that the more parathyroid exposure during operation was accompanied by the more decrease of serum PTH and blood calcium levels after operation. Therefore, the location of thyroid lesions, lymph node dissection, nano-carbon, number of lymph node metastases, intraoperative parathyroid exposure, and parathyroidectomy are risk factors for transient hypoparathyroidism after thyroid surgery. Moreover, intraoperative parathyroid exposure significantly affected serum PTH and blood calcium levels. Performing more accurate thyroidectomy and reducing parathyroid exposure help reduce the occurrence of postoperative hypoparathyroidism and hypocalcemia.

A Miniaturized Endoscopic Device Integrating Raman Spectroscopy and Laser Speckle Technology Via an Image Fusion Algorithm for Intraoperative Identification and Functional Protection of Parathyroid Glands

Abstract The importance of parathyroid glands (PGs) protection is increasingly recognized by thyroid surgeons in the field of minimally invasive video-assisted thyroidectomy (MIVAT). However, current techniques for intra-operative identification and vascularity assessment of the PGs are contentious and complex. This study presents the design and validation of a miniaturized device for fusion near-infrared autofluorescence (NIRAF) based on Raman spectroscopy and laser speckle contrast imaging (LSCI) via an image fusion algorithm for functional protection of PGs in the MIVAT. Our light source components include an integrated light emitting diode (LED) light source fiber, an NIRAF optical fiber, an acquisition optical fiber, and a laser speckle optical fiber in the endoscopic system to achieve identification and vascularity assessment of PGs using a single endoscopic probe. It has been validated in ex vivo tissue experiments that the fluorescence intensity detected by the device was equivalent to that of the marker indocyanine green (ICG) in visual images and superior to that of the thyroid and all other tissues in the neck. Based on clinical studies, MIVAT using functional fluorescence endoscopy, compared with the White light pattern group, the NIRAF combined with LSCI modality group increased the number of intra-operative confirmations of the PGs (P < 0.001), declined the decrease in parathyroid hormone (PTH) (P < 0.05) and calcium levels (P < 0.05) on the first postoperative day, and reduced the incidence of symptomatic hypocalcemia (P < 0.05). Our device may reduce the incidence of postoperative permanent hypoparathyroidism. Application of an miniaturized functional fluorescence endoscope for real-time and label-free PGs identification and vascularity assessment in MIVAT could be realized.

Significant role of 1,25-dihydroxyvitamin D on serum calcium levels after total thyroidectomy: a prospective cohort study.

Although active vitamin D (VD) has been used both preoperatively and postoperatively to prevent hypocalcemia risk in patients undergoing total thyroidectomy, the role of 1,25-dihydroxyvitamin D (1,25(OH)2D) has not been examined. This study comprehensively investigated the effects of 1,25(OH)2D on calcium (Ca) concentrations after total thyroidectomy. Serum Ca, parathyroid hormone (PTH), and 1,25(OH)2D levels were measured in 82 patients with thyroid disease before and after surgery. Serum Ca, PTH, and 1,25(OH)2D levels decreased significantly on the morning of the first postoperative day. Notably, the decrease in 1,25(OH)2D concentration was significantly lower than that of PTH concentration (10.5 ± 33.4% vs. 52.1 ± 30.1%, p<0.0001), with 28% of patients showing increases in 1,25(OH)2D. The only factor predicting a postoperative 1,25(OH)2D decrease was a high preoperative 1,25(OH)2D concentration. Postoperative 1,25(OH)2D concentrations, as well as the magnitude and rate of decrease from preoperative levels, showed strong positive correlations with preoperative 1,25(OH)2D concentrations (p<0.0001 for all three variables) but not with PTH concentrations. These findings suggest that 1,25(OH)2D concentrations after thyroidectomy were more strongly dependent on preoperative concentrations than on the effect of PTH decrease and were relatively preserved, possibly preventing sudden severe postoperative hypocalcemia. A high 1,25(OH)2D level was the most important preoperative factor for hypocalcemia (<2 mmol/L; p<0.05) on the first postoperative day; however, only PTH decrease was statistically significant (p<0.001) when intraoperative factors were added. In the PTH >10 pg/mL group, the decrease in 1,25(OH)2D levels was significantly associated with postoperative hypocalcemia (p<0.05). Similarly, in the PTH levels >15 pg/mL group, a decrease in 1,25(OH)2D concentration was a significant factor, and the amount of PTH decrease was no longer significant. 1,25(OH)2D plays an important role in preventing sudden, severe hypocalcemia due to decreased PTH levels after total thyroidectomy, whereas high preoperative 1,25(OH)2D levels are a significant risk factor for postoperative hypocalcemia. Optimizing preoperative protocols to adjust Ca, PTH, and 1,25(OH)2D levels to improve the management of patients undergoing total thyroidectomy and to prevent extreme intraoperative PTH decreases may reduce the risk of hypocalcemia.

