Hypoparathyroidism In Patients Research Articles

Risk of Permanent Hypoparathyroidism After Total Thyroidectomy for Benign Disease: A Nationwide Population-based Cohort Study From Sweden.

To investigate the prevalence and risk factors for permanent hypoparathyroidism after total thyroidectomy for benign disease in a population-based setting with data independent of input of complication data. The reported rate of permanent hypoparathyroidism is highly variable and mostly rely on reported complication data from national or institutional registries. All patients who underwent total thyroidectomy in Sweden from 2005 to 2015 were identified through Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery and the Swedish National Patient Register. Patients were matched to outcome data from the Swedish Prescribed Drug Register. Permanent hypoparathyroidism was defined as treatment with calcium and/or active vitamin D more than 1 year after surgery. Seven thousand eight hundred fifty-two patients were included and 938 (12.5%) developed permanent hypoparathyroidism. The risk was lower in patients registered in the quality register (11.0% vs 16%, P < 0.001). In a multivariable analysis there was a higher risk of permanent hypoparathyroidism in patients with parathyroid autotransplantation [Odds ratio (OR) 1.72; 95% confidence interval 1.47-2.01], center-volume <100 thyroidectomies per year (OR 1.22; 1.03-1.44), age above 60 year (OR 1.64; 1.36-1.98) and female sex (OR 1.27; 1.05-1.54). Reported data from the quality register only identified 178 of all 938 patients with permanent hypoparathyroidism. The risk of permanent hypoparathyroidism after total thyroidectomy was high and associated with parathyroid autotransplantation, higher age, female sex and surgery at a low volume center. Reported follow-up data might underestimate the rate of permanent hypoparathyroidism.

Elective Central Compartment Lymph Node Dissection Does not Increase the Risk of Postoperative Hypoparathyroidism in Patients Treated for Differentiated Thyroid Cancer

SUMMARYAimThe aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer.MethodsA retrospective analysis of 179 patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups.ResultsA total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLNd group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLNd group. The rate of persistent hypoparathyroidism in the TT and TT + CCLNd groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLNd group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant.DiscussionWhile its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies.ConclusionOur results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy.

Postoperative hypoparathyroidism in patients after total thyroidectomy - experience of a tertiary center in Romania

Postoperative hypoparathyroidism in patients after total thyroidectomy - experience of a tertiary center in Romania

Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis

The prevalence of postoperative hypoparathyroidism has been studied in registries and in surgical series with highly variable and imprecise results. However, the frequency of this hormonal deficiency in the clinical practice of endocrinologists is not known with accuracy. We aimed to assess the prevalence and risk factors of hypoparathyroidism in patients undergoing total thyroidectomy in Spain. We designed a retrospective, multicentre and nation-wide protocol including all patients with total thyroidectomy who were seen in the endocrinology clinic of the participant centers from January to March 2018. Prevalence of hypoparathyroidism was evaluated at discharge of surgery, 3-6 months after surgery, 12 months after surgery and at last visit. Twenty hospitals participated in the study. Of 1792 patients undergoing total thyroidectomy, 866 (48.3%) developed postoperative hypoparathyroidism at discharge of surgery. Most of them recover parathyroid function over time. Prevalence of hypoparathyroidism at 3-6 months, 12 months and at last visit was 22.9%, 16.7% and 14.5%, respectively. The risk of developing definitive hypoparathyroidism was related to the presence of parathyroid tissue at histology, lymph node dissection, and two-stage thyroidectomy. Patients with thyroid cancer, with higher postoperative calcium levels and treated by expert surgical teams exhibited lower risk of developing permanent hypoparathyroidism. Although most patients with postsurgical hypoparathyroidism recover parathyroid function, the prevalence of permanent disease in clinical practice is non negligible (14.5%). Postoperative calcium, extent and timing of surgery, the presence of cancer, expert surgical team, and parathyroid tissue at histology are predictors of permanent hypoparathyroidism.

