Postsurgical Hypoparathyroidism Research Articles

Impact of autofluorescence-guided surgery of parathyroid glands during total thyroidectomy in experienced surgeons: A randomized clinical trial.

Post-surgical hypoparathyroidism often occurs after total thyroidectomy (TT). The aim of this study is to investigate whether the use of near-infrared autofluorescence (NIRAF) of parathyroid glands (PGs) can aid experienced surgeons in identifying more PGs during surgery, potentially reducing unintended resection, and assessing its impact on post-surgical hypoparathyroidism. All patients undergoing at least a TT by two experienced surgeons, between 2020 and 2021, were enrolled and randomized into two cohorts: NIRAF group (NG) and CONTROL group (CG). Transient hypoparathyroidism was defined by serum concentration of PTH<12ng/mL at the 1st post-operative day and permanent by the need of calcium-active vitamin D treatment >6months from the surgery with still undetectable PTH or <12ng/m. Among 236 patients (111 in NG, 125 in CG), the number of PGs identified was higher in NG (93.9%, 417/444) compared to CG (81.4%, 407/500) (p<0.001), with a mean of 3.76±0.44 PGs per patient in NG and 3.25±0.79 in CG. The number of unintendedly resected PGs was 14 in NG and 42 in CG (p<0.0001). Transient hypoparathyroidism was observed in 18 patients (16.2%) in NG and 40 patients (32.0%) in CG (p=0.004). Permanent hypoparathyroidism affected 1 patient in NG and 7 patients in CG (p=0.06). The mean operative time was longer in NG (104.3±32.08min) compared to CG (85.5±40.62min) (p<0.001). NIRAF enhances the identification of PGs, preventing their inadvertent resection and reducing the overall incidence of post-surgical hypoparathyroidism.

Hypoparathyroidism update.

Since the release of the 2022 Second International Workshop Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines, updates and advances are now available in the cause, complications, and treatment of adult chronic hypoparathyroidism (hypoPTH). This review aims to highlight these new findings and implications to patient care. Postsurgical hypoparathyroidism remains the most common cause, immune-related hypoparathyroidism from checkpoint inhibitors is an emerging autoimmune cause. In a large retrospective cohort study of thyroidectomies, incident fracture was lower, particularly in the vertebra, in the hypoPTH cohort, compared with postthyroidectomy control group. Hypercalciuria increases risk for renal calculi in hypoPTH independent of disease duration and treatment dose. Quality of life is impaired in hypoPTH patients on conventional therapy, improvement was noted post-PTH replacement. TranCon PTH phase 3 RCT reported eucalcemia with reduced renal calcium excretion, normalization of bone turn-over markers, stable BMD and improved quality of life. HypoPTH is a chronic disease associated with significant morbidity and poor Quality of Life. Awareness of treatment targets and follow-up investigations can alleviate patient anxiety regarding over-treatment and under-treatment. Progress in long-acting PTH replacement strategies might provide accessible, feasible alternatives to conventional therapy in brittle hypoPTH patients.

Early parathyroid hormone (PTH) level as a predictor of post-surgical hypoparathyroidism

Introduction Post-operative hypocalcemia and postoperative persistent hypoparathyroidism remain the most common complications after thyroidectomy. Many approaches have been developed to prevent them, but actually, a common protocol is not yet individuated. Materials and methods We retrospectively analyzed the results of a prospectively collected database. We dosed PTH preoperatively and 4 h after surgery (PTH_4); calcium was evaluated preoperatively, on the first (I_POD) and on the second postoperative day (II_POD). Hypocalcemia was defined when calcium <8 mg/dl. PTH_4 and I_POD calcium serum levels are identified to predict postoperative hypocalcemia. Results Three hundred and forty-eight patients were enrolled, 37 patients resulted as hypocalcemic on I_POD and 41 on the II_POD. PTH_4 is related to I_POD (p < 0.001, r = 0.45) and II_POD (p < 0.001, r = 0.44) calcemia. PTH_4-cut-off predicting I_POD hypocalcemia was 10.50 pg/ml (sensitivity: 78.7%, specificity: 72.7%). A PTH_4 value of 11.5 pg/ml is able to predict hypocalcemia during II_POD (sensitivity: 76.5%, specificity: 69.2%). We set up a combined test to predict II_POD hypocalcemia, using PTH_4 and I_POD calcium (sensitivity: 77.8%, specificity: 89.9%). Conclusion This research shows the association between PTH_4 and postoperative hypocalcemia. The PTH_4 cut-off to predict I_POD-hypocalcemia was 10.5 pg/ml. We analyzed the calcemia trend during the postoperative period and we realized a combined test using PTH_4 and I_POD-calcemia. This test improves the accuracy of the previous test. Further studies, in particular multicentric, with a larger sample are necessary to validate the combined model.

