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Deering KL, Larsen NJ, Loustau P, Weiss B, Allas S, Culler MD, Harshaw Q, Mitchell DM. Economic burden of patients with post-surgical chronic and transient hypoparathyroidism in the United States examined using insurance claims data. Orphanet J Rare Dis 2024; 19:164. [PMID: 38637809 PMCID: PMC11025287 DOI: 10.1186/s13023-024-03155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Hypoparathyroidism (HP) is a rare endocrine disease commonly caused by the removal or damage of parathyroid glands during surgery and resulting in transient (tHP) or chronic (cHP) disease. cHP is associated with multiple complications and comorbid conditions; however, the economic burden has not been well characterized. The objective of this study was to evaluate the healthcare resource utilization (HCRU) and costs associated with post-surgical cHP, using tHP as a reference. METHODS This analysis of a US claims database included patients with both an insurance claim for HP and thyroid/neck surgery between October 2014 and December 2019. cHP was defined as an HP claim ≥ 6 months following surgery and tHP was defined as only one HP claim < 6 months following surgery. The cHP index date was the first HP diagnosis claim following their qualifying surgery claim, whereas the tHP index date was the last HP diagnosis claim following the qualifying surgery claim. Patients were continuously enrolled at least 1 year pre- and post-index. Patients' demographic and clinical characteristics, all-cause HCRU, and costs were descriptively analyzed. Total all-cause costs were calculated as the sum of payments for hospitalizations, emergency department, office/clinic visits, and pharmacy. RESULTS A total of 1,406 cHP and 773 tHP patients met inclusion criteria. The average age (52.1 years cHP, 53.5 years tHP) and representation of females (83.2% cHP, 81.2% tHP) were similar for both groups. Neck dissection surgery was more prevalent in cHP patients (23.6%) than tHP patients (5.3%). During the 1-2 year follow-up period, cHP patients had a higher prevalence of inpatient admissions (17.4%), and emergency visits (26.0%) than the reference group -tHP patients (14.4% and 21.4% respectively). Among those with a hospitalization, the average number of hospitalizations was 1.5-fold higher for cHP patients. cHP patients also saw more specialists, including endocrinologists (28.7% cHP, 15.8% tHP), cardiologists (16.7% cHP, 9.7% tHP), and nephrologists (4.6% cHP, 3.3% tHP). CONCLUSION This study demonstrates the increased healthcare burden of cHP on the healthcare system in contrast to patients with tHP. Effective treatment options are needed to minimize the additional resources utilized by patients whose HP becomes chronic.
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Vilar Tabanera JA, Gómez Ramirez J, Brabyn P, Barranquero AG, Puerta Vicente A, Porrero B, Luengo P, Fernández Cebrián JM. Dynamics of PTH levels in the development of post-operative hypoparathyroidism. Acta Chir Belg 2024; 124:99-106. [PMID: 36948883 DOI: 10.1080/00015458.2023.2194598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Post-operative hypoparathyroidism is the most frequent complication after total thyroidectomy. The identification of preoperative predictors could be helpful to identify patients at risk. This study aimed to evaluate the potential influence of preoperative PTH levels and their perioperative dynamics as a predictor of transient, protracted, and permanent post-operative hypoparathyroidism. METHODS A prospective, observational study that includes 100 patients who underwent total thyroidectomy between September 2018 and September 2020. RESULTS Transient hypoparathyroidism was present in 42% (42/100) of patients, 11% (11/100) developed protracted hypoparathyroidism, and 5% (5/100) permanent hypoparathyroidism. Patients who presented protracted hypoparathyroidism had higher preoperative PTH levels. The protracted and permanent hypoparathyroidism rate was higher in groups with greater preoperative PTH [0% group 1 (<40 pg/mL) vs. 5.7% group 2 (40-70 pg/mL) vs. 21.6% group 3 (>70 pg/mL); p = 0.03] and (0 vs. 8.3 vs. 20%; p = 0.442), respectively. The rate of protracted and permanent hypoparathyroidism was higher in patients with PTH at 24 h lower than 6.6 pg/mL and whose percentage of PTH decline was higher than 90%. The rate of transient hypoparathyroidism was higher in patients who showed a PTH decline rate of more than 60%. The percentage of PTH increase one week after surgery in patients with permanent hypoparathyroidism was significantly lower. CONCLUSION The prevalence of protracted hypoparathyroidism was higher in groups with higher preoperative PTH levels. PTH levels 24 h after surgery lower than 6.6 pg/mL and a decline of more than 90% predict protracted and permanent hypoparathyroidism. The percentage of PTH increase a week after surgery could predict permanent hypoparathyroidism.
