Parathyroidectomy In Patients Research Articles

부갑상선 절제술에 있어 반회후두신경의 수술 중 신경감시술의 임상적 의의

Background and Objectives Intraoperative nerve monitoring (IONM) has been gaining acceptance as a formal practice of thyroid and parathyroid surgery. However, most studies of IONM for recurrent laryngeal nerve (RLN) primarily focused on thyroid surgery. In this study, we evaluated clinical implications of IONM solely in parathyroid surgery, by comparing results of parathyroidectomy in patients with or without IONM. Materials and Methods This study designed as a retrospective cohort study. Between 2010 and 2022, patients who underwent parathyroidectomy for the treatment of hyperparathyroidism were included. Patients were divided into the no IONM and IONM groups and compared clinicopathological and surgical parameters according to the use of IONM. Results A total of 107 patients involving 65 patients in the IONM group and 42 patients in the IONM group were included in the study. In the IONM group, proportion of surgical type of uni- and bilateral neck exploration was significantly higher in the IONM group than the no IONM group (35.7% vs. 6.2%, p<0.001). Rate of RLN identification during surgery was significantly higher in the IONM group than the no IONM group (81.0% vs. 43.1%, p<0.001). Operating time for minimal invasive/focused parathyroidectomy was significantly shorter in the IONM group than the no IONM group (61.8 min vs. 85.6 min, p<0.001). Vocal cord paralysis occurred only 1 case in each group without significant difference in the incidence. Conclusion Use of IONM would contribute to safe and faster parathyroidectomy, justifying its routine use in parathyroid surgery.

#3065 Factors associated with recurrence or persistently high parathormone levels after parathyroidectomy in patients with CKD

Abstract Factors associated with recurrence or persistently high parathormone levels after parathyroidectomy in patients with secondary hyperparathyroidism receiving renal replacement therapy Background and Aims Resistant hyperparathyroidism that indicates surgery usually occurs in patients with CKD who receive renal replacement therapy (RRT). This study aims to evaluate the factors associated with persistent or recurrent high levels of PTH after parathyroidectomy due to SHPT in patients receiving RRT. Method In this retrospective study, we included 66 adult patients (mean age: 46.86 ± 13.79) with parathyroidectomy for SHPT receiving renal replacement therapy. Clinicopathological features, laboratory parameters (preoperatively, at the first hour of surgery, at least every three months for at least two years after surgery), type of surgery and pathologic diagnosis were recorded from the medical records. Persistence was defined as failure to achieve a decrease in PTH level of more than fifty percent of preoperative PTH level. Recurrence was defined as elevated PTH levels after six months post-operation (>600 pg/mL). Results The demographics and clinical characteristics of the study population are described in Table 1. High PTH levels were observed in nineteen patients, while recurrence was observed in nine. Persistence was associated with lower preoperative ALP levels (455.27 ± 296.23, 619.72 ± 593.18, p = 0.017). Recurrence was associated with higher preoperative CRP levels (22.89 ± 6.82, 6.82 ± 5.35, p:0,046) and postoperative high phosphorus levels (4.93 ± 0.99, 4.16 ± 1.09, p = .049). Conclusion In our study persistence of high parathormone levels were more common in patients with lower preoperative ALP levels and recurrence was associated with higher preoperative CRP levels and postoperative inadequate phosphorus control. In conclusion, patients with lower ALP and higher CRP levels can be suitable for total parathyroidectomy, which is associated with a lower recurrence rate in SHPT. Also, postoperative phosphorus control can be a key point for preventing the patients' recurrence of high PTH level.

Letter to the editor: a commentary on 'predictive factors for persistent hypercalcemia following parathyroidectomy in patients with persistent hyperparathyroidism after kidney transplantation: a retrospective cohort study'.

Letter to the editor: a commentary on 'predictive factors for persistent hypercalcemia following parathyroidectomy in patients with persistent hyperparathyroidism after kidney transplantation: a retrospective cohort study'.

Pretransplant Parathyroidectomy in Patients with Severe Secondary Hyperparathyroidism and Long-Term Effectiveness After Kidney Transplantation.