Postoperative parathyroid hormone (PTH) is equivalent to perioperative PTH drop in predicting postsurgical hypoparathyroidism.

Postoperative surgical hypoparathyroidism (PoSH) following thyroid surgery is an established complication. Several predictive factors have been identified including perioperative parathyroid hormone (PTH) levels. The aim of the study is to compare the drop in perioperative PTH to postoperative day 1 PTH in predicting hypocalcaemia and hypoparathyroidism. Records of consecutive patients who had either total or completion thyroidectomy with or without central neck dissection in a 3-year period in a single thyroid surgery unit were accessed to retrieve data on demographics, pathology, surgery, perioperative biochemistry and management. Of 295 included patients, there were 227 (76.9%) females. Forty-five (15.3%) had completion thyroidectomy, and the rest had total thyroidectomy. Seventy-eight (26.4%) had concomitant central neck dissection. Sixty-four (21.7%) had hypocalcaemia on the day after surgery. Hypoparathyroidism persisted in 10.5% of patients at 6 months. Both day 1 PTH and a drop in PTH predicted day 1 hypocalcaemia (p < 0.001) and 6-month hypoparathyroidism (p < 0.001). The area under the receiver operating characteristic (ROC) curves for day 1 PTH and drop in PTH for the prediction of day 1 hypocalcaemia (0.729 vs 0.726, respectively) and for 6-month hypoparathyroidism (0.964 vs 0.958, respectively) were similar, albeit slightly better for day 1 PTH. Day 1 PTH is equivalent to (if not better than) drop in PTH in predicting short- and long-term PoSH. Preoperative PTH measurements may not be needed in the detection and/or management of PoSH after thyroid surgery.

Performance in Behavioral Testing in an Animal Model of Post-Surgical Hypoparathyroidism.

Hypoparathyroidism (HypoPT) is characterized by hypocalcemia and undetectable/inappropriately low PTH. Post-surgical HypoPT (PS-HypoPT) is the most common cause. Patients with PS-HypoPT present neuropsychological symptoms, probably due to the PTH deprivation in the central nervous system (CNS). However, these mechanisms are still not elucidated. The aim of this study was to evaluate the effects of PTH deprivation on CNS in an animal model of PS-HypoPT via a cognitive/behavioral assessment approach. A surgical rat model of PS-HypoPT was obtained and treated with calcium to maintain normocalcemia. Twenty PS-HypoPT rats and twenty sham-operated controls (Crl) underwent behavioral testing in a Morris Water Maze (MWM), Open Field (OF), and Elevated Plus Maze (EPM). In the MWM, PTx rats showed a higher Escape Latency Time compared to Crl rats (p < 0.05); we observed a statistically significant improvement in the performance (day 1 to 8 p < 0.001), which was less pronounced in PTx group. In the OF test, the time and distance spent in the zone of interest were significantly lower in the PTx group compared with the Crl (p < 0.01 and p < 0.01). In the EPM experiment, the time spent in the close arm was significantly higher in the PTx group compared with the Crl (p < 0.01). This animal model of PS-HypoPT shows an impairment in spatial memory, which improved after training, and a marked anxiety-like behavior, resembling the condition of patients with PS-HypoPT. Further studies are needed to elucidate mechanisms.

Green Tea Intake: A Protective Factor Against Postsurgical Hypothyroidism and Hypoparathyroidism

PurposeTea and coffee are the most common consumed types of drinks, identified with multiple health benefit. However, the association between tea and coffee intake and postsurgical hypothyroidism and hypoparathyroidism (PHypoTP) is still unclear. Therefore, the objective of this study is to explore the effect of tea and coffee intake on the risk of PHypoTP. DesignTwo-sample Mendelian randomization (MR). MethodsThe primary approach for MR estimates was the inverse-variance weighted (IVW) method. MR-Egger, MR Pleiotropy RESidual Sum and Outlier (PRESSO), weighted median, simple mode and weighted mode were used to detect pleiotropy and heterogeneity. FindingsWe found that green tea intake was causally associated with the decreased risk of PHypoTP (β = -0.019; 95% confidence interval [CI]: -0.038 to -0.001; P = 0.029). However, there was no significant association between coffee intake and risk of PHypoTP. No heterogeneity or pleiotropy in these results was detected. ConclusionsOur findings provide the genetic evidence supporting that green tea intake was a protective factor against PHypoTP. Accordingly, we may suggest the patients after thyroidectomy to add green tea into their habitual diet during nursing education.

Restless leg syndrome as a complication of primary hyperparathyroidism: insights from a retrospective study.

Restless leg syndrome (RLS) is an invalidating neurological disorder with a complex, largely unknown pathophysiology. While RLS is observed in Parkinson's disease and in renal failure, idiopathic cases are common. Limited reports associate RLS with parathyroid hormone (PTH). This study analyzes a cohort of patients with primary hyperparathyroidism (PHPT) and chronic post-surgical hypoparathyroidism (hypo PTH), to investigate RLS prevalence, and associated risk factors. Ninety-five patients (54 PHPT, 41 hypo PTH) were consecutively enrolled at the bone metabolism outpatient clinic. The revised IRLSSG diagnostic criteria were used to diagnose RLS, with assessments conducted through face-to-face interviews and neurological examination. When RLS was confirmed, the RLS severity scale was applied. Retrospective records included calcium-phosphate metabolism-related parameters, surgery details, renal lithiasis, fragility fractures, and densitometric features (T-score). RLS was diagnosed in 22.2% PHPT patients, compared to 4.9% of patients with hypo PTH (p = 0.02). Of RLS diagnosed patients, 91.7% had a history of parathyroidectomy, compared to 47.6% of patients without RLS (p = 0.01). Most of the operated patients reported that surgery determined an improvement of symptoms; however, mean score severity of RLS at our evaluation was 15/40, defined as moderate. PTH and calcium levels were not statistically associated to the presence of RLS. Our study suggests that PHPT may be one of the etiologies of RLS. Parathyroidectomy alleviates symptoms in the vast majority of the cases but does not remove them.

Incidence of post-surgical hypoparathyroidism (POSH) after total thyroidectomy

Post-surgical hypoparathyroidism (POSH) is a recognised complication of total thyroidectomy, leading to hypocalcaemia and its associated adverse effects. This retrospective study aimed to determine the incidence of POSH and identify perioperative predictors for its development. Data from patients who underwent total or completion thyroidectomy between January 2017 and July 2022 were retrospectively analysed. The incidence of POSH was assessed, and patients were categorised into transient or prolonged POSH at six months postoperatively. Potential predictors for POSH were investigated including gender, histological diagnosis, and preoperative thyroid function. A total of 133 adult patients were included in the study. The incidence of patients recovering from transient POSH within six months was 15%, and 5% had prolonged POSH beyond six months of surgery. Parathyroid hormone (PTH) levels normalised in 83% of prolonged POSH patients within 14–33 months, reducing the incidence of persistent POSH to 0.75%. Despite normal PTH levels, overall, 3% had persistent marginally low calcium levels (mean 2.11 mmol/L) in keeping with relative parathyroid insufficiency. Histological diagnosis of malignancy was the only significant risk factor for both transient and prolonged POSH (RR 2.95, CI 1.54 to 5.67, p = 0.001) in this cohort. Cautious capsular dissection during thyroidectomy and protection of the parathyroid glands and vascular supply produce a low incidence of POSH. Although the vast majority of patients with POSH recover after six months, hypocalcaemia may persist due to relative parathyroid insufficiency, requiring long-term calcium supplementation. Further research is needed to determine the best strategies for preventing and treating this condition.

SAT233 Clinical And Economic Burden Of Postsurgical Chronic Hypoparathyroidism: A US Medicare Retrospective Analysis

Abstract Disclosure: W. Noori: Employee; Self; Ascendis Pharma, Inc. S. Inguva: Employee; Self; OPEN Health. Other; Self; Research Funding (institution): Ascendis. C.T. Sibley: Employee; Self; Ascendis Pharma, Inc. V. Chirikov: Employee; Self; OPEN Health. Stock Owner; Self; OPEN Health. Other; Self; Research Funding (institution): Ascendis. A.R. Smith: Employee; Self; Ascendis Pharma, Inc. Background: Hypoparathyroidism is a rare endocrine disease characterized by insufficient parathyroid hormone (PTH) production and is associated with substantial burden of illness. Individuals with hypoparathyroidism often report physical, emotional, and cognitive symptoms indicating impaired health-related quality of life (HRQoL). Objective: To describe demographics, clinical characteristics, healthcare resource utilization (HCRU), and costs among individuals with postsurgical chronic hypoparathyroidism compared to individuals without hypoparathyroidism in Medicare Fee-For-Service (FFS). Methods: Adults with newly diagnosed postsurgical chronic hypoparathyroidism were identified from the Medicare 100% Limited Data Set between July 1, 2017, to March 31, 2020. All had a confirmed diagnosis within 6-12 months after index diagnosis. Individuals were required to be continuously enrolled for ≥6 months pre- and ≥12 months post-index for baseline and follow-up assessments. Those with a prior hypoparathyroidism diagnosis in the baseline period were excluded. A random sample of enrollees without hypoparathyroidism was synthetically assigned an index date of diagnosis to ensure similar baseline and follow-up periods as individuals with postsurgical chronic hypoparathyroidism. Baseline demographics and comorbidities were compared descriptively. All-cause HCRU and costs during baseline and follow-up were evaluated. All costs were inflated to 2021 US dollars. Results: Individuals with postsurgical chronic hypoparathyroidism (N=1,166) were older than those without hypoparathyroidism (N=11,258) (median age of 69 vs 64 years) and more were female (76% vs 57%); they also had higher Charlson Comorbidity Index scores at baseline (3.24 vs 0.73) and a higher prevalence of moderate or severe renal disease (28.8% vs 5.6%), nephrolithiasis (8.3% vs 1.0%), urinary tract infections (9.9% vs 2.2%), hospitalizations for infections (11.9% vs 2.5%), congestive heart failure (13.1% vs 3.0%), among others. Over a median follow-up of 30 months, mean [SD] all-cause medical costs per patient per year (PPPY) were significantly higher among individuals with postsurgical chronic hypoparathyroidism ($199,297 [$443,294] vs $61,897 [$210,825]). This difference was largely attributable to higher all-cause medical utilization among individuals with postsurgical chronic hypoparathyroidism (22.0 vs 11.6 inpatient days PPPY; 15.3 vs 5.8 outpatient visits PPPY). Individuals with postsurgical chronic hypoparathyroidism also had higher mortality compared to those without hypoparathyroidism (HR=2.75 (95% CI: 2.15-3.51). Conclusions: The clinical and economic burden of individuals with postsurgical chronic hypoparathyroidism in Medicare FFS is substantial, highlighting the need for innovative treatment options to replace the missing PTH hormone. Presentation: Saturday, June 17, 2023

SAT218 Refractory Hypocalcemia From Combined Autosomal Dominant Hypocalcemia Type 2 And Postsurgical Hypoparathyroidism

Abstract Disclosure: M. Sonmez Ince: None. F. Hannan: None. N. Esfandiari: None. M. Hussain: None. M.R. Haymart: None. R.V. Thakker: None. G.A. Clines: None. Background: Autosomal dominant hypocalcemia type 2 (ADH2), due to activating mutations in GNA11, is a rare disorder that causes hypocalcemia with low or inappropriately normal PTH. Postsurgical hypoparathyroidism (PSHP) is the most common etiology for hypoparathyroidism. The patient described was afflicted by both conditions and had persistent hypocalcemia despite aggressive management. Clinical Case: A 50-year-old female was found to have an enlarged thyroid on exam and subsequently diagnosed with papillary thyroid cancer (PTC). She underwent a total thyroidectomy without parathyroid autotransplantation since parathyroid glands were not identified during intraoperative pathologic survey. Surgical pathologic examination confirmed PTC with the identification of a single and small intrathyroidal parathyroid gland. Due to the patient’s low risk (T1N0M0), radioactive iodine ablation was not performed. Before thyroidectomy, serum corrected calcium was 6.4-8.5 mg/dL (8.6-10.3 mg/dL) and PTH was 9-21 pg/mL (10-65 pg/mL) during the previous 20 years. Following thyroidectomy, the patient had multiple emergency department visits due to hypocalcemia, hand cramping, and paresthesias. The patient was diagnosed with postsurgical hypoparathyroidism: corrected calcium 5.6-6.7 mg/dL, 24-hour urine calcium 112 mg (100-300 mg/24hour), magnesium 1.4-1.9 mg/dL (1.6-2.6 mg/dL), phosphorus 3-8.2 mg/dL (2.7-4.6 mg/dL). PTH remained &amp;lt;6 pg/mL. The patient was then referred to an academic endocrinology. TSH, AM cortisol, 25-vitamin D, iron, ceruloplasmin, copper, and 21-hydroxylase antibody concentrations were normal. Genetic testing revealed a pathogenic GNA11 variant (c.178C&amp;gt;T, p.(Arg60Cys)); no mutations were identified with CASR or AP2S1. Despite aggressive management with total daily oral calcitriol up to 12 mcg daily, calcium 8 grams, and chlorthalidone, the patient required calcium infusions thrice weekly. Despite the addition of teriparatide 20 mcg BID, the patient remained dependent on calcium infusions, with improvement after the addition of IV calcitriol. Recently, continuous teriparatide delivery was started using an Omnipod insulin pump that has significantly reduced the patient’s dependence on calcium infusions with serum calcium that are now 8-9 mg/dL. Conclusion: ADH2, due to gain-of-function mutations of GNA11, that encodes the Gα11 protein, causes life-long hypocalcemia that is often asymptomatic and undiagnosed. We report here the first documented case of combined ADH2 and PSHP. This case highlights that patients with ADH2 likely have hypoplastic parathyroid glands and that caution is required with procedures that may disrupt parathyroid gland function. Furthermore, the refractory nature of this patient’s hypocalcemia may suggest that GNA11 mutations in the kidney and skeleton reduce the effectiveness of standard hypocalcemia treatments. Presentation: Saturday, June 17, 2023

Chronic hypoparathyroidism is associated with increased cortical bone density evaluated using high-resolution peripheral quantitative computed tomography.

This cross-sectional study aimed to assess bone mineral density (BMD), bone microarchitecture and fracture prevalence in women with chronic postsurgical hypoparathyroidism (hypoPT). Twenty-seven women with postsurgical hypoPT and 44 age-matched healthy women were included. Dual-energy X-ray absorptiometry was used to evaluate areal BMD and vertebral fracture assessment. High-resolution peripheral quantitative computed tomography assessed microarchitecture and volumetric BMD at the distal radius and tibia. Biochemical parameters, including fibroblast growth factor 23, C-terminal cross-linking telopeptide of type I collagen (ICTP), and procollagen type I N-terminal propeptide (P1NP), were also measured. Previous low-impact fractures were assessed and the 10-year fracture risk was estimated using the FRAX tool for the Brazilian population. No participant had prevalent clinical fractures, and both groups showed low risk for major and hip based on FRAX tool, but two hypoPT patients had moderate to severe morphometric vertebral fractures. Women with hypoPT had increased aBMD in the lumbar spine, femoral neck and total hip (p < 0.05) and higher cortical vBMD in the radius (p = 0.020) and tibia (p < 0.001). Trabecular bone was not affected. Both P1NP and ICTP suggested low bone turnover rates, but no significant correlation was observed between bone density or microstructure and any of the biochemical parameters. The prevalence of fragility fractures was low in HypoPT women and compatible with low fracture risk estimated by the FRAX tool. Patients had a higher aBMD and cortical vBMD than those of healthy control women, but the association with decreased bone turnover remains unclear.

Features of patients and fracture risk in hypoparathyroidism; a single center study.

Patients with hypoparathyroidism (hypoPT) have low bone turnover and high bone mineral density (BMD). However, data on fracture risk are conflicting. The objectives of this study were: 1. To describe clinical/biochemical characteristics of hypoPT patients followed at a single medical center. 2. To identify postsurgical hypoPT patients and investigate their fracture rate compared with gender/age-matched post-surgical normocalcemic patients. Retrospective analysis of patient's medical records treated at the tertiary medical center in 2010-2021 identified by computerized medical database search. The cohort included 133 patients (91% women, mean age 64 ± 13 years) of whom 105 (79%) had post-thyroidectomy hypoparathyroidism and the remainder had an autoimmune/idiopathic/other etiology. Mean follow-up time was 21 ± 12 and 27 ± 12 years, respectively. The control group included 142 post-thyroidectomy patients without hypoparathyroidism. Patients in the postsurgical hypoparathyroidism group were older and had higher calcium and PTH levels at diagnosis than the non-surgical hypoPT patients. Comparing the postsurgical hypoPT and postsurgical normocalcemic control patients revealed a significantly higher BMD in the hypoPT group. Yet, fracture rates were 31% in the postsurgical hypoparathyroidism group and 21% in the control group (P = 0.1) over a similar median follow-up period (17 and 18.4 years, respectively). In both groups the most common fracture site was the spine (50% and 70%, respectively; p = 0.33), mainly nonclinical morphometric fractures. Higher phosphorus blood level was associated with increased fracture risk. The relatively high BMD in patients with postsurgical hypoparathyroidism is not associated with lower fracture risk. Silent morphometric fractures are quite common in this group of patients.

