1
|
Wang X, Wang SL, Cao Y, Li CQ, He W, Guo ZM. Postoperative hypoparathyroidism after thyroid operation and exploration of permanent hypoparathyroidism evaluation. Front Endocrinol (Lausanne) 2023; 14:1182062. [PMID: 37361530 PMCID: PMC10286794 DOI: 10.3389/fendo.2023.1182062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Abstract
Background To investigate the risk factors for hypoparathyroidism, discuss the prevention of postoperative hypoparathyroidism, and explore permanent postoperative hypoparathyroidism evaluation (PPHE). Methods A total of 2,903 patients with thyroid nodules were treated between October 2012 and August 2015. Serum calcium and intact parathyroid hormone (iPTH) levels were measured at 1 day, 1 month, and 6 months postoperatively. The incidence and management of hypoparathyroidism were analyzed. The PPHE was established based on the risk factors and clinical practice. Results A total of 637 (21.94%) patients developed hypoparathyroidism, and 92.15% of them had malignant nodules. The incidence rates of transient and permanent hypoparathyroidism were 11.47% and 10.47%, respectively. The iPTH level was lower in patients with malignant nodules who underwent total thyroidectomy (TT) and central-compartment neck dissection (CND). These factors were independently associated with the recovery rate of parathyroid function. The formula for PPHE is as follows: {iPTH} + {sCa} + {surgical procedure} + {reoperation} + {pathologic type}. A scoring system was developed, and we scored low, middle, and high risk of permanent postoperative hypoparathyroidism as 4-6, 7-9, and 10-13, respectively. The differences in the recovery rates of parathyroid function in several risk groups were statistically significant (p < 0.001). Conclusion Simultaneous TT and CND is a risk factor for hypoparathyroidism. The reoperation is not associated with hypoparathyroidism. Identification of parathyroid glands in situ and preservation of their vascular pedicles are key factors in managing hypoparathyroidism. PPHE can forecast the risk of permanent postoperative hypoparathyroidism well.
Collapse
Affiliation(s)
- Xi Wang
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
- The First School Of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shun-lan Wang
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Yang Cao
- Department of Oncology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Chun-qiao Li
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Weiping He
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Zhu-ming Guo
- Department of Head and Neck, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
2
|
Khurana KV, Ranjan A. ST-Segment Elevation in Conditions of Non-cardiovascular Origin Mimicking an Acute Myocardial Infarction: A Narrative Review. Cureus 2022; 14:e30868. [DOI: 10.7759/cureus.30868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/30/2022] [Indexed: 11/07/2022] Open
|
3
|
Lin C, Chen CC, Chau T, Lin CS, Tsai SH, Lee DJ, Lee CC, Shang HS, Lin SH. Artificial intelligence-enabled electrocardiography identifies severe dyscalcemias and has prognostic value. Clin Chim Acta 2022; 536:126-134. [PMID: 36167147 DOI: 10.1016/j.cca.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
CONTEXT Abnormal serum calcium concentrations affect the heart and may alter the electrocardiogram (ECG), but the detection of hypocalcemia and hypercalcemia (collectively dyscalcemia) relies on blood laboratory tests requiring turnaround time. OBJECTIVE The study aimed to develop a bloodless artificial intelligence (AI)-enabled (ECG) method to rapidly detect dyscalcemia and analyze its possible utility for outcome prediction. METHODS This study collected 86,731 development, 15,611 tuning, 11,105 internal validation, and 8401 external validation ECGs from electronic medical records with at least 1 ECG associated with an albumin-adjusted calcium (aCa) value within 4 h. The main outcomes were to assess the accuracy of AI-ECG to predict aCa and follow up these patients for all-cause mortality, new-onset acute myocardial infraction (AMI), and new-onset heart failure (HF) to validate the ability of AI-ECG-aCa for previvor identification. RESULTS ECG-aCa had mean absolute errors (MAE) of 0.78/0.98 mg/dL and achieved an area under receiver operating characteristic curves (AUCs) 0.9219/0.8447 and 0.8948/0.7723 to detect severe hypercalcemia and hypocalcemia in the internal/external validation sets, respectively. Although < 20 % variance of ECG-aCa could be explained by traditional ECG features, the ECG-aCa was found to be associated with more complications. Patients with ECG-hypercalcemia but initially normal aCa were found to have a higher risk of subsequent all-cause mortality [hazard ratio (HR): 2.05, 95 % conference interval (CI): 1.55-2.70], new-onset AMI (HR: 2.88, 95 % CI: 1.72-4.83), and new-onset HF (HR: 2.02, 95 % CI: 1.38-2.97) in the internal validation set, which were also seen in external validation. CONCLUSION The AI-ECG-aCa may help detecting severe dyscalcemia for early diagnosis and ECG-hypercalcemia also has prognostic value for clinical outcomes (all-cause mortality and new-onset AMI and HF).