Kidney transplantation (KT) is the best option for patients with end-stage renal disease, but recipients still have legacy bone mineral disease from the pretransplant period, especially patients with severe secondary hyperparathyroidism (sHPT). Patients who had severe sHPT and underwent KT were analyzed retrospectively. Two groups were identified (patients with severe sHPT who had parathyroidectomy or calcimimetic before KT). Bone mineral density (BMD) was measured in the first year and last follow-up at the femoral neck, total hip, and lumbar spine using the dual-energy X-ray absorptiometry (DXA). Persistent hyperparathyroidism (perHPT) incidence was significantly higher in the calcimimetic group (75% vs. 40%, p=0.007). In patients with parathyroidectomy, BMDs were higher at femoral neck (0.818±0.114 vs. 0.744±0.134, p=0.04) and lumbar spine (1.005±0.170 vs. 0.897±0.151, p=0.01) at the first assessment. The BMD comparison between patients treated with parathyroidectomy and calcimimetic found a significant difference only in the femoral neck at second evaluation (0.835±0.118 vs. 0.758±0.129; p=0.03). In multivariate, linear regression revealed a positive association between the last BMD of the femoral neck with body mass index (CC: 0.297, 95% CI, 0.002-0.017) and parathyroidectomy (CC: 0.319, 95% CI, 0.021-0.156). Parathyroidectomy is associated with a significantly better femoral neck BMD and a lower incidence of perHPT in patients with severe sHPT.

Outcomes of parathyroidectomy in patients with primary hyperparathyroidism

Outcomes of parathyroidectomy in patients with primary hyperparathyroidism

Association between preoperative cholecalciferol therapy and hypocalcemia after parathyroidectomy in patients with primary hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH) from parathyroid gland tumors. Parathyroidectomy (PTE) is the main treatment for PHPT, but it can lead to hypocalcemia in up to 46% of cases. Hypocalcemia is associated with seizures and life-threatening cardiac arrhythmias, and vitamin D deficiency can exacerbate PHPT severity and contribute to «hungry bones syndrome,» resulting in severe and persistent postoperative hypocalcemia. To evaluate the association and determine the strength of the relationship between preoperative cholecalciferol therapy and the occurrence of hypocalcemia within 1-3 days after PTE in patients with PHPT. The study was conducted at the Endocrinology Research Centre, during the periods of 1993-2010 and 2017-2020. The inclusion criteria consisted of patients diagnosed with PHPT who required PTE, had a serum 25-hydroxyvitamin D (25(OH)D) level below 20 ng/mL, and a serum total calcium level below 3 mmol/L. The exclusion criterion was the use of medications that affect calcium-phosphorus metabolism, including cinacalcet, denosumab, or bisphosphonates, either as monotherapy or as part of combination therapy. There were 117 patients, including 110 (94%) females and 7 (6%) males. The median age and interquartile range were 58 [49; 65] years. Among the participants, 21 (18%) received cholecalciferol supplementation for a duration of 2 weeks to 2 months prior to PTE, aiming to address vitamin D deficiency. The remaining 96 (82%) participants did not receive -cholecalciferol supplementation. Both groups, i.e., participants receiving cholecalciferol and those who did not, were similar in terms of anthropometric factors (sex and age at the time of surgery), preoperative clinical characteristics (BMD decrease), and laboratory parameters (PTH, total calcium, phosphorus, ALP, OC, CTX-1, and 25(OH)D levels). The occurrence of postoperative hypocalcemia was significantly lower in participants who received cholecalciferol supplementation (10% vs. 63%, p<0,001, FET2). Cholecalciferol intake showed a negative association with hypocalcemia development (RR=0,15, 95% CI (0,03; 0,51)). Preoperative cholecalciferol supplementation for 2 weeks to 2 months before PTE reduces the risk of postoperative hypocalcemia in patients with PHPT by 2-33 times.

PHQ-9 and GAD-7 Score Response After Parathyroidectomy for Primary Hyperparathyroidism: a Systematic Review and Meta-analysis.