Effectiveness and Safety of Percutaneous Treatment in Lesions Suggestive of Thyroid Cancer (Bethesda V and VI-T1aN0M0) Compared to Surgical Treatment: Systematic Review and Meta-Analysis.

Thyroid nodules are common entities, with 5% malignancy. Differentiated thyroid cancer represents 90% of thyroid malignancies, with papillary carcinoma being the most common. Management is generally surgical; among its complications are injury to the recurrent laryngeal and superior laryngeal nerve, causing hoarseness, postsurgical hypoparathyroidism, hypothyroidism, and pain. Other noninvasive percutaneous interventions of thermal ablation such as microwave, radiofrequency, or laser incur lower costs and could be an option for treatment. To determine the effectiveness and safety of thermal ablation in lesions suspected of thyroid cancer (Bethesda V and VI/T1aN0M0) compared to surgical treatment. Systematic review/meta-analysis of observational studies and clinical trials. Database search includes MEDLINE/PUBMED, Embase, Scopus, Scielo, and BVS/LILACS. Studies on patients over 18 years of age with lesions suspicious of thyroid cancer were included. A total of 10 studies were obtained, with 2939 patients: 1468 subjected to thermal ablation and 1471 to surgery. Regarding effectiveness, no differences were found in local recurrence [relative risk (RR) 1.17 (95% CI 0.69-1.99)] and cervical lymph node metastasis [RR 0.76 (95% CI 0.43-1.36)]. Regarding safety, infection [RR 0.29 (95% CI 0.05-1.74)], hematoma [RR 0.57 (95% CI 0.17-1.94)], and transient hoarseness [RR 0.77 (95% CI 0.39-1.51)] were evaluated, without difference. However, permanent hoarseness had significant differences in favor of thermal ablation [RR 0.29 (95% CI 0.11-0.75)]. Thermal ablation for the treatment of T1aN0M0 papillary thyroid carcinoma is equally effective when compared to surgical techniques and offers a better safety profile, particularly in permanent hoarseness.

Fracture Risk in Patients with Hypoparathyroidism.

To summarize the recently published scientific evidence on fracture risk in hypoparathyroidism. Hypoparathyroidism is characterized by a low bone turnover and a high bone mineral density. Data on fracture risk are sparse and due to the rarity of the disease, available studies have only been able to include relatively few patients. Risk of non-vertebral fractures does not seem to be affected to any major degree, although epidemiological studies suggest a decreased risk of fractures at the humerus in postsurgical hypoparathyroidism, whereas an increased risk of fractures at the upper arm has been shown in non-surgical hypoparathyroidism. Several, but not all, studies have also pointed towards an increased risk of vertebral fractures, especially in non-surgical hypoparathyroidism. Fractures at the appendicular skeleton do not seem to be of specific concern in hypoparathyroidism, but emerging data suggest an increased risk of vertebral fractures, which needs to be clarified further in upcoming studies.

Fahr’s Syndrome Secondary to Hypoparathyroidism Presenting with Paralysis and Recurrent Seizures: A Case Report