Collapse
Affiliation(s)
- Chin Lin
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chien-Chou Chen
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tom Chau
- Department of Medicine, Providence St. Vincent Medical Center, Portland, OR, USA
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shi-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ding-Jie Lee
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Cheng Lee
- Department of Medical Informatics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hung-Sheng Shang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
| |
Collapse
|
4
|
Ajith A, Corbett M, Garry S, Young O. Case of coronary vasospasm caused by hypocalcaemia post parathyroidectomy mimicking ST-elevation myocardial infarction. BMJ Case Rep 2022; 15:e247919. [PMID: 35450875 PMCID: PMC9024207 DOI: 10.1136/bcr-2021-247919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/03/2022] Open
Abstract
A man in his 30s with primary hyperparathyroidism underwent an elective four-gland parathyroid exploration with intraoperative parathyroid hormone monitoring. On the fourth postoperative day (POD), the patient presented to the emergency department with severe symptomatic hypocalcaemia. ECG findings were in keeping with inferior-posterior ST-elevation myocardial infarction (STEMI); however, he was asymptomatic with no chest pain. Biochemistry revealed elevated serial troponin levels. Coronary angiogram and transthoracic echocardiogram were normal, suggesting coronary vasospasm, mimicking STEMI on ECG because of severe hypocalcaemia post parathyroidectomy. This is an uncommon and unreported complication of parathyroid surgery. The patient was successfully managed with intravenous calcium and discharged on oral calcium replacement on the tenth POD.
Collapse
Affiliation(s)
- Aiswarya Ajith
- ENT department, Galway University Hospital, Galway, Ireland
| | - Mel Corbett
- ENT department, Galway University Hospital, Galway, Ireland
| | - Stephen Garry
- ENT department, Galway University Hospital, Galway, Ireland
| | - Orla Young
- ENT department, Galway University Hospital, Galway, Ireland
| |
Collapse
|
5
|
Manzur Barbur MC, Martínez-Ávila MCMÁ, Imitola Madero A. Acute ST-segment elevation myocardial infarction: to be or not to be? Arch Clin Cases 2022; 9:19-23. [PMID: 35529096 PMCID: PMC9066581 DOI: 10.22551/2022.34.0901.10198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Calcium has a significant effect on cells in the myocardium, affecting conduction, intracellular signaling and contraction of muscle fibers. In fact, calcium levels could affect myocardial action potential and affect heart conduction. Hypocalcemia manifest on ECG with arrythmias or QT prolongation, in some extraordinary cases, it could present with variations in the ST segment, which requires the study of differential diagnoses of cardiac origin, such as acute myocardial infarction with ST elevation (STEMI) or pericarditis. We expose a case of a 28-year-old male patient who arrived at the emergency department with chest pain and was misdiagnosed with STEMI, after a complex process finally it was a severe hypocalcemia mimicking acute myocardial infarction.
Collapse
|
6
|
Symanski JD, Kowalchuk GJ, Littmann L. Action Potential-Like ST Elevation in a Young Patient with No Heart Disease. Am J Med 2021; 134:335-338. [PMID: 33181109 DOI: 10.1016/j.amjmed.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Laszlo Littmann
- Department of Internal Medicine, Atrium Health - Carolinas Medical Center, Charlotte, NC.
| |
Collapse
|
7
|
Laundon RK, Littmann L. Spiked helmet pattern ST elevation in subarachnoid hemorrhage. J Electrocardiol 2018; 52:96-98. [PMID: 30529812 DOI: 10.1016/j.jelectrocard.2018.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/27/2018] [Indexed: 01/29/2023]
Abstract
Subarachnoid hemorrhage (SAH) is occasionally associated with the electrocardiographic (ECG) pattern of ST-segment elevation myocardial infarction (STEMI). Missing the true clinical diagnosis can result in inappropriate and harmful interventions. We report the case of a 40-year-old female who was found down. The ECG was diagnostic for acute lateral STEMI. Further analysis of the ECG showed marked prolongation of the QT interval and the "spiked helmet sign" (SHS). The patient was ruled out for myocardial infarction and a head CT demonstrated a massive SAH with acute hemorrhage into the ventricles. Review of the literature and of our own ECG files revealed additional cases where severe acute central nervous system (CNS) conditions were associated with the SHS.