Currently, the relationship between parathyroidectomy and objective neuropsychiatric outcomes are not clearly defined. The purpose of this study is to perform the first ever Meta-analysis of preoperative and postoperative PHQ-9 and GAD-7 scores in patients with primary hyperparathyroidism undergoing parathyroidectomy with the goal of identifying a specific psychometric score that could be used as an indication for surgical intervention. A comprehensive search of the literature was performed using PubMed, Embase, PsycINFO, Web of Science, and Ovid All EBM Reviews. Studies met inclusion criteria if they evaluated preoperative and postoperative PHQ-9 and/or GAD-7 scores in patients with primary hyperparathyroidism undergoing parathyroidectomy. Random effects Meta-analyses were used to analyze the compiled data. The literature search returned 1433 articles for initial review of which 6 (1105 participants) met criteria for inclusion and Meta-analysis. Meta-analysis revealed that primary hyperparathyroidism patients had significantly higher presurgical PHQ-9 scores when compared to control groups. Additionally, patients experienced a statistically significant and sustained decrease in PHQ-9 scores following parathyroidectomy. Notably, there was a dramatic decrease in the percentage of patients with PHQ-9 scores ≥10 (considered clinically significant for depression) following parathyroidectomy. Patients with primary hyperparathyroidism experience a statistically significant and sustained improvement in PHQ-9 scores following parathyroidectomy. Additionally, symptoms of anxiety and suicidal ideation appear to decrease after parathyroidectomy. We propose that a PHQ-9 score ≥10 could potentially be used as an indication for parathyroidectomy in patients with asymptomatic primary hyperparathyroidism.

Predictive factors for persistent hypercalcemia following parathyroidectomy in patients with persistent hyperparathyroidism after kidney transplantation: a retrospective cohort study.

Surgery for irreversible hyperparathyroidism is the preferred management for kidney transplant patients. The authors analyzed the factors associated with persistent hypercalcemia after parathyroidectomy in kidney transplant patients and evaluated the appropriate extent of surgery. The authors retrospectively analyzed 100 patients who underwent parathyroidectomy because of persistent hyperparathyroidism after kidney transplantation at a tertiary medical center between June 2011 and February 2022. Patients were divided into two groups: 22 with persistent hypercalcemia after parathyroidectomy and 78 who achieved normocalcemia after parathyroidectomy. Persistent hypercalcemia was defined as having sustained hypercalcemia (≥10.3mg/dl) 6 months after kidney transplantation. The authors compared the biochemical and clinicopathological features between the two groups. Multivariate logistic regression analysis was used to identify potential risk factors associated with persistent hypercalcemia following parathyroidectomy. The proportion of patients with serum intact parathyroid hormone (PTH) level is greater than 65pg/ml was significantly high in the hypercalcemia group (40.9 vs. 7.7%). The proportion of patients who underwent less than subtotal parathyroidectomy was significantly high in the persistent hypercalcemia group (17.9 vs. 54.5%). Patients with a large remaining size of the preserved parathyroid gland (≥0.8cm) had a high incidence of persistent hypercalcemia (29.7 vs. 52.6%). In the multivariate logistic regression analysis, the drop rate of intact PTH is less than 88% on postoperative day 1 (odds ratio 10.3, 95% CI: 2.7-39.1, P =0.001) and the removal of less than or equal to 2 parathyroid glands (odds ratio 6.8, 95% CI: 1.8-26.7, P =0.001) were identified as risk factors for persistent hypercalcemia. The drop rate of intact PTH is less than 88% on postoperative day 1 and appropriate extent of surgery for controlling the autonomic function were independently associated with persistent hypercalcemia. Confirmation of parathyroid lesions through frozen section biopsy or intraoperative PTH monitoring can be helpful in preventing the inadvertent removal of a parathyroid gland and achieving normocalcemia after parathyroidectomy.

Preoperative identification of small parathyroid adenomas-better done by fluorocholine positron emission tomography/computed tomography.

Preoperative localization imaging studies are crucial for safe and successful parathyroidectomy in patients with primary hyperparathyroidism (pHPT), especially in focused approaches. A common imaging sequence is ultrasound followed by scintigraphy. These techniques, but not 18F-fluorocholine positron emission tomography/computed tomography (PET/CT), show lower detection rates in multiglandular disease (MGD), which is associated with smaller adenomas. In this study, we evaluate the accuracy of these modalities in small parathyroid adenomas (PAs) and discuss the potential sequence of preoperative localization diagnostics. Patients undergoing parathyroidectomy for pHPT were retrospectively categorized into small adenoma (specimen diameter <10 mm) and large adenoma. The groups were compared for accuracy of preoperative imaging studies, short-term and long-term outcomes. Among 147 patients retrospectively analyzed in this study, 38 small PAs were found. Preoperative correct quadrant prediction for small adenomas was significantly lower for ultrasound (P=0.03) and single-photon emission computed tomography/CT (SPECT/CT) (P<0.01) but not for choline PET/CT. While PET/CT was performed significantly more often in small PAs (P<0.01), it showed highly significant superiority over the other imaging modalities in accurate preoperative localization in both small (P<0.0001) and large PAs (P<0.01). There was no difference in calcium and parathyroid hormone (PTH) levels at latest follow-up with slightly more recurrences in small adenomas (P=0.08). Choline PET/CT showed a better diagnostic yield especially for small and multiple adenomas and was better in prediction of the correct localization. It could therefore serve as a second-line imaging modality.

FRI690 Should Treatment For Osteoporosis Be Started In Patients With Primary Hyperparathyroidism Within The First Year After Parathyroidectomy?

Abstract Disclosure: K. Swe: None. A. Chiu: None. E. Pelley: None. Osteoporosis is one of the indications for parathyroidectomy in patients with primary hyperparathyroidism. Studies show the improvement of bone mineral density (BMD) in the lumbar spine and hip within the first year after parathyroidectomy. Therefore, the decision to treat osteoporosis has usually been delayed until a follow-up bone densitometry scan (DXA) at least one year after parathyroidectomy. To study the BMD changes with or without osteoporosis treatment till first follow-up DXA after parathyroidectomy, we retrospectively reviewed a prospective database of patients undergoing parathyroidectomy for primary hyperparathyroidism between 2010 to 2017 at our institution. We included both male and female patients between the ages 50 to 80, with a history of fragility fracture and/ or T score less than -2.4, and normal renal function. We excluded patients with persistent hyperparathyroidism post-surgery, osteoporosis medication within 3 years before surgery, and DXA performed outside of our facility. Patients who received osteoporosis medication between surgery and the first follow-up DXA were compared to those who underwent surgery alone. We compared the changes in BMD at the total hip and lumbar spine (L1-L4) between baseline and the first follow-up DXA for the two groups. Data was evaluated using a student’s t-test. A total of 386 patients underwent parathyroidectomy during the study period of which 92 patients met the inclusion criteria. Among them, 28 patients were treated after surgery and 64 patients had parathyroidectomy alone. The mean duration to treatment initiation after surgery was approximately 4 months (SD +/- 3 months), and the mean duration until the first follow-up DXA after the surgery was 17 months (SD +/- 8 months). There was no difference in the change of BMD at the total hip between two groups. Both increased by 0.01 g/cm2 (p=0.74). However, there was a greater increase in BMD at the lumber spine for those treated (0.047 g/cm2 increase) compared to surgery alone (0.019 g/cm2 increase) (p=0.02). We concluded that initiation of osteoporosis treatment within the first year after parathyroidectomy led to similar BMD outcomes at the total hip, but the treatment group experienced greater gains in BMD at the lumbar spine compared to parathyroidectomy alone, in patients with primary hyperparathyroidism and osteoporosis. Presentation: Friday, June 16, 2023

Pediatric head and neck manifestations associated with multiple endocrine neoplasia syndromes.

Multiple endocrine neoplasia (MEN) syndromes are a group of hereditary cancer syndromes that can predispose children to endocrine neoplasms developing within the head and neck. To examine the neoplastic manifestations of MEN type 1 (MEN1) and MEN type 2 (MEN2) in the pediatric head and neck. Single-institution, retrospective review of pediatric MEN between 2005 and 2022. Fifty-three children were genetically confirmed with MEN (15 MEN1, 34 MEN2A, and 4 MEN2B), while three patients received clinical diagnoses of MEN1. The male to female ratio was essentially equal (1.15:1), and a documented family history of cancer was present in 89% (50/56). After multidisciplinary evaluation, a familial MEN diagnosis was confirmed in 91% (51/56). The mean ages of initial presentation and surgical intervention were 8.9 years (SD 5) and 9.8 years (SD 4.8), respectively. Although patients with MEN2 received surgery earlier than patients with MEN1 (8.7 vs 12.7 years), surgical patients with MEN2 in this cohort were older relative to current American Thyroid Association (ATA) guidelines primarily due to late presentation. Thyroid malignancies were identified in 36% (9/25) of thyroidectomy specimens (21 MEN2A, 4 MEN2B), with medullary thyroid carcinoma (MTC) present in five MEN2A patients and three MEN2B patients (89%), and papillary thyroid carcinoma (PTC) present in one MEN2A patient (11%). Nearly 90% (8/9) of thyroid malignancies were occult, with some occurring earlier than predicted by current guidelines (ATA-MOD and ATA-H). Central neck dissections were performed in 24% (2 MEN1, 2 MEN2A, and 4 MEN2B), with two MEN2B (50%) demonstrating cervical lymph node (LN) metastases. Additional histopathologic findings included C-cell hyperplasia in 57% (12/21) of MEN2A thyroidectomy patients. Of the eight MEN1 parathyroidectomy patients, four demonstrated parathyroid hyperplasia and four presented with parathyroid adenoma. Nearly 60% required head and neck procedures. While MEN1 guidelines were appropriate for our cohort, we identified patients with MEN2 that developed MTC earlier than expected based on current ATA guidelines, including children in categories considered lower risk. In conjunction with a multidisciplinary approach, pediatric head and neck surgeons should be aware of the potential need for earlier surgical intervention in the pediatric MEN2 population.