Clinical administration of cinacalcet in parathyroid diseases

Cinacalcet has emerged as an effective therapeutic option for the management of secondary hyperparathyroidism (SHPT) and chronic kidney disease-mineral and bone disorder (CKD-MBD). Through its modulation of the calcium-sensing receptor (CaSR), cinacalcet demonstrates considerable clinical benefits in maintaining parathyroid hormone and serum calcium levels within target ranges. It offers a valuable addition to the available treatment options for patients with these conditions. Cinacalcet binds to the CaSR on parathyroid cells, increasing its sensitivity to extracellular calcium. This results in decreased parathyroid hormone (PTH; parathormone), release through inhibition of intracellular signaling pathways involved in PTH synthesis and secretion. Cinacalcet also indirectly reduces serum calcium and phosphorus levels by suppressing PTH-mediated bone resorption and enhancing renal phosphate excretion.

An individual approach to intraoperative parathyroid hormone measurement during total thyroidectomy

PurposeHypocalcemia is a common complication of thyroidectomy. Measurement of the intraoperative serum parathyroid hormone (PTH) levels became an established technique but it requires further improvements. We aimed to assess intraoperative PTH level testing results against the hypothesis that the PTH assay may be performed almost immediately after thyroid gland removal. MethodsA retrospective cohort study. During total thyroidectomy surgery, the patients had PTH levels measured at the cutting time and again immediately after the thyroid gland is removed. Post-operatively, serial total blood calcium levels were obtained twice daily and recorded. ResultsAmong 63 enrolled patients, 39 had multinodular goiter, 15 thyroid carcinoma, and nine had Graves' disease. The mean age was 59.8 ± 15.3 years, 43 females. The mean PTH level before surgery was 45.8 ± 22.0 pg/mL. Post-operatively, 11/63 patients developed hypocalcemia with serum calcium levels <8 mg/dL. Four patients with ≥50 % decrease in PTH concentration were normocalcemic a day after surgery and were discharged early. Four patients with ≥70 % PTH decrease were treated accordingly during prolonged hospitalization and did not suffer from permanent hypocalcemia. The cut-off value of 70 % decrease after the gland removal was able to predict postoperative hypocalcemia with a sensitivity of 100 %, specificity 82.9 %, PPV 60.0 % and NPV 100 %. ConclusionMeasurements of intraoperative PTH may not be performed at fixed time intervals but after 1–2 min after removal of the thyroid gland. Defining those not at risk would allow the majority of patients to be waived from post-operative blood calcium testing and safely discharged early after surgery.

A >50% Intraoperative Parathyroid Hormone Decrease Into Normal Reference Range Predicts Complete Excision of Malignancy in Patients With Parathyroid Carcinoma

IntroductionThe mainstay of successful treatment for parathyroid carcinoma remains complete surgical excision. Although intraoperative parathyroid hormone (ioPTH) monitoring is a useful adjunct during parathyroidectomy for benign primary hyperparathyroidism, its utility for parathyroid carcinoma remains unclear. MethodsA retrospective review of 796 patients who underwent parathyroidectomy with ioPTH monitoring for primary hyperparathyroidism revealed 13 patients with parathyroid carcinoma on final pathology from two academic institutions. A systematic review yielded 5 additional parathyroid carcinoma patients. Complete excision of malignancy, or operative success (eucalcemia ≥6 mo. after parathyroidectomy); operative failure (persistent hypercalcemia <6 mo. after parathyroidectomy); and perioperative complications were evaluated. Comparison of the >50% ioPTH decrease alone to >50% ioPTH decrease into normal reference range was analyzed using Chi-squared, Kolmogorov–Smirnov, Kruskal–Wallis tests. ResultsAll 18 parathyroid carcinoma patients achieved a >50% ioPTH decrease, and 14 patients also had a final ioPTH level decrease into normal reference range. 93% of patients who met normal parathyroid hormone reference range had operative success, whereas only two of the four (50%) patients with parathyroid carcinoma with a >50% ioPTH decrease alone demonstrated operative success. ConclusionsParathyroidectomy guided by a >50% ioPTH decrease into normal reference range may better predict complete excision of malignant tissue in patients with parathyroid carcinoma compared to >50% ioPTH decrease alone. IoPTH monitoring should be used in conjunction with clinical judgment and complete en bloc resection for optimal treatment and success.

Parathyroid Hormone Decrease During Sepsis Predicts Re-Hospitalization in Hemodialysis Patients

Parathyroid Hormone Decrease During Sepsis Predicts Re-Hospitalization in Hemodialysis Patients

Quality of life in patients with hyperparathyroidism before and after surgical treatment

BACKGROUND: Hyperparathyroidism (HPT) is a syndrome characterized by excessive synthesis of parathyroid hormone (PTH), an imbalance of phosphorus-calcium metabolism, and damage to target organs. Radical treatment of any clinical variant of HPT is surgical. In this regard, the assessment of the quality of life (QoL) of patients before and after surgery is an indicator that reflects the impact of the disease on the patient’s health and the effectiveness of the treatment.AIM: To study QoL of patients with various clinical variants of HPT before and after surgical treatment.MATERIALS AND METHODS: The single-center prospective study included patients operated on for primary (PHPT), secondary (SHPT) and tertiary HPT in 2019–2021. A comparison was made of preand postoperative QoL indicators with a sample comparable in sex and age from residents of the Irkutsk region.RESULTS: The study included 100 patients, of which 13 had multiple lesions of the parathyroid glands (PTG) and 51 with solitary lesions in PHPT, 34 with SHPT and 2 with SHPT. Indicators QoL of patients with HPT before surgery is statistically significantly lower than in the region. The greatest decrease in QoL was found in the group of patients with multiple PTG lesions in PHPT. Improvement in QoL was achieved in 90% of the studied patients. Despite the identified complications, there was an improvement in QoL after surgery in case of achieving remission of the disease. Persistence of the disease is an outcome that does not allow for a statistically significant improvement in QoL after surgery for any type of HPT. Deterioration of QoL according to some indicators was found in 10% of patients. In patients with solitary PTG lesions in PHPT, deterioration in QoL is associated with postoperative hypocalcemia against the background of the «hungry bones» syndrome, and in patients with SHPT with a decrease in parathyroid hormone below population indicators.CONCLUSION: The study demonstrates QoL of patients with various clinical variants of hyperparathyroidism before and after surgical treatment. The dynamics of QoL indicators depending on the nosology, volume, duration, outcome and complications of operations is shown.

Cinacalcet Reverses Short QT Interval in Familial Hypocalciuric Hypercalcemia Type 1.

Familial hypocalciuric hypercalcemia type 1 (FHH-1) defines an autosomal dominant disease, related to mutations in the CASR gene, with mild hypercalcemia in most cases. Cases of FHH-1 with a short QT interval have not been reported to date. Three family members presented with FHH-1 and short QT interval (<360 ms), a condition that could lead to cardiac arrhythmias, and the effects of cinacalcet, an allosteric modulator of the CaSR, in rectifying the abnormal sensitivity of the mutant CaSR and in correcting the short QT interval were determined. CASR mutational analysis was performed by next-generation sequencing and functional consequences of the identified CaSR variant (p.Ile555Thr), and effects of cinacalcet were assessed in HEK293 cells expressing wild-type and variant CaSRs. A cinacalcet test consisting of administration of 30 mg cinacalcet (8 Am) followed by hourly measurement of serum calcium, phosphate, and parathyroid hormone during 8 hours and an electrocardiogram was performed. The CaSR variant (p.Ile555Thr) was confirmed in all 3 FHH-1 patients and was shown to be associated with a loss of function that was ameliorated by cinacalcet. Cinacalcet decreased parathyroid hormone by >50% within two hours, and decreases in serum calcium and increases in serum phosphate occurred within 8 hours, with rectification of the QT interval, which remained normal after 3 months of cinacalcet treatment. Our results indicate that FHH-1 patients should be assessed for a short QT interval and a cinacalcet test used to select patients who are likely to benefit from this treatment.

#3579 AN INITIAL LOW-DOSE ETELCALCETIDE APPROACH IS EFFECTIVE AND COST-SAVING IN HEMODIALYSIS PATIENTS WITH MODERATE SECONDARY HYPERPARATHYROIDISM

Abstract Background and Aims Etelcalcetide (ETC) is an intravenous calcimimetic approved for the management of secondary hyperparathyroidism (sHPT) in hemodialysis (HD) patients, with benefits in terms of reduction of FGF23 levels and prevention of progression of left ventricular hypertrophy. The label recommendation is a starting dose of 5 mg after HD, to be titrated every 4 weeks according to parathyroid hormone (PTH) and calcium levels. However, it remains unclear what dosage is best to start with and, thus, how this treatment can be implemented in a real-life setting. The aim of this study was to assess the efficacy and cost-effectiveness of ETC started at lower doses than those suggested by the manufacturer in patients with moderate sHPT. Methods This is a retrospective observational study comparing two different initial ETC dosing strategies, a “Low-dose approach” (LD, ETC starting dose&amp;lt;10 mg/week) and a “Classic approach” (CL, ETC starting dose≥10 mg/week), in terms of effects on CKD-MBD related biomarkers and costs during the first year of prescription. The study was conducted on HD patients with basal PTH between 500 and 1500 ng/l, treated with ETC for at least 3 months between 2018 and 2022 at ASST Spedali Civili di Brescia. Monthly monitoring of serum calcium, phosphorus and PTH was performed in both groups for dose adjustment. Results Overall, 53 patients were identified, 24 in the LD and 29 in the CL group. Both groups showed similar baseline characteristics (Table 1). Median follow-up was 52 weeks, during which 4 patients (one in the LD and three in the CL group) discontinued ETC (Table 1). At the end of follow-up, 92% of patients in the LD and 90% in the CL group achieved a decrease in PTH ≥30% compared to baseline, with median PTH levels of 282 (207 - 332) and 294 (151 – 382) ng/l, respectively (p = 0.825). Other CKD-MBD biochemical parameters were comparable between the two groups at all timepoints (Figure 1). The median of average ETC weekly doses per patient was 7.6 (6.2 – 10.2) mg in the LD and 10.6 (9.7 – 15) mg in the CL group (p&amp;lt;0.001). During follow-up, the median ETC dose remained stable in the LD group, while partially decreasing in the CL group (Figure 1). Use of paricalcitol was comparable in both groups. At cost analysis, the median of average ETC weekly costs per patient was €36.6 (29.6 – 50.0) in the LD and €50.5 (46.4 – 71.7) in the CL group (p&amp;lt;0.001). This translates into an average yearly cost per patient of €1909 and €2635 using the LD and CL approach, respectively, with a saving of €726 per patient-year in favour of the LD strategy. Conclusion In this retrospective study in HD patients with moderate sHPT, we showed that starting ETC at a lower dose than the one suggested by the manufacturer is as effective as the classic approach in terms of control of CKD-MBD parameters, with a significant reduction in treatment costs. Future prospective studies will be needed to validate the results in bigger cohorts, test whether these benefits can extend beyond the first year of treatment and assess the effects on FGF23 levels and other relevant clinical outcomes.