Aim: To describe a rare case of Fahr’s syndrome (FS) associated with chronic post-surgical hypoparathyroidism and hypocalcemia.&#x0D; Case Presentation: A 63-year-old female with a previous history of total thyroidectomy and hemiplegia presented to our hospital with altered mentation and recurrent generalized tonic-clonic seizures. Laboratory evaluation revealed hypoparathyroidism, hypocalcemia, and hypokalemia. Head computed tomography (CT) scan was consistent with FS, demonstrating extensive, bilateral, and symmetrical calcified deposits in the brain, predominantly in basal ganglia, corona radiata, and cerebellar hemispheres. The association with post-surgical hypoparathyroidism and relevant biochemical indices determined the suspected etiology of the pathologic process of ectopic calcification.&#x0D; Discussion: FS is a rare, neurodegenerative disorder characterized by abnormal bilateral ectopic calcified deposits in the basal ganglia and other brain structures. FS presents with a wide variety of neurological and psychiatric manifestations. The diagnosis is confirmed by neuroimaging studies such as a head CT scan or magnetic resonance imaging, which displays the calcification of BG and other structures in a bilateral and symmetrical pattern. Biochemical analysis may adjunctively identify the underlying risk factor of the disease.&#x0D; Conclusion: Our case represents a long-term severe consequence of untreated post-surgical hypoparathyroidism, which has consequently led to irreversible secondary FS. Maintenance of eucalcemic and euphosphatemic states is essential to prevent the progression of ectopic cerebral calcification.

ARTERIAL STIFFNESS IN NORMOTENSIVE PATIENTS WITH HYPOPARATHYROIDISM COMPARED TO CONTROLS

Objective: Hypoparathyroidism is a rare disease characterized by the inability of parathyroid hormone (PTH) to maintain calcium homeostasis. Multiple etiologies, congenital or acquired can cause this morbidity. However, the most common cause is hormone deficiency secondary to cervical surgical explorations. Patients with post-surgical hypoparathyroidism have an increased risk of mortality, with various clinical and molecular evidence of the effects on the cardiovascular system. This study aimed to assess arterial stiffness by measuring the carotid-femoral pulse wave velocity (PWV) in a population of patients with hypoparathyroidism. Design and method: This is a cross-sectional study with 30 patients with post-surgical hypoparathyroidism and 25 normal volunteers from the Endocrinology Outpatient Clinic of the Medical School. Arterial stiffness was evaluated by the analysis of PWV using SphygmoCor system. Statistical analysis was made with software IBM-SPSS Statistics 27 (IBM Corporation, NY, USA). Results: The average PWV in patients with hypoparathyroidism was not different compared to controls (8.70 vs 7.50; p = 0.084). However, when comparing only normotensive patients in both groups (21 hypoparathyroidism and 16 controls), levels of PWV in patients with hypoparathyroidism was higher and statistically significant (7.64 vs 6.50; p = 0.039). Age, hypertension, LDL cholesterol levels, ionized calcium, total calcium, and the Calcium x Phosphorus product were independent predictor variables for PWV. Conclusions: Post-surgical hypoparathyroidism increases arterial stiffness in normotensive individuals, evaluated by PWV and total calcium level, as well the Calcium x Phosphorus product are involved in this condition. Therefore, vascular stiffness may be one of the pathophysiologic mechanisms of the cardiovascular disease in patients with hypoparathyroidism. Further studies are necessary to elucidate this condition.

Chronic hypoparathyroidism: clinical manifestations, complications and impact on the quality of life

Hypoparathyroidism is a relatively rare endocrine disorder caused by the absence production of parathyroid hormone, leading to the classical biochemical features such as hypocalcaemia and hyperphosphataemia.The data from Europe, the USA and Asian countries shows that the long course of chronic postsurgical and non-surgical hypoparathyroidism can lead to many complications from different organs and systems. Hypoparathyroidism increases the risk of kidney disease, including kidney failure, neuropsychiatric disorders and infections. The frequency and degree of disease complications depend on its etiology. Non-surgical hypoparathyroidism is associated with an increased risks of cataracts, cardiovascular diseases and vertebral fractures; however, the pathogenesis of these disorders is not fully understood. Various parameters of mineral homeostasis were discussed in the context of identified complications. For example, persistent hypercalciuria and intake of large doses of calcium and vitamin D supplements were associated with the structural pathology of the kidneys (nephrolithiasis, nephrocalcinosis).This review covers the issue of the clinical manifestations and complications of chronic hypoparathyroidism, as well as predictors of their development.

Post-surgical hypoparathyroidism with teriparatide treatment

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

Healthcare resource utilization associated with post-surgical and non-surgical chronic hypoparathyroidism in England: A linked Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics retrospective analysis

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

Evaluation of PTH deprivation effects on anxiety and stress response in a rat model of Chronic Post-Surgical Hypoparathyroidism

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