Dynamic nomogram for predicting hungry bone syndrome before parathyroidectomy.

The objective of this study was to develop a dependable and uncomplicated prediction model utilizing clinical information readily accessible to patients before surgery. This model aimed to assess the likelihood of hungry bone syndrome occurrence in post-surgery patients with secondary hyperparathyroidism (SHPT), and to assist clinicians in adjusting treatment plans promptly. In this study, we constructed an online nomogram utilizing independent variables determined through multiple logistic regression to predict the probability of HBS occurrence after parathyroidectomy in patients with secondary hyperparathyroidism. To evaluate the precision and dependability of the nomogram, we used receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Multivariate logistic regression analyses on 136 eligible patients identified age, parathyroid hormone (PTH), and blood calcium as independent HBS risk factors, which were then integrated into the nomogram. The area under ROC curve demonstrated the nomogram's strong predictive accuracy. The calibration curve demonstrates consistency between the model's prediction probability and observed probability, reflecting high prediction accuracy of the nomogram. Dynamic nomograms were found to hold significant practical clinical value as demonstrated by clinical decision analysis. It can be accessed on https://min115.shinyapps.io/dynnomapp/ . In patients with secondary hyperparathyroidism, the dynamic nomogram based on age, parathyroid hormone, and blood calcium can more accurately predict the likelihood of HBS after parathyroidectomy, allowing doctors to make clinical decisions more quickly and adjust treatment plans in a timely manner to reduce the incidence of HBS.

A New Calculation Model for Calcium Requirements After Parathyroidectomy in Patients With Secondary Hyperparathyroidism.

We aimed to develop a new calculation model for calcium requirements in dialysis patients following parathyroidectomy. A total of 98 patients with secondary hyperparathyroidism receiving parathyroidectomy from January 2014 to January 2022 were enrolled in this study. Among these patients, 78 were randomly selected for construction of the calcium requirement calculation model, and the remaining 20 patients were selected for model validation. The calcium requirement model estimated the total calcium supplementation for 1 week after surgery using variables with significant relationships in the derivation group by stepwise multiple linear regression analysis. Bias, precision, and accuracy were measured in the validation group to determine the performance of the model. The model was as follows: calcium requirement for 1 week after surgery=33.798-8.929×immediate postoperative calcium+0.190×C-reactive protein-0.125×age+0.002×preoperative intact parathyroid hormone+0.003×preoperative alkaline phosphatase (R2=0.8). The model was successfully validated. We generated a novel model to guide calcium supplementation. This model can assist in stabilizing the serum calcium levels of patients during the early postoperative period. Furthermore, it contributes to the individualized and precise treatment of hypocalcemia in patients following parathyroidectomy.