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Affiliation(s)
| | | | - Philip Brabyn
- Department of Head and Neck Surgery, Niño Jesús University Hospital, Madrid, Spain
| | | | | | - Belén Porrero
- Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Patricia Luengo
- Department of Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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Slutzky-Shraga I, Hirsch D, Gorshtein A, Masri-Iraqi H, Shochat T, Robenshtok E, Shimon I, Tsvetov G. Features of patients and fracture risk in hypoparathyroidism; a single center study. J Endocrinol Invest 2024; 47:593-601. [PMID: 37610611 DOI: 10.1007/s40618-023-02177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE 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. METHODS Retrospective analysis of patient's medical records treated at the tertiary medical center in 2010-2021 identified by computerized medical database search. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- I Slutzky-Shraga
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
- Clalit Healthcare Services, Yaffo District, Tel Aviv, Israel.
- Department of Endocrinology, Diabetes & Metabolism, Rabin Medical Center - Beilinson Hospital, 39 Jabotinski St., 4941492, Petach Tikva, Israel.
| | - D Hirsch
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Gorshtein
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Masri-Iraqi
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Shochat
- Statistical Consulting Unit, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - E Robenshtok
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Shimon
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Tsvetov
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abood A, Ovesen T, Rolighed L, Triponez F, Vestergaard P. Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution. Front Endocrinol (Lausanne) 2024; 15:1330524. [PMID: 38304463 PMCID: PMC10833226 DOI: 10.3389/fendo.2024.1330524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Background Hypoparathyroidism following total thyroidectomy is globally the most common complication to thyroid surgery. The reported complication rates vary widely and might be highly dependent on the surgical experience. In this study we aimed to evaluate the rate of hypoparathyroidism following primary total thyroidectomy at a low-volume institution that only performs thyroid surgery and does not have any experience with parathyroid surgery. Methods Retrospective cohort study. All patients undergoing primary total thyroidectomy at the ENT-Department, Goedstrup Hospital, Denmark, over a 5-year period (2016-2020) were identified through the procedure codes for total thyroidectomy. Medical records, pathology reports, biochemical and medical histories were fully assessed for each patient. The primary endpoint was the rate of hypoparathyroidism- both immediate and permanent. Secondary outcomes were parathyroid gland identification rates, rates of parathyroid gland autotransplantation, and rates of inadvertent parathyroid gland excision. Results A total of 89 patients were included in the final analysis. A total of 33 patients (37.1%) experienced immediate hypoparathyroidism following surgery, while 30 patients (33.7%) still were on active vitamin D two months postoperatively. One year following surgery, 28 patients (31.5%) were still on active vitamin D and were considered as having permanent hypoparathyroidism. Sixty-one percent of the parathyroid glands were identified intraoperatively, and 19% of the patients experienced parathyroid autotransplantation. Inadvertent parathyroid gland excision occurred for 21% of the patients and was associated with a significantly increased risk of permanent hypoparathyroidism (RR = 2.99; 95% CI: 1.36 - 6.62, p = 0.005). Conclusion Both transient and permanent hypoparathyroidism following total thyroidectomy at a low-volume, non-parathyroid institution occurred with much higher frequencies than previously reported. The elevated rates were most likely due to the low-volume, non-parathyroid nature of the surgeons which in part was mirrored in low parathyroid gland identifications rates, and high rates of autotransplantation and inadvertent parathyroid gland excision.
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Affiliation(s)
- Ali Abood
- Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Frédéric Triponez
- Thoracic and Endocrine Surgery Division, Geneva University Hospital, Geneva, Switzerland
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Annebäck M, Osterman C, Arlebrink J, Mellerstedt S, Papathanasakis N, Wallin G, Hessman O, Annerbo M, Norlén O. Validating the risk of hypoparathyroidism after total thyroidectomy in a population-based cohort: plea for improved follow-up. Br J Surg 2024; 111:znad366. [PMID: 37995259 PMCID: PMC10776524 DOI: 10.1093/bjs/znad366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/28/2023] [Accepted: 09/27/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND A previous nationwide study from Sweden showed that the rate of permanent hypoparathyroidism is high and under-rated in the Swedish Quality Register. This retrospective population-based study aimed to validate the rate and diagnosis of permanent hypoparathyroidism found in the previous study. A secondary aim was to assess the relationship between the rate of low parathyroid hormone (PTH) levels within 24 h after surgery and the rate of permanent hypoparathyroidism. METHODS All patients who underwent total thyroidectomy from 2005 to 2015 in a region of Sweden were included. Data were retrieved from local health records, the National Patient Registry, the Swedish Prescribed Drug Registry, and the Swedish Quality Register. A strict definition of permanent hypoparathyroidism was used, including biochemical data and attempts to stop the treatment. RESULTS A total of 1636 patients were included. Altogether, 143 patients (8.7 per cent) developed permanent hypoparathyroidism. Of these, 102 (6.2 per cent) had definitive permanent hypoparathyroidism, whereas 41 (2.5 per cent) had possible permanent hypoparathyroidism, because attempts to stop the treatment were lacking (28) or patients were lost to follow-up (13). The agreement between the Swedish Quality Register and the chart review was 29.3 per cent. A proportion of 23.2 per cent with a PTH level below the reference value corresponded to a 6.7 per cent rate of permanent hypoparathyroidism. CONCLUSION The risk of permanent hypoparathyroidism after total thyroidectomy is high. Some patients are overtreated because attempts to stop the treