Hypocalcemia Group Research Articles

Main Prognostic Factors for Well Differentiated Thyroid Cancer: Analis of Combined Patients Treatment Results during 20 Years after Surgery

Background: Thyroid surgeries are among the most common operations performed in the world. Hypocalcemia following total thyroidectomy is a common complication that is sometimes difficult to correct. The aim of this study was to compare two groups of patients: those with normocalcemia and those with hypocalcemia following total thyroidectomy upon discharge from the hospital and 6 to 12 months following surgery as well as to determine the clinical value. Methods: From January 2015 through April 2017, 400 patients were included in this prospective multicenter study. All the patients underwent total thyroidectomy due to various thyroid diseases. The following risk factors were analyzed: preoperative and postoperative biochemical blood parameters, clinical effects and factors related to surgery, the patient and the disease. By way of random of selection, 2 groups of patients were formed: 30 patients who had a normal level of calcium detected in the blood upon discharge from the hospital following total thyroidectomy (normocalcemia group), and 30 patients who had a reduced level of calcium in the blood upon discharge from the hospital (hypocalcemia group). In these groups of patients, the following parameters were determined: calcium, ionized calcium, 25-hydroxyvitamin D, parathyroid hormone, clinical expression of hypocalcaemia and the use of calcium and 25-hydroxyvitamin D preparations upon discharge from the hospital and 6 to 12 months following surgery. Results: Based on the data of our study, the comparison of patient groups with normocalcemia and hypocalcemia upon discharge from the hospital and 6 to 12 months following surgery demonstrated that there were no statistically significant factors for postoperative hypocalcaemia. Generally, there were no differences between the groups 6 to 12 months following surgery. A reduced level of calcium was determined only in 2 of 30 patients with hypocalcaemia 6 to 12 months following surgery. In the group of patients with normocalcemia, the level of calcium remained normal both on day 2 when they were discharged from the hospital and 6 to 12 months following surgery. Comparing the normocalcemia and hypocalcemia groups on day 2 following surgery and 6 to 12 months following surgery, McNemar’s test showed a statistically significant distribution between these patient groups (p<0.01). Of the 2 mentioned patients with hypocalcemia, clinical symptoms were not observed in 1 patient 6 to 12 months following surgery. The patient did not take calcium and calcitriol preparations. Another patient complained about numbness of fingers. The patient used calcium and calcitriol preparations. In the hypocalcemia group, a reduced level of parathyroid hormone was determined in 9 patients on day 1 following surgery. A reduced level of parathyroid hormone was determined in 1 patient of this group 6 to 12 months following surgery. Conclusion: Hypocalcemia following total thyroidectomy is among the most common complications. Treatment with calcium and 25-hydroxyvitamin D preparations after surgery leads to disappearance of both biochemical and clinical expression of hypocalcemia in the majority of cases. Upon discharge from the hospital, patients with more pronounced hypocalcemia should be administered calcium and calcitriol preparations, even in the absence of clinical symptoms.

Energetic metabolic profile of ewes presenting low body condition score induced to subclinical hypocalcemia in early postpartum

ABSTRACT: The aim of the present study is to assess plasma concentrations of metabolites related to energy balance in ewes showing low body condition score (BCS) induced to subclinical hypocalcemia in early postpartum. Sixteen crossbred ewes (Ideal x Corriedale) presenting BCS 0.05), whereas the mean concentrations of these marks after five days were lower in the hypocalcemia group (P 0.05) level. These results evidence that, despite the subclinical hypocalcemia induction at early postpartum, ewes presenting low body condition do not change the concentrations of energy balance-related metabolites in the following five days.

Hypocalcemia in trauma patients receiving massive transfusion

BackgroundMassive transfusion protocol (MTP) is increasingly used in civilian trauma resuscitation. Calcium is vital for coagulation, but hypocalcemia commonly occurs during massive transfusion due to citrate and serum calcium chelation. This study was conducted to determine the incidence of hypocalcemia and severe hypocalcemia in trauma patients who receive massive transfusion and to compare characteristics of patients with severe versus nonsevere hypocalcemia. Materials and methodsThis was a retrospective study of trauma patients who received massive transfusion between January 2009 and November 2013. The primary outcome was the incidence of hypocalcemia (ionized calcium [iCa] < 1.12 mmol/L) and severe hypocalcemia (iCa < 0.90 mmol/L). Secondary outcomes included calcium monitoring, calcium replacement, and correction of coagulopathy. ResultsThere were 156 patients included; 152 (97%) experienced hypocalcemia, and 111 (71%) had severe hypocalcemia. Patients were stratified into iCa ≥ 0.90 (n = 45) and iCa < 0.90 (n = 111). There were no differences in demographics or baseline laboratories except the severe hypocalcemia group had higher baseline activated partial thromboplastin time (29.7 [23.7–50.9] versus 25.8 [22.3–35.9], P = 0.003), higher lactic acid (5.8 [4.1–9.8] versus 4.0 [3.1–7.8], P = 0.019), lower platelets (176 [108–237] versus 208 [169–272], P = 0.003), and lower pH (7.14 [6.98–7.28] versus 7.23 [7.14–7.33], P = 0.019). Mortality was higher in the severe hypocalcemia group (49% versus 24%, P = 0.007). Patients in the iCa < 0.90 group received more blood products (34 [23–58] versus 22 [18–30] units, P < 0.001), and calcium chloride (4 [2–7] versus 3 [1–4] g, P = 0.002), but there was no difference in duration of MTP or final iCa. Neither group reached a median iCa > 1.12. ConclusionsHypocalcemia is common during MTP, and vigilant monitoring is warranted. Research is needed to effectively manage hypocalcemia during massive transfusion.

Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients

Postoperative hypocalcemia is the most frequent complication of total thyroidectomy. It may have a delayed onset, and therefore delays the discharge from the hospital, requiring calcium replacement therapy to alleviate clinical symptoms. During a 7-month period, 2,631 consecutive patients undergoing primary or completion thyroidectomy were prospectively followed up and underwent analysis regarding postoperative hypoparathyroidism. Data were prospectively collected by questionnaires from 39 Italian endocrine surgery units affiliated to the Italian Endocrine Surgery Units Association (Club delle Unità di EndocrinoChirurgia-UEC), where thyroid surgery is routinely performed. The incidence of hypoparathyroidism was 28.8 % (757 patients), including transient hypocalcemia (27.9 %-734 patients) and permanent hypocalcemia (0.9 %-23 patients). The rate of asymptomatic hypocalcemia was 70.80 %. The incidence of permanent hypocalcemia was higher in the symptomatic hypocalcemia group (7.5 %) than in asymptomatic one (1.5 %). Female patients experienced a transient postoperative hypocalcemia more frequently than male patients (29.7 and 21.2 %, respectively; p < 0.0001). The percentage developing hypocalcemia in patients in which parathyroid glands were intraoperatively identified and preserved was higher than in the patients in which the identification of parathyroid glands was not achieved (29.2 vs. 18.7 %, p < 0.01). This prospective study confirmed the main risk factors for postoperative hypocalcemia: thyroid cancer, nodal dissection, and female gender. It farther showed that identifying parathyroids has an important role to prevent permanent hypocalcemia though with a higher risk of transient hypocalcemia. A suitable informed consent should especially emphasize the importance of some primary factors in increasing the risk of hypocalcemia after thyroid surgery.

Predictors of early post-operative hypocalcemia after parathyroidectomy for secondary hyperparathyroidism

We sought to identify predictors of development of early post-operative hypocalcemia after parathyroidectomy for secondary hyperparathyroidism. The patients were divided into two groups according to their serum calcium (Ca) levels within 24 hours of undergoing para-thyroidectomy: the hypocalcemia group (22 patients) with post-operative serum Ca levels of 2 mmol/L or less, and the normocalcemia group (48 patients), with post-operative serum Ca levels higher than 2 mmol/L. By using multivariate stepwise logistic regression analysis, high pre-operative serum Ca level had the strongest predictive value of development of early hypocalcemia with an adjusted odds ratio (aOR) of 3.01, followed by hypo-albuminemia (aOR = 2.72), younger age (aOR = 2.56), and high pre-operative alkaline phosphatase (ALP) levels (aOR = 2.28). We conclude that among patients with secondary hyperparathyroidism, age, levels of pre-operative serum Ca, ALP and albumin correlate positively with the development of early post-operative hypocalcemia. Patients with one of these factors should be monitored more closely in the early post-parathyroidectomy period.

Predictors of Early Postoperative Hypocalcemia in Hemodialysis Patients With Secondary Hyperparathyroidism

We sought to investigate predictors of early development of postoperative hypocalcemia in secondary hyperparathyroidism. Thirty-six hemodialysis patients (21 men, 15 women; mean age, 39.6 ± 13.2 years; mean hemodialysis duration, 77.9 ± 47.1 months) underwent parathyroidectomy. We recorded preoperative adjusted serum calcium (Ca +2), phosphate, alkaline phosphatase, intact parathyroid hormone, and hemoglobin levels; mean systolic and diastolic blood pressure levels; parathyroid ultrasonography and scintigraphic data; and number and weight of the resected adenomas. Patients were divided into two groups based on Ca +2 levels within 24 hours of parathyroidectomy: the hypocalcemia group (serum Ca +2 levels ≤ 8 mg/dL; n = 26 patients) and the normocalcemia group (>8 mg/dL; n = 10 patients). A total parathyroidectomy with autotransplant was performed in 23 patients and a subtotal parathyroidectomy in 13 patients. Age (36.0 ± 9.7 vs 49.2 ± 16.6 years; P = .006); levels of preoperative serum Ca +2 (9.6 ± 0.7 vs 10.4 ± 1.1 mg/dL; P = .01), alkaline phosphatase (346.7 ± 354.7 vs 653.3 ± 553.7 mg/dL; P = .05), and hemoglobin (10.5 ± 1.4 vs 12.3 ± 2.5 g/dL; P = .009); and number (2.0 ± 1.3 vs 2.9 ± 0.9; P = .04) and weight (1.9 ± 2.1 vs 3.2 ± 1.7; P = .01) of excised parathyroid adenomas were significantly lower among the hypocalcemia than the normocalcemia group. Among hemodialysis patients with secondary hyperparathyroidism, age, levels of preoperative serum Ca +2 and alkaline phosphatase, and number and weight of adenomas were associated with early development of postoperative hypocalcemia.

Hypocalcemia after Neck Exploration for Untreated Primary Hyperparathyroidism

Hypocalcemia after neck exploration for hyperparathyroidism is an important postoperative management issue. With increasing acceptance of less invasive surgical approaches, hypocalcemia is less frequent. This study was conducted to evaluate postoperative hypocalcemia after current surgical exploration techniques in patients with untreated primary hyperparathyroidism. From the University of Louisville parathyroid database, charts of patients undergoing surgery for untreated primary hyperparathyroidism from May 1, 1998 to May 30, 2004 were reviewed. Data was analyzed based on age, sex, preoperative calcium and parathyroid hormone levels, preexisting diseases, and extent of neck exploration. One hundred sixty-nine patients were identified with adequate data for analysis. Transient postoperative hypocalcemia occurred in 21 per cent (36/169) for the total group, in 18 per cent (22/125) after minimally invasive radio-guided parathyroidectomy, and in 32 per cent (14/44) after bilateral neck exploration. Patients with postoperative hypocalcemia had a statistically significant association with older age and pre-existing hypertension. Patients with postoperative hypocalcemia were more likely to have undergone longer surgical procedures and were more likely to have had pre-existing diabetes and mental disorders. These findings were not statistically significant and were considered trends. The frequency of osteoporosis in the hypocalcemia group was increased but was not significant. Transient hypocalcemia occurred in 21 per cent of patients after parathyroid surgery. It was more likely after bilateral neck exploration, a longer duration of surgery, and with hypertension, diabetes, and mental disorders.

Prophylactic Calcium Administration for Hyperkalemia in Extremely Low Birthweight Infants

The objective of this study was to clarify the relationship between the blood potassium and calcium levels, and the efficacy of prophylactic calcium (Ca) administration early in life for nonoliguric hyperkalemia in extremely low birthweight (ELBW) infants. This was a retrospective study including 55 ELBW infants with gestational age less than 26 weeks (mean, 24.4 weeks; mean body weight, 681 g). The plasma potassium concentration and whole blood ionized calcium (iCa) concentration were measured every 2 to 3 hours. Laboratory data obtained up to 24 hours after birth were collected. The infants were divided into two groups based on whether or not Ca gluconate was administered prophylactically starting at admission (prophylactic and nonprophylactic group). There was a negative correlation between the plasma potassium and iCa levels at 12 and 24 hours, and the maximum plasma potassium level was higher in the hypocalcemia group (minimum iCa level, < 0.9 mmol/L) than in the normocalcemia group. The iCa level was significantly higher and the plasma potassium level was significantly lower in the prophylactic group than in the nonprophylactic group at 12 and 24 hours. The increment in the plasma potassium level at 24 hours compared with that at admission was significantly lower in the prophylactic than in the nonprophylactic group. Nonoliguric hyperkalemia may be attenuated by maintaining the iCa level within normal limits by prophylactic Ca administration early in life. Prospective studies are needed to confirm this.

Role of creatine phosphokinase in predicting acute renal failure in hypocalcemic exertional heat stroke.

Recruits frequently develop hypocalcemia in exertional heat stroke (ExHS) with rhabdomyolysis and acute renal failure (ARF) from intensive training. It usually indicated severe skeletal muscle damage. However, the relative risk of ARF in ExHS patients complicated with hypocalcemia was unknown. The present study was undertaken to evaluate the value of peak serum creatine phosphokinase (CPK) level in predicting ARF in ExHS patients with hypocalcemia. Sixty-eight army recruits with ExHS were hospitalized at the Tri-Service General Hospital, Taiwan: 17 with ARF and hypocalcemia (group A); 7 with ARF but without hypocalcemia (group B); 20 without ARF but with hypocalcemia (group C); and 24 without ARF or hypocalcemia (group D). In the 24 patients with ARF (groups A and B) the serum phosphate and peak CPK levels were significantly higher than in patients without ARF (groups C and D; p < 0.001), serum calcium levels were also significantly lower in the former (p < 0.001). In the 37 patients with hypocalcemia (groups A and C), the peak serum CPK levels were significantly higher than in those without hypocalcemia (groups B and D; p < 0.001). There was a higher proportion of hypocalcemic patients with peak serum CPK levels greater than 10,000 U/l among ARF compared with patients without ARF (chi 2 = 12.48, p < 0.001). In 24 patients with ARF, there was a negative correlation between serum Ca and peak CPK levels (t = 3.37, r = -0.58, p < 0.01). However, a positive correlation was found between serum creatinine and peak serum CPK levels in 37 patients with hypocalcemia (t = 2.47, r = 0.39, p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

The role of oxygen free radicals and extracellular calcium ions in reperfusion-induced arrhythmias.

To examine the role of oxygen free radicals and extracellular calcium ions in reperfusion-induced ventricular arrhythmias, we evaluated the effects of hypoxic reperfusion, oxygen free radical scavengers, allopurinol and hypocalcemic reperfusion on reperfusion-induced ventricular arrhythmias. The hearts of male Sprague-Dawley rats were perfused in the working heart mode. Whole heart ischemia was induced for 15 min and then reperfused. Rats were divided into 5 groups: control group, scavenger group, allopurinol group, hypoxia group and hypocalcemia group. Scavenger, hypoxic and hypocalcemic perfusions were undertaken only during the period of perfusion. The incidence of reperfusion-induced ventricular fibrillation (Vf) was reduced in the scavenger group (100% to 38%) and the hypoxia group (100% to 50%). Spontaneous reversion of Vf to regular sinus rhythm was recognized in the hypoxia and hypocalcemia groups. In conclusion, oxygen free radicals would play an important role in the genesis of the reperfusion arrhythmias, and extracellular calcium concentration would also play an important role in sustaining the reperfusion arrhythmias. Notably, hypoxic reperfusion had protective effects on both processes.

Parturient Paresis in the Cow

Serum ionized calcium concentrations (CaF) were determined in 87 Swedish red-and-white cows and 10 Swedish Friesian cows with clinical signs of parturient paresis. All cows were in the week prior to or after parturition. A classification of the severity of hypocalcemia in terms of serum ionized calcium was devised. Eight cows had normal serum ionized calcium concentrations (Cap 1.06–1.26 mmol/1); 15 had slight (CaF 0.80–1.05 mmol/1); 43 a moderate (CaF 0.50–0.79 mmol/1), and 31 asevere (CaF 1.80 mmol/1 (severe hypercalcemia). This was also found in 13 of 15 (86.7 %) slightly hypocalcemic cows and in 31 of 43 (72.1 %) moderately hypocalcemic cows. In the severe hypocalcemia group 14 of 31 (45.2 %) had maximum posttreatment Cap > 1.80 mmol/1). These findings emphazise the need of a rapid pretreatment evaluation of the degree of hypocalcemia. The present study also underlined the difficulty in predicting serum ionized calcium from serum total calcium concentrations.