Persistently Elevated Parathyroid Hormone Level after Curative Parathyroidectomy in Patients with Primary Hyperparathyroidism

Background: Persistent elevation of parathyroid hormone (PPTH) levels following curative parathyroidectomy is a dynamic &amp; multifactorial process. This study was designed to study the frequency of persistent hyperparathyroidism in our patients and to identify the potential causal factors for persistent PTH elevation following parathyroidectomy.&#x0D; Methodology: The study included prospectively collected data on post-operative patients of primary hyperparathyroidism who underwent parathyroidectomy from 2004-2018. Data was analyzed by SPSS version-21. For descriptive statistics, frequency and percentages were calculated, while mean ±standard deviation were calculated for age, duration of disease, pre-operative and post-operative biochemical parameters, like serum PTH, calcium and vitamin D levels.&#x0D; Results: A total of 11 (39.3%) patients, were diagnosed as persistent hyperparathyroidism, out of the 30 patients, who underwent parathyroidectomy. All patients were female with a mean age of 45.27+17.2 years and a mean duration of symptoms of 21.3 months. The mean post-operative PTH level, vitamin D and calcium were 154.04±78.64 pg/ml, 22.28±13.79 ng/ml 9.46±0.79 mg/dl, respectively. Fluctuation of PTH hormone in relation to erratic vitamin D intake was reported in 8 patients, and recurrent parathyroid adenoma was reported in three patients, which was subsequently re-operated.&#x0D; Conclusion: Adequate vitamin D supplementation is essential in the pre and post-operative period to prevent persistent parathyroid stimulation and possible dysregulation. Surveillance for recurrence of hyperparathyroidism should be maintained long term.

#4958 IMPROVEMENT OF NUTRITIONAL STATUS AFTER PARATHYROIDECTOMY IN PATIENTS RECEIVING MAINTENANCE HEMODIALYSIS

Abstract Background and Aims Improvement in quality of life and survival have been reported after parathyroidectomy in patients with end-stage kidney disease. In addition to bone loss, protein-energy wasting has also been linked to excess parathyroid hormone (PTH) level. The present study examined the changes of nutritional parameters after parathyroidectomy in patients receiving maintenance hemodialysis compared non-parathyroidectomized patients. Method One hundred eighty-seven hemodialysis patients who underwent parathyroidectomy during 2012–2018 were identified (PTX group) and matched 1:1 to 479 patients with parathyroid hormone (PTH) levels ≤1000 pg/mL (non-PTX control group) and 187 patients with PTH levels &amp;gt;1000 pg/mL (pre-PTX control group) by propensity score. The matchings yielded 120 matched pairs from PTX and non-PTX groups (cohort 1) and 76 matched pairs from PTX and pre-PTX groups (cohort 2). Baseline and follow-up nutritional data were compared over the 12-month study period. Results In cohort 1, substantially lower serum albumin and creatinine/body surface area (Cr/BSA) and higher proportions of patients with serum albumin ≤38 g/L (low serum albumin) and Cr/BSA ≤380 μmol/L/m2 (low serum Cr/BSA) were observed in the PTX group. These parameters and the percentage of patients with total lymphocyte count &amp;lt;800 cells/mm3 (low TLC) improved substantially after parathyroidectomy. At follow-up, serum albumin, Cr/BSA and proportions of patients with low serum albumin and Cr/BSA became comparable to the non-PTX control group. The percentage of patients with low TLC was also lower at follow-up in the PTX group. Mixed-models analysis confirmed significant differences in the changes of serum albumin, Cr/BSA, proportions of patients with low serum albumin and TLC between the two groups. In cohort 2, there was no significant difference in baseline nutritional parameters. At follow-up, serum Cr/BSA was higher and proportions of patients with body mass index (BMI) ≤18.5 kg/m2, low TLC and low Cr/BSA were lower in the PTX group. Weight gain was more frequent and of greater magnitude in the PTX group in both cohorts. Higher baseline PTH level, parathyroidectomy and lower baseline serum albumin and creatinine were significantly associated with ≥10% increase in the BMI. Conclusion Parathyroidectomy was associated with nutritional improvement in maintenance hemodialysis patients with severe hyperparathyroidism.

Comparison of Medical Management versus Parathyroidectomy in Patients with Mild Primary Hyperparathyroidism: A Meta-Analysis