Morbidity Outcomes of Prophylactic Central Neck Dissection with Total Thyroidectomy versus Total Thyroidectomy Alone in Patients with Node Negative Papillary Thyroid Cancer: A Meta-Analysis of Observational Studies

Objective: The primary objective of this meta-analysis is to compare locoregional recurrence, vocal cord paralysis, and permanent hypoparathyroidism in patients with thyroid papillary carcinoma without neck node metastases, after total thyroidectomy with and without prophylactic central neck dissection.&#x0D; Methods: Two independent reviewers performed a detailed literature search of MEDLINE (PubMed), HERDIN and Cochrane Library electronic databases to assess research studies until 2018 for inclusion. The primary endpoints of locoregional recurrence, permanent hypoparathyroidism, and vocal cord paralysis were included in the assessment.&#x0D; Design: Meta-Analysis of Retrospective Cohort Studies&#x0D; Setting: University Hospitals and Tertiary Referral Centers&#x0D; Participants: Patients with node-negative papillary thyroid cancer who underwent either total thyroidectomy alone or total thyroidectomy with prophylactic central neck dissection (either unilateral or bilateral).&#x0D; Results: This meta-analysis showed that there is a significantly increased risk for locoregional recurrence in the total thyroidectomy alone group (1.96% TT with pCND VS 2.60% TT, RR=0.62, 95% Cl=0.40-0.95, p=.03), permanent hypoparathyroidism in the total thyroidectomy with prophylactic central neck dissection group (5.72% TT with pCND vs 3.34% TT, RR=2.19, 95% Cl=1.62-2.98, p=.00001) and no significant difference for vocal cord paralysis between the 2 groups (RR=1.56, 95% Cl=0.86-2.84, p=.14).&#x0D; Conclusion: This meta-analysis revealed that performing pCND in patients with node-negative PTC increases the risk of morbidity for hypoparathyroidism but not for vocal cord paralysis. More importantly, the incidence of recurrence is decreased in the pCND group, which may have implications on the overall survival of patients. The benefit of performing pCND may outweigh the risk but the role of prophylactic CND in the treatment of patients with PTC with clinically negative lymph nodes is still debatable in terms of overall survival.&#x0D; &#x0D; Keywords: thyroidectomy, complications; neck dissection; papillary thyroid carcinoma; lymph node dissection; recurrence; vocal cord paralysis; hypoparathyroidism

Postoperative Hypoparathyroidism in Patients After Total Thyroidectomy - Experience of a Tertiary Center in Romania.

Background: Post-surgical hypoparathyroidism (PoSH) is a common long-term complication after thyroid surgery. The reported median (range) incidence rates of temporary and permanent PoSH was 27% (19 - 38%) and 1% (0 - 3%) respectively. Material and Methods: We retrospectively analyzed the files of 552 patients who underwent thyroidectomy in our surgery department between 2015- 2017 with the aim to assess the prevalence of PoSH and to identify patient and disease related factors associated with postoperative hypocalcemia. Results: 171 (30.97%) patients developed PoSH, 88.37% transient, 11.63% permanent. The median (IQR) duration of postoperative hypocalcemia was 60 (67.5) days. Preoperative biological parameters were similar in PoSH and the control group, except median (IQR) serum magnesium level that was significantly higher in PoSH group [2.04 (0.17) vs. 1.89 (0.28) mg/dl, p=0.005]. In the subgroup of patients with thyroid carcinoma the surgery duration was longer in PoSH patients compared to the control group [135 (60) vs. 110 (43) minutes, p=0.020]. In patients with PoSH, median post-operative serum calcium was significantly higher in patients with reported difficult surgery [8.2 (0.2) vs. 7.9 (0.6) mg/dl, p=0.043] and the mean serum calcium decrease was higher in patients with cervical neck dissection and lymphadenectomy (1.94 +-0.59 vs. 1.68 +-0.56 mg/dl, p=0.033). Conclusions: Our data show a high prevalence of PoSH that is likely to increase given the rising number of thyroid surgeries being performed. Further research is needed in order to better define this condition, to establish appropriate treatment and preventive measures.

Evaluation of Thyroid Functions and Anti-Thyroid Peroxidase Antibodies in Patients with Vitiligo

Vitiligo is a common skin disorder, and the pathogenesis is unknown. An increased prevalence of autoimmune thyroid diseases has been described in these patients. The aim of this study is to assess the prevalence of thyroid dysfunction and hypoparathyroidism in patients with vitiligo. One hundred and twenty patients (48 males and 72 females) with vitiligo were enrolled. Thyroid physical examination was carried out. Thyroid function tests, thyroid antibodies, calcium and phosphorus were assessed. The collected data were analysed. Thyromegaly was found in 32.1% of patients. Hypothyroidism was found in 18 (16.7%) out of 120 cases. Two of them had clinical and 14 had subclinical hypothyroidism. One patient had Grave's disease. Antibody positivity was the most common disorder (anti-TPO and anti-tg were positive in 38.7 and 34.1%, respectively). No patient had hypoparathyroidism. Thyroid dysfunction, particulary hypothyroidism and thyroid antibodies increased in patients with vitiligo.