#6814 A NEW SORBENT DEVICE FOR MULTIPLE CLINICAL PURPOSES: CURRENT EVIDENCE AT A PRIVATE HOSPITAL IN MEXICO

Abstract Background and Aims Adsorption is an extracorporeal technique utilized for blood purification, it also complements convection and diffusion for solute removal. Since 1991 we had used blood purification techniques, over the years, new adsorption cartridges had been developed, the new ones involving treatment for inflammatory conditions, chronic uremic symptoms and autoimmune diseases. HA130, HA230, and HA330 (Jafron, Zhuhai City, China) are among the widely used adsorption cartridges in China. We report highlights of the use of hemoperfusion using HA130 cartridges in the Mexican population cohorts in the context of multiple chronic inflammatory conditions in order to support evidence of effectiveness and safety. Method We retrospectively analyzed the medical records of 14 critically ill patients in the context of chronic inflammatory conditions such as acute kidney injury in chronic kidney disease, acute lung injury due to SARS-COV-2 infection and sepsis. Hemoperfusion in addition to standard therapy (fluid resuscitation, vasopressors, antimicrobial therapy and ventilatory support) resulted in the improvement of inflammatory substances levels when compared to standard therapy alone. Out of the 14 patients, 7 patients used HA130 cartridges and 7 patients with standard therapy alone. Results There were no significant side effects associated with HA130 cartridge use. HA 130 cartridges were found to be effective in reducing uremic symptoms in chronic hemodialysis patients, improvement of pruritus score and decreased parathyroid hormone and phosphate product (p&amp;lt;0.5) when compared to HD alone, creatinine (MARS: −24 μmol/L, −19.5 to −10.46, p &amp;lt; 0.001; SPAD: −2 μmol/L, −9.0 to +7.0/L, p = 0.314) and urea (MARS: −0.9 mmol/L, −318 to −0.189, p = 0.024; SPAD: −0.1 mmol/L, −1.0 to +0.68, p = 0.523). 66.6% of cost-effectiveness when compared to standard therapy. Conclusion In the group of patients that used HA130 cartridges we found statistically significant (p &amp;lt;0.05) reduction of pruritus score, PTH, phosphate product, creatine and urea when compared to the group of patients with standard therapy alone. The development in new cartridges technology allows more wide applications for renal patients. As we expand to involve other indications for this therapy there is cost-effectiveness improvement for the patients.More studies in different clinical settings are needed in order to achieve adsorption therapy national recommendations. We also found that the HA130 cartridges are effective in reducing uremic symptoms and microinflammatory status in acute kidney injury in chronic kidney disease patients due to the elimination of middle and small molecule uremic toxins and inflammatory mediators and endotoxins. This may translate as an improvement of quality of life and survive rates in patients with chronic hemodialysis, even though more studies are needed in order to prove this assumption.

Vitamin D Deficiency and its Relation to Lipid Profile

Background Vitamin D deficiency is considered as a major public health problem all over the world. Vitamin D acts as a hormone with multi-functions. The main source of vitamin D is solar UV radiation, which converts 7-dehydrocholesterol to pro-vitamin D which is modified to vitamin D given normal skin temperature. Vitamin D deficiency is a common disorder presents in all ages and in both genders. Vitamin D plays an important role in modulating the immune response to infections and reduction inflammatory response. Vitamin D deficiency has a genetic predisposition. There is a correlation between low 25-hydroxyvitamin D levels and dyslipidemia, so correction of vitamin D deficiency is important for treating disturbance in lipid profile. Repletion of 25-hydroxy vitamin D levels raised serum calcium level and decrease parathyroid hormone levels.