Background: Parathyroidectomy is the definitive cure for patients with primary hyperparathyroidism (pHPT) and has an annual prevalence of 0.2–1% in the United States. Some patients with mild disease are medically managed effectively using calcium-lowering medications and drugs against complications such as osteoporosis; however, many maintain a persistently high calcium level that negatively impacts their skeletal, renal, and psychogenic systems over the long term. This meta-analysis aims to compare the outcomes of medical management versus parathyroidectomy in patients with mild pHPT. Study Design: This meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, and Web of Science by two teams of investigators. Analysis was run using R packages. Results: A total of 12 publications including seven randomized control, two prospective, and three retrospective trials with a total of 1346 patients were included for analysis. The average follow-up for all patients was 41 ± 23.8 months. Demographics, pre-treatment calcium, PTH, and bone mineral density (BMD) were similar between the medical (N = 632) and surgical (N = 714) cohorts. Post-treatment calcium and PTH levels were significantly higher in the medical cohort (10.46 vs. 9.39, p &lt; 0.01), (106.14 vs. 43.25, p = 0.001), respectively. Interestingly, the post-treatment PTH in the medical cohort increased when compared to pre-treatment (83.84 to 106.14). Patients in the medical cohort had lower BMD in lumbar (0.48 g/cm2; OR = 0.42, 95% CI = 0.21, 0.83), femoral (0.48; OR = 0.42, 95% CI = 0.29, 0.61), and hip (0.61; OR = 0.33, 95% CI = 0.13, 0.85). Incidences of fracture, nephrolithiasis, cardiovascular death, or overall mortality were not significantly different between the cohorts. Conclusions: The present study is the most comprehensive meta-analysis on mild pHPT to date. Our findings reflect that parathyroidectomy is the superior option in the treatment of mild pHPT patients as opposed to medical management.

Forestalling Hungry Bone Syndrome after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism.

overview HBS following PTx according to a dual perspective: pre- and post-operative outcome in PHPT and RHPT. This is a case- and study-based narrative review. key research words "hungry bone syndrome" and "parathyroidectomy"; PubMed access; in extenso articles; publication timeline from Inception to April 2023. non-PTx-related HBS; hypoparathyroidism following PTx. We identified 120 original studies covering different levels of statistical evidence. We are not aware of a larger analysis on published cases concerning HBS (N = 14,349). PHPT: 14 studies (N = 1545 patients, maximum 425 participants per study), and 36 case reports (N = 37), a total of 1582 adults, aged between 20 and 72. Pediatric PHPT: 3 studies (N = 232, maximum of 182 participants per study), and 15 case reports (N = 19), a total of 251 patients, aged between 6 and 18. RHPT: 27 studies (N = 12,468 individuals, the largest cohort of 7171) and 25 case reports/series (N = 48), a total of 12,516 persons, aged between 23 and 74. HBS involves an early post-operatory (emergency) phase (EP) followed by a recovery phase (RP). EP is due to severe hypocalcemia with various clinical elements (<8.4 mg/dL) with non-low PTH (to be differentiated from hypoparathyroidism), starting with day 3 (1 to 7) with a 3-day duration (up to 30) requiring prompt intravenous calcium (Ca) intervention and vitamin D (VD) (mostly calcitriol) replacement. Hypophosphatemia and hypomagnesiemia may be found. RP: mildly/asymptomatic hypocalcemia controlled under oral Ca+VD for maximum 12 months (protracted HBS is up to 42 months). RHPT associates a higher risk of developing HBS as compared to PHPT. HBS prevalence varied from 15% to 25% up to 75-92% in RHPT, while in PHPT, mostly one out of five adults, respectively, one out of three children and teenagers might be affected (if any, depending on study). In PHPT, there were four clusters of HBS indicators. The first (mostly important) is represented by pre-operatory biochemistry and hormonal panel, especially, increased PTH and alkaline phosphatase (additional indicators were elevated blood urea nitrogen, and a high serum calcium). The second category is the clinical presentation: an older age for adults (yet, not all authors agree); particular skeleton involvement (level of case reports) such as brown tumors and osteitis fibrosa cystica; insufficient evidence for the patients with osteoporosis or those admitted for a parathyroid crisis. The third category involves parathyroid tumor features (increased weight and diameter; giant, atypical, carcinomas, some ectopic adenomas). The fourth category relates to the intra-operatory and early post-surgery management, meaning an associated thyroid surgery and, maybe, a prolonged PTx time (but this is still an open issue) increases the risk, as opposite to prompt recognition of HBS based on calcium (and PTH) assays and rapid intervention (specific interventional protocols are rather used in RHPT than in PHPT). Two important aspects are not clarified yet: the use of pre-operatory bisphosphonates and the role of 25-hydroxyitamin D assay as pointer of HBS. In RHPT, we mentioned three types of evidence. Firstly, risk factors for HBS with a solid level of statistical evidence: younger age at PTx, pre-operatory elevated bone alkaline phosphatase, and PTH, respectively, normal/low serum calcium. The second group includes active interventional (hospital-based) protocols that either reduce the rate or improve the severity of HBS, in addition to an adequate use of dialysis following PTx. The third category involves data with inconsistent evidence that might be the objective of future studies to a better understanding; for instance, longer pre-surgery dialysis duration, obesity, an elevated pre-operatory calcitonin, prior use of cinalcet, the co-presence of brown tumors, and osteitis fibrosa cystica as seen in PHPT. HBS remains a rare complication following PTx, yet extremely severe and with a certain level of predictability; thus, the importance of being adequately identified and managed. The pre-operatory spectrum of assessments is based on biochemistry and hormonal panel in addition to a specific (mostly severe) clinical presentation while the parathyroid tumor itself might provide useful insights as potential risk factors. Particularly in RHPT, prompt interventional protocols of electrolytes surveillance and replacement, despite not being yet a matter of a unified, HBS-specific guideline, prevent symptomatic hypocalcemia, reduce the hospitalization stay, and the re-admission rates.