Does the number of parathyroid glands autotransplanted affect the incidence of hypoparathyroidism and recovery of parathyroid function?

BackgroundThe relationship between the number of parathyroid glands autotransplanted and hypoparathyroidism as well as recovery of parathyroid function is not understood fully. The aim was to ascertain whether the number of autotransplanted glands affected the incidence of hypoparathyroidism and recovery of parathyroid function in long-term follow-up after thyroidectomy. MethodsA retrospective cohort study included all patients with papillary thyroid carcinoma who underwent first-time total thyroidectomy with central neck dissection between June 2012 and June 2015. The patients were divided into 4 groups (0, 1, 2, and 3) on the basis of the number of parathyroid glands autotransplanted. ResultsOf the 766 patients, 283 (36.9%) had no gland autotransplanted, and 373 (48.7%), 97 (12.7%), and 13 (1.7%) had 1, 2, and 3 glands autotransplanted, respectively. More lymph nodes and more metastatic ones in the central compartment were retrieved in groups 2 and 3 (P < .05). With increasing number of autotransplanted glands, the incidence of transient hypoparathyroidism was 26.1%, 36.2%, 52.6%, and 84.6% (P < .05), and the incidence of permanent hypoparathyroidism was 1.8%, 1.1%, 1.0%, and 0% (P > .05). The recovery rates of serum parathyroid hormone concentration were 84.7%, 82.2%, 82.0%, and 79.2% after 2-year follow-up (P > .05). ConclusionAutotransplantation is an effective strategy for restoration of parathyroid function. Transient hypoparathyroidism is positively correlated to the number of autotransplanted parathyroid glands during total thyroidectomy with central neck dissection. There is no increase in permanent hypoparathyroidism in patients with a higher number of autotransplanted glands, despite more extensive lymph node disease. (Surgery 2018;161:XXX-XXX.)

LONG-TERM RESULTS FOR THE TREATMENT OF PATIENTS WITH THE APPLICATION OF ORGAN-PRESERVING OPERATIONS IN PAPILARY THYROID CANCER

Іn order to analyse the changes in the structural and functional state of the thyroid gland, a group of 185 patients (67.8 %) were examined after the surgical treatment of papillary thyroid cancer. Of these, 94 patients belonged to the first group – the comparison group where thyroidectomy was performed, and 91 to the second – the main group where, mainly, organ-preserving operations were performed. The average follow-up was 6.5 ± 5.1 years (varied from 2 to 11 years. Hypoparathyroidism in patients receiving replacement therapy was observed in 20 (16.4 %) patients after thyroidectomy and only in 4 (6.3 %) patients after organ-preserving techniques (the differences are significant, p &lt; 0.05). Side effects of replacement therapy were observed in 21 (17.2 %) patients after thyroidectomy and only in 4 (6.3 %) patients after organ-preserving techniques (the differences are significant, p &lt; 0.05). Disease recurrence was detected in 4 (3.3 %) patients after thyroidectomy and in 1 (1.6 %) patient after organ-preserving techniques (the differences are not significant, р &gt; 0.05). The use of organ-preserving approaches in the main group allowed improving functional results by reducing the frequency of hypothyroidism and side effects of replacement therapy, due to the preservation of thyroid secretion and its regulation, without worsening the results of relapse-free survival.

A nomogram to predict the likelihood of permanent hypoparathyroidism after total thyroidectomy based on delayed serum calcium and iPTH measurements.