Collapse
Affiliation(s)
- Robert K Laundon
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Laszlo Littmann
- Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, USA.
| |
Collapse
|
8
|
Adeel MY, Clarke JRD, Shetty S, Arora A, Buscher MG. Severe hypocalcemia mimicking acute inferior ST-segment elevation myocardial infarction. Oxf Med Case Reports 2018; 2018:omy103. [PMID: 30487989 PMCID: PMC6247139 DOI: 10.1093/omcr/omy103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/10/2018] [Accepted: 09/18/2018] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 52-year-old gentleman, admitted to the medical intensive care unit with multiple organ system dysfunction due to acute severe pancreatitis. He was found to have severe hypocalcemia, bradycardia and an electrocardiogram (EKG) showing ST-segment elevation in infero-lateral leads. The patient was treated with intravenous calcium gluconate with prompt improvement of heart rate and reversal of EKG changes. Subsequent evaluation for myocardial ischemia was negative. We believe the EKG changes mimicking acute ST-segment elevation myocardial infarction were due to severe hypocalcemia. To our knowledge this is very rare occurrence.
Collapse
Affiliation(s)
- Muhammad Y Adeel
- Department of Internal Medicine, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT, USA
| | - John-Ross D Clarke
- Department of Internal Medicine, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT, USA
| | - Safal Shetty
- Departments of Emergency Medicine & Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT, USA
| | - Ashish Arora
- Departments of Emergency Medicine & Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT, USA
| | - Michael G Buscher
- Departments of Emergency Medicine & Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT, USA
| |
Collapse
|
9
|
Durant E, Singh A. ST elevation due to hypercalcemia. Am J Emerg Med 2017; 35:1033.e3-1033.e6. [PMID: 28209241 DOI: 10.1016/j.ajem.2017.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 12/27/2022] Open
Abstract
Characteristic ECG changes with hypercalcemia include shortening of the QoT, QaT, and QeT intervals which are measured from the beginning of the QRS complex to the origin (O), apex (A), and end (E) of the T wave respectively. At very high serum calcium levels ECG changes include slight prolongation of the PR and QRS intervals, T wave flattening or inversion, and the appearance of a J wave at the end of the QRS complex. We present a case of a 22year-old male, who had been bedbound for 5months following a severe motor vehicle collision, presenting with shortening of the QoT and QaT intervals leading to anterior ST elevation mimicking acute myocardial infarction. Cardiac troponin testing was negative, however, laboratory testing revealed a serum calcium level of 15mg/dL (normal 7.3-10.5mg/dL). We review the published literature regarding the link between hypercalcemia and the appearance of ST elevation.
Collapse
Affiliation(s)
- Edward Durant
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States.
| | - Amandeep Singh
- Department of Emergency Medicine, Alameda Health System - Highland, Hospital, Oakland, CA, United States
| |
Collapse
|
10
|
Gómez-Domínguez R, Hidalgo R, García-Rubira JC. Severe Hypocalcemia Masquerading as Acute Coronary Syndrome. J Emerg Med 2013; 45:715-7. [DOI: 10.1016/j.jemermed.2013.01.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 01/15/2013] [Accepted: 01/28/2013] [Indexed: 12/29/2022]
|
11
|
Abstract
PURPOSE OF REVIEW This review provides an update on hypoparathyroidism (HPT), focusing on the major aspects of diagnosis, clinical manifestations and management of patients with hypocalcaemia due to HPT. RECENT FINDINGS Recent advances in the understanding of the physiologic actions of parathormone (PTH) and vitamin D, and the application of molecular genetics, have clarified certain aspects of the pathogenesis, classification, diagnosis and management of HPT. SUMMARY PTH promotes bone resorption, decreases urinary calcium excretion, enhances the conversion of 25-hydroxyvitamin D to 1, 25-dihydroxyvitamin D and increases intestinal calcium absorption and phosphate renal excretion. Understanding the molecular cause of the disease in patients and their families has the potential for proper tailoring of genetic counselling, family screening and treatment. Signs and symptoms may be associated not only with the severity, chronicity and therapeutic endpoints in HPT but also with the different causes of the disease. Hypocalcaemia may be an asymptomatic laboratory finding or a life-threatening metabolic disturbance. Although the therapy of acute hypocalcaemia is usually readily accomplished, chronic hypocalcaemia remains a very difficult treatment problem. Replacement therapy with PTH could be a therapeutic option for refractory HPT.
Collapse
Affiliation(s)
- Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
| | | | | |
Collapse
|