Evaluation of the Consequences of Targeted or Focused Mini-Incision Parathyroidectomy in Patients With Primary Hyperparathyroidism

Surgical approaches to primary hyperparathyroidism (PHPT) have been associated with a change from invasive to non-invasive methods in the last 20 years. In this cross-sectional descriptive study, 55 patients with primary adenoma-induced HPT underwent surgery. The parathyroid gland in patients with primary hyperparathyroidism caused by parathyroid adenoma was removed by open surgery with an incision of about 2 cm in the neck in a targeted manner in a site localized by ultrasound or Sestamibi scan. The patients' personal information, including age, sex, length of hospital stay, serum calcium and parathyroid hormone (PTH) levels, success rate, and problems and unwanted adverse consequences of surgery (e.g. infection and bleeding) were recorded for each patient and collected information was analyzed in SPSS software. Most patients were women (80%) and individuals in the age range of 41-60 years (47.3%). The hospital stay length ranged from 2 to 5 days with an average of 3.25±0.9 days. Success was considered as a decrease in PTH and calcium levels during the first 24 h after the intervention, and success rates of 100, 98.2, and 69.1%, respectively, were evaluated for a reduction of at least 50% in PTH levels and less than 40 ng/ml of PTH levels. No major complications were reported in the studied patients. Wilcoxon test revealed significant decreases in patients' postoperative serum calcium and PTH levels (P=0.000). Mini-incision Parathyroidectomy with limited incision was associated with significant reductions in serum calcium and PTD without complications.

A Single Vitamin D3 Bolus Supplementation Improves Vitamin D Status and Reduces Proinflammatory Cytokines in Healthy Females.

Vitamin D deficiency is a global health problem that not only leads to metabolic bone disease but also to many other illnesses, most of which are associated with chronic inflammation. Thus, our aim was to investigate the safety and effectiveness of a single high dose of vitamin D3 (80,000 IU) on vitamin D status and proinflammatory cytokines such as interleukin (IL)6, IL8 and tumor necrosis factor (TNF) in healthy Saudi females. Fifty healthy females were recruited and orally supplemented with a single vitamin D3 bolus (80,000 IU). All participants donated fasting blood samples at baseline, one day and thirty days after supplementation. Serum 25-hydroxyvitamin D3 (25(OH)D3), IL6, IL8, TNF, calcium, phosphate, parathyroid hormone (PTH) and blood lipid levels were determined. Serum 25(OH)D3 significantly increased one and thirty days after supplementation when compared with baseline without causing elevation in calcium or phosphate or a decrease in PTH to abnormal levels. In contrast, the concentrations of the three representative proinflammatory cytokines decreased gradually until the end of the study period. In conclusion, a single high dose (80,000 IU) is effective in improving serum vitamin D status and reducing the concentration of the proinflammatory cytokines in a rapid and safe way in healthy females.

Impact of Sesamum indicum oil on the heamatologycal parametrers on albino mice

The current study was conducted to find out the effect of sesame oil on white female rats by studying some biochemical parameters that included vitamin D, parathyroid hormone and calcium ion. The study included 35 animals divided into two main groups divided into groups, each group included 5 animals dosed with different doses 0.5'0.8' 1 ml. The period of dosing was for a month between one day and one day. After the end of the experiment, the animals were sacrificed and the serum was obtained. A significant increase in the volume of vitamin D (13.21±0.312, 16.01± 0.51, 19.51±0.78) (ng/dl) respectively compared with control group (9.739±0.096) (ng/dl) and a decrease in parathyroid hormone (0.101± 0. 001, 0.086± 0. 002 , 0.074± 0.002) (ng/dl) respectively compared with control group (0. 112± 0.002) (ng/dl), which caused an increase in calcium ion (9.85±0.206, 10.948±0.178, 12.62±0.158) mg/dL respectively compared with control group (8.7±0.063) mg/dL, was shown.

Change in parathyroid hormone levels from baseline predicts hypocalcemia following total or completion thyroidectomy.