Retrospective studies have shown that delayed high-normal serum calcium and detectable iPTH are independent variables positively influencing outcome of prolonged parathyroid failure after total thyroidectomy (TT). The aim of the present study was to examine prospectively the ability of these two variables to predict permanent hypoparathyroidism in patients under replacement therapy for postoperative hypocalcemia. Prospective observational multicenter study of patients undergoing TT followed by postoperative parathyroid failure (serum calcium <8 mg/dL within 24 h and PTH <15 pg/mL 4 h after surgery). Serum calcium, vitamin D and iPTH were determined before thyroidectomy, 24 h after surgery, at 1 month and then periodically until recovery of the parathyroid function or permanent hypoparathyroidism was diagnosed after at least 1 year follow-up. Some 145 patients with postoperative hypocalcemia were investigated [s-Ca24h 7.5 (0.5) mg/dL]. Hypocalcemia recovered within 30 days in 91 (63%) patients and 54 (37%) developed protracted hypoparathyroidism {iPTH 5.8 [4] pg/mL at 1 month}, of whom 32 recovered within 1 year and 22 developed permanent hypoparathyroidism. Protracted hypoparathyroidism was related to few parathyroid glands remaining in situ (PGRIS). Serum calcium concentration (mg/dL) at 1 postoperative month correlated positively with the rate of recovery (percent) from protracted hypoparathyroidism: <8.5 (20%); 8.5-9 (29%); 9.1-9.5 (70%); 9.6-10 (89%); >10 (83%) (P=0.013). Serum iPTH at 1 month was also higher (7.3 vs. 3.7 pg/mL; P=0.002) in recovered protracted hypoparathyroidism. The combination of both variables predicts the likelihood of recovery of the parathyroid function with >90% accuracy. High-normal serum calcium and low but detectable iPTH concentrations at 1 month after TT were associated with better outcome of protracted hypoparathyroidism. A nomogram combining both variables may guide medical treatment and monitoring of post-thyroidectomy prolonged hypoparathyroidism.

Prolonged Duration of Surgery Predicts Postoperative Hypoparathyroidism among Patients Undergoing Total Thyroidectomy in a Tertiary Referral Centre

Background: Postoperative hypoparathyroidism is a common complication following total thyroidectomy. The aim of this study was to investigate the incidence of both transient and permanent hypoparathyroidism in patients undergoing total thyroidectomy in a tertiary referral centre and, furthermore, to identify early predictive risk factors. Methods: Based on a single-institution retrospective review, we identified 582 patients who underwent total thyroidectomy between January 2010 and March 2015. Information on age, gender, pathological diagnosis, duration of surgery, autotransplantation of parathyroid glands, neck dissection, and experience and position of the surgeon was retrieved from the medical records. Furthermore, serum levels of parathyroid hormone and calcium were registered pre- and postoperatively and after 3 and 12 months. Results: The incidence of transient hypoparathyroidism during the first 24 h and 3 months after surgery was 47.8 and 17.8%, respectively. Furthermore, the incidence of permanent hypoparathyroidism 1 year after surgery was 10.7%. A prolonged duration of surgery was significantly associated with hypoparathyroidism. Moreover, autotransplantation of parathyroid glands was a significant predictor of transient hypoparathyroidism after 24 h and 3 months, but was not associated with permanent hypoparathyroidism. Conclusions: Transient and permanent hypoparathyroidism is common among patients undergoing total thyroidectomy in a tertiary referral centre. A duration of surgery >120 min constitutes an independent risk factor due to the risk of ischaemic damage. Regain of function of devascularized parathyroid glands must be expected to last at least 1 year postoperatively. Furthermore, the recovery of autotransplanted parathyroid glands should not be evaluated within 1–3 months after surgery.

Long-Term Follow-Up and Treatment of Postoperative Permanent Hypoparathyroidism in Patients with Medullary Thyroid Carcinoma: Differences in Complete and Partial Disease.

This study aimed to identify factors influencing long-term outcome in complete or partial postoperative hypoparathyroidism (parathyroid hormone ≤10 or >10 ng/l, respectively) in medullary thyroid carcinoma (MTC). It was designed as retrospective, long-term follow-up with single-center outpatient visits. Quality of treatment, renal calcification, and function were evaluated. In 33 patients with MTC and postoperative hypoparathyroidism, current medication includes: calcium (73%), calcitriol (73%), alfacalcidol (6%), dihydrotachysterol (3%), and cholecalciferol supplements (21%). Mean hypoparathyroidism duration was 15.9±9.4 years. Initially, 15% of patients received high cholecalciferol dosages. Initial calcium dosages were higher (1 542±1 179 mg/day) than final dosages (1 188 ± 595 mg/day) (p<0.05); calcitriol dosages remained constant. Over the median observation period of about 12 years it was found that serum calcium was within the target range (2.0-2.3 mmol/l) in 63% of visits, decreased (<2.0 mmol/l) in 20.4%, high-normal (2.4-2.6 mmol/l) in 15.8%, and increased (>2.65 mmol/l) in 0.9% of visits. Calcitriol dosages were 0.73±0.22 μg/day and 0.47±0.20 μg/day in patients with complete (n=13) and partial (n=20) hypoparathyroidism, respectively (p=0.008). Renal function decreased slightly during follow-up (eGFR: 102±22 vs. 90±27 ml/min). eGFR was negatively correlated with hypoparathyroidism duration (r=-0.35, p=0.05). Of 9 patients with renal calcification, 5 had received high initial cholecalciferol doses. eGFR was lower in patients with than in those without calcification (77±17 vs. 95±29 ml/min) (p=0.07). At least one tetanic episode occurred in 60.6% of patients, and 9% had repeated tetanic complaints. In conclusion, severity of hypoparathyroidism affects treatment: Partial hypoparathyroidism required lower calcitriol dosages than complete hypoparathyroidism. Renal calcifications occurred more frequently in patients treated initially with high cholecalciferol dosages. Impaired renal function was related to hypoparathyroidism duration and renal calcification.