The Influence of Hyperparathyroidism Patient Profile on Quality of Life After Parathyroidectomy.

Improvements in quality of life (QoL) after parathyroidectomy in patients with primary hyperparathyroidism (PHPT) is discussed. It has not been analyzed whether these improvements can be influenced by a specific socio-personal or clinical patient profile. to analyze QoL differences after parathyroidectomy and to determine a socio-personal and clinical profile that influences improvement after parathyroidectomy. A longitudinal prospective cohort study in patients with PHPT. SF-36 and PHPQOL questionnaires were completed by the patients. A comparative preoperatory analysis was carried out, at three and twelve months after surgery. Student's t test was used for the correlations. The size of the effect was assessed using G*Power software. A multivariate analysis was performed to evaluate the socio-personal and clinical variables affecting the improvement in QoL after surgery. Forty-eight patients were analyzed. Three months after surgery an improvement was found in physical function, general health, vitality, social function, emotional role, mental health and in the patient's declared health assessment. One year after the intervention a general improvement was observed, with a greater effect on mental health and declared health evolution. Patients with bone pain presented with a higher probability of improvement after surgery. Patients with prior psychological disease had a lower associated probability of an improvement and high levels of PTH related to a greater probability of improvement after surgery. There is an improvement in the QoL of PHPT patients after parathyroidectomy. Patients with bone pain and high PTH levels prior to the parathyroidectomy present with a greater probability of having a greater improvement in QoL after surgery.

O158 Telephone post-operative follow-ups can be safely used for thyroidectomy and parathyroidectomy patients

Abstract Introduction The aim of this study was to implement and evaluate the efficiency of telephone post-operative follow-ups (TFUs) in an Endocrine Surgical Unit. Methods Patients operated [thyroidectomy (Tx) or parathyroidectomy (PTx)] in the Department of Endocrine Surgery between 6/2019 and 1/2021 were included in this study. Patients with a cancer diagnosis on histology were automatically converted to a clinic appointment. Results 155 patients were included. There were 75 and 80 patients with a Tx or a PTx operation respectively. The mean age for Tx and PTx patients was 50 (SD:17) and 56 (SD:15) respectively. The male/female ratio for Tx and PTx patients was 1:5. and 1:4 respectively. The main indication for an operation was Thy3a/f tumour and PHPT. The mean hospital stay for Tx and PTx patients was 1.3 (SD:1.5) and 1.2 (SD:0.9) days respectively. The % of patients discharged back to the GP after the 1st TFU was 50% and 46% for Tx and PTx patients respectively. 15% and 8% of Tx and PTx patients respectively required a 3rd FU. 8%, and 5% of Tx and PTx patients respectively required a conversion a subsequent clinic appointment. The mean (SD) distance of the patient's residence from hospital was 16 km (SD:25) and 23 km (SD: 20) for Tx and PTx patients respectively. There were no complaints from the patients in this study. Conclusion Post-operative TFUs are suitable for patients undergoing a Tx and/or PTx. A small percentage of patients will require conversion to a face-to-face clinic follow-up.

Long-term outcomes of parathyroidectomy in patients with primary hyperparathyroidism from patient's perspective

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