This study aims to identify the strongest predictor of postoperative hypocalcemia following thyroid surgery. Study of patients who underwent total/completion thyroidectomy. No patients received postoperative calcium supplementation. Demographic and perioperative data were collected including preoperative baseline parathyroid hormone (PTH) levels, PTH levels at 30 min and 6h post-excision, and 18 h post-excision calcium levels. Of 124 patients studied, 20.2% developed temporary hypocalcemia (Ca <8.5mg/dL at 18 h post-excision). In multivariate analyses, absolute PTH levels at 30 min and 6h post-excision as well as change in PTH from baseline at 30 min and 6h post-excision were statistically significantly associated with postoperative hypocalcemia. Per 10units decrease in PTH from baseline at 30 min post-excision, the risk of developing temporary hypocalcemia increases by 17%. Absolute PTH levels and change in PTH from baseline at 30 min and 6h post-excision predict hypocalcemia after total or completion thyroidectomy.

The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone.

Background: Cinacalcet is a calcimimetic drug that has increasingly been used as a bridging therapy for primary hyperparathyroidism (pHPT), especially during the COVID-19 pandemic. The aim of our study was to investigate if preoperative cinacalcet therapy affects intraoperative parathyroid hormone (IOPTH) monitoring during parathyroidectomy, which is an important indicator for the success of surgery. Methods: In this single-center retrospective analysis, we studied the outcomes of 72 patients who underwent surgery for pHPT. We evaluated two groups: those with cinacalcet therapy before operation—the cinacalcet group (CG)—and those without medical therapy preoperatively (non-CG). In order to perform a between-group comparison of time trends, we fit a linear mixed-effects model with PTH as the response variable and predictors PTH levels preoperatively, group (cinacalcet yes/no), time, the group-by-time interaction, and a random intercept (per subject). Results: Our cohort included 51 (71%) women and 21 (29%) men, who were operated upon for pHPT in the period from January 2018 until August 2021. All patients were diagnosed with pHPT and 54% of the cohort were symptomatic for hypercalcemia. Moreover, 30% of the patients were treated with cinacalcet as a bridging therapy preoperatively, and this increased during the COVID-19 pandemic, as 64% of this group were treated in the last two years. Calcium values were significantly different before (p < 0.001) and after (p = 0.0089) surgery, but calcium level change did not differ significantly between the CG and non-CG. Parathyroid hormone (PTH) levels dropped significantly in both groups during 10 min IOPTH monitoring (p < 0.001), but there was no significant difference between the two groups (p = 0.212). Conclusions: In the examined patient cohort, the use of cinacalcet did not affect the value of IOPTH monitoring during surgery for pHPT.

Effect of Ascorbic acid on Serum Calcium Levels in Hyperparathyroid and Euparathyroid Individuals with and without Physical Activity

Introduction: In end-stage renal disease, there is a high incidence of secondary hyperparathyroidism. It is proposed that increasing vitamin C levels by dietary supplementation results in a decrease of parathyroid hormone (PTH) in vitamin C-deficient hemodialysis patients with secondary hyperparathyroidism. The aim of this study was the evaluation of vitamin C administration for reduction of serum PTH level in hemodialysis patients.

INDIVIDUAL-TYPOLOGICAL APPROACH IN EVALUATION OF VITAMIN D CONTENT AND ITS ERGOGENIC EFFECTS IN WOMEN OF REPRODUCTIVE AGE IN PREGRAVIDARY PREPARATION