Prevalence of Hypoparathyroidism in Patients with Thalassemia Major in Iran

BACKGROUND AND OBJECTIVE: Hypoparathyroidism is one the common complications of endocrine in patients with thalassemia major. Several studies have been conducted to report the prevalence of Hypoparathyroidism in patients with thalassemia major in Iran. However, there is no comprehensive assessment of it. Therefore, the present study was conducted to investigate the prevalence of Hypoparathyroidism in patients with thalassemia major in Iran through systematic review and meta-analysis. METHOD:The present study was conducted based on PRISMA checklist for systematic review and meta-analysis studies. We searched national and international online databases such as Magiran, Iranmedex, SID, Medlib, Scopus, PubMed, Science Direct, Cochrane, Web of Science, Springer, Online library Wiley and Google Scholar for certain standard keywords without time limit until 2016. FINDING:In 19 studies, 3219 patients with thalassemia major were examined. Prevalence of Hypoparathyroidism in patients with thalassemia major in Iran was calculated to be 10 (CI-95: 7-10). Moreover, the percentage for various regions of Iran was different; 14 in the west, 18 in the east, 10 in the north, 12 in the south and 7 in the center of Iran. Prevalence of Hypoparathyroidism in men and women was estimated to be 9 and 14, respectively. CONCLUSIONS:Prevalence of Hypoparathyroidism in patients with thalassemia major in Iran is high. Therefore, new policy and planning are necessary to minimize the complications of endocrine glands including Hypoparathyroidism in patients with thalassemia major in Iran. © 2016, Babol University of Medical Sciences. All rights reserved.

Bone disease in the field of CKD-MBD

The pathophysiology and treatment for renal bone disease have made remakable progress. Moreover, osteocyte reseach has made tremendous progress. In the clinical aspect, (1) hyperphosphatemia, (2) hyperparathyroid and hypoparathyroid bone disease in patients with chronic kidney disease, (3) increased serum level of fibroblast growth factor 23 (FGF-23) and(4) reduced level of Klotho should be taken into consideration when analyzing these conditions. On the other hand, hyperphosphatemia must be successfully treated. Hyperparathyroid bone disease has been successfully treated with vitamin D sterol, cinacalcet hydrochloride and parathyroidectomy, however, the treatment of hypoparathyroidism inpatient with diabetes or non-diabetes met with high hurdles. We must treat these patients in thinking about osteocytic perilacunar/canalicular system.

Risk factors of hypoparathyroidism following total or near total thyroidectomy

To study the risk factors for postoperative hypoparathyroidism or hypocalcemia. Totally 414 patients with thyroid diseases who underwent total or near total thyroidectomy at Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute from June 2007 to June 2014 were studied retrospectively. There were 119 male and 295 female patients with a median age of 47 years. The clinical and pathological features that related to post-operative hypoparathyroidism were studied by χ(2) test and multivariate Logistic regression analysis. Of the 414 patients, 36.2% developed transient hypocalcemia, 36.5% developed transient hypoparathyroidism, 2.2% developed permanent hypoparathyroidism. In regression analysis, unilateral or bilateral center lymph node dissection were associated with mild transient hypocalcemia after surgery (OR=2.366, P=0.022; OR=5.216, P=0.000); unilateral or bilateral center lymph node dissection as well as surgical options were significant risk factors for severe transient hypocalcemia (OR=4.029, P=0.001; OR=8.384, P=0.000; OR=2.073, P=0.017) and hypoparathyroidism (OR=1.755, P=0.040; OR=4.144, P=0.000; OR=2.287, P=0.000). The parathyroid hormone concentration on postoperative day 1 was an independent risk factor for permanent hypoparathyroidism (OR=2.011, P=0.014). The concentration of parathyroid hormone threshold <5.28 ng/L was a predictor to permanent hypoparathyroidism with accuracy of 95.0%. Bilateral center lymph node dissection is a risk factor of permanent hypoparathyroidism in patients received total thyroidectomy should be taken thoughtfully. The parathyroid hormone concentration on postoperative day 1 provides better prediction for persistent hypoparathyroidism.

Recovery from Permanent Hypoparathyroidism After Total Thyroidectomy.

Permanent hypoparathyroidism after total thyroidectomy is a rare but potentially serious iatrogenic complication. The aim of this study was to investigate the rate of recovery from postoperative, permanent hypoparathyroidism in patients undergoing thyroidectomy without parathyroid autotransplantation. This study was a prospective case series with a postoperative follow-up of up to 3 years. We enrolled patients with thyroid cancer who underwent total thyroidectomy with central compartment dissection, with or without lateral neck dissection, and who had postoperative permanent hypoparathyroidism, defined as serum levels of intact parathyroid hormone (PTH) <15 pg/mL for at least 1 year. In the postoperative follow-up period, the serum levels of PTH and calcium were measured regularly. Recovery from permanent hypoparathyroidism was defined as return to normal serum levels of PTH (15-65 pg/mL) and calcium (8.5-10.1 mg/dL) without calcium and/or vitamin D supplementation. In the 1467 patients who underwent total thyroidectomy, 22 presented with permanent postoperative hypoparathyroidism. In 5 of these 22 patients, the PTH levels increased steadily and returned to normal in 27.6±2.9 months, after which supplementation of calcium and vitamin D could be discontinued. Although recovery from permanent hypoparathyroidism is rare, patients should be monitored for serum PTH levels so that unnecessary treatments such as calcium and vitamin D supplementation can be avoided.

Graves’ disease: a review of surgical indications, management, and complications in a cohort of 59 patients

An analysis of 59 patients who underwent total thyroidectomy for the treatment of Graves’ disease over a 6-year period was conducted in order to assess the current indications and identify any specific factors that may influence the patient's decision to opt for surgical treatment. A comparison of outcomes between the current study and a similar one from Hong Kong was also attempted. Patient preference was the most common reason for opting for surgery over radioactive iodine in both studies. Other indications for surgery, such as Graves’ ophthalmopathy, patient refusal for radioactive iodine, large goitre with pressure symptoms, planning for pregnancy, young age, and intolerance to anti-thyroid drugs, were also similar in the two groups. There were no statistically significant differences in laryngeal nerve palsy between the two groups. The rates of permanent hypoparathyroidism in patients in Hong Kong and in the present study were 5.4% and 5.1%, respectively. No patient in either study had recurrent Graves’ disease after total thyroidectomy. Our findings confirmed that patient preference is the leading indication for surgery, implicating a continuous misconception of radioactive substances and increasing confidence in surgical outcomes. In experienced hands, the risks of recurrent laryngeal nerve injury and permanent hypoparathyroidism remain minimal.

Long-Term Hypoparathyroidism and Hypophosphatemia in Dialysis Patients.

Background and Objectives. Hypoparathyroidism in patients with functioning kidneys leads to hyperphosphatemia. This article reviews data suggesting that hypoparathyroidism in patients on dialysis leads to hypophosphatemia. Design. Clinical data of the following were reviewed: (a) a patient with hypoparathyroidism before and during chronic dialysis; (b) patients on dialysis with surgically created hypoparathyroidism; (c) dialysis patients being treated with Cinacalcet, a calcium-sensing receptor agonist that lowers parathyroid hormone (PTH) levels; and (d) dialysis patients being treated with Velcalcetide, a new calcium-sensing receptor agonist that also lowers PTH. Results. In the patient presented in this study, in patients with surgically created hypoparathyroidism, and those receiving Cinacalcet or Velcalcetide, a fall in PTH was associated with hypophosphatemia or a fall in serum phosphorus. Conclusion. In patients on dialysis, hypoparathyroidism may lead to hypophosphatemia.

Clinical Characteristics for Early Recovery from Temporary Hypoparathyroidism in Patients Undergoing Total Thyroidectomy

Clinical Characteristics for Early Recovery from Temporary Hypoparathyroidism in Patients Undergoing Total Thyroidectomy

Heart failure due to chronic hypoparathyroidism in patient with acute coronary syndrome

Severe heart failure can be a rare symptom of hypocalcemia. We report a case of a 58 year-old male admitted with a diagnosis of acute coronary syndrome. The ECG showed prolonged QTc interval with severly impared left ventricular ejection fraction recognised in echocardiography. During the hospitalisation hypocalcemia due to primary hypoparathyreoidism was revealed to be the cause of those symptoms.