The development of a new direction in preventive medicine and obstetric practice requires the active development and implementation of effective comprehensive programs to optimize motor activity, increase the functional capabilities of the body and dynamic control of the content of vitamin D in the blood serum of women of reproductive age. Materials and methods. 133 patients aged 20-35 years with normal body weight (70 women of group I) and overweight (63 women of group II) had a consistent increase in the level of motor activity (mobile applications on Android and Apple platforms) by 1 cent for 7 days for 5-7 weeks, which was combined with the appointment of vitamin D (respectively at a dose of 2000 ME/ day and 4000 ME/ day. The evaluation of the effectiveness of pregravidar preparation is given taking into account the dynamics of body weight, as well as the content of 25-hydroxyvitamin D in blood serum [25 (OH)D], total and ionized calcium, phosphorus and parathyroid hormone in comparison with the initial data. Results. In comparison with the initial data after pregravidar preparation using the author's algorithm for increasing motor activity and the appointment of vitamin D, unidirectional positive effects of exercise tolerance and the dynamics of phosphorus-calcium metabolism in both groups were established within the reference values, but with higher serum levels of total and ionized calcium, phosphorus and a decrease in parathyroid hormone in women with normal body weight compared with women with BMI. Conclusions. The combined use of the proposed daily physical activity with the appointment of vitamin D determined an increase in its content in blood serum, a decrease in body weight and an increase in the effectiveness of pregnancy in women with a BMI of up to 52.3%, and in women with normal body weight up to 91.4%. A comparative analysis of the results of vitamin D content and its ergogenic effects in women of reproductive age allows for a consistent centile increase in the daily number of locomotions and the administration of vitamin D up to 10-12 weeks and the approximation of body weight to the upper limit of the regulatory corridor (75-90 cents) in women with BMI, taking into account their personal consent and under dynamic control of calcium-phosphorus metabolism.

Vitamin D Supplementation for 12 Months in Older Adults Alters Regulators of Bone Metabolism but Does Not Change Wnt Signaling Pathway Markers.

ABSTRACTVitamin D status and supplementation regulates bone metabolism and may modulate Wnt signaling. We studied the response of hormonal regulators of bone metabolism, markers of Wnt signaling and bone turnover and bone mineral density (BMD) and bone mineral content (BMC) in a randomized vitamin D intervention trial (12,000 IU, 24,000 IU, 48,000 IU/mo for 1 year; men and women aged >70 years; n = 379; ISRCTN35648481). Associations with total and free 25(OH)D concentrations were analyzed by linear regression. Baseline vitamin D status was (mean ± SD) 25(OH)D: 40.0 ± 20.1 nmol/L. Supplementation dose‐dependently increased total and free 25(OH)D concentrations and decreased plasma phosphate and parathyroid hormone (PTH) (all p < 0.05). The procollagen 1 intact N‐terminal (PINP)/C‐terminal telopeptide (CTX) ratio, C‐terminal fibroblast growth factor‐23 (cFGF23), and intact FGF23 (iFGF23) significantly increased with no between‐group differences, whereas Klotho was unchanged. 1,25(OH)2D and PINP significantly increased in the 24 IU and 48,000 IU groups. Sclerostin (SOST), osteoprotegerin (OPG), receptor activator of NF‐κB ligand (RANKL), BMD, BMC, and CTX remained unchanged. Subgroup analyses with baseline 25(OH)D <25 nmol/L (n = 94) provided similar results. Baseline total and free 25(OH)D concentrations were positively associated with 1,25(OH)2D, 24,25(OH)2D (p < 0.001), vitamin D binding protein (DBP) (p < 0.05), BMD, and BMC (p < 0.05). Associations with PTH (p <0.001), cFGF23 (p < 0.01), and BAP (p < 0.05) were negative. After supplementation, total and free 25(OH)D concentrations remained positively associated only with 24,25(OH)2D (p < 0.001) and DBP (p < 0.001) and negatively with estimated glomerular filtration rate (eGFR) (p < 0.01). PTH and SOST were significantly associated only with free 25(OH)D. There were no significant relationships with BMD and BMC after supplementation. The decrease in PTH and increase in PINP/CTX ratio suggest a protective effect of supplementation on bone metabolism, although no significant effect on BMD or pronounced changes in regulators of Wnt signaling were found. The increase in FGF23 warrants caution because of its negative association with skeletal and cardiovascular health. Associations of total and free 25(OH)D with biomarkers were similar and known positive associations between vitamin D status and BMD were confirmed. The change in associations after supplementation might suggest a threshold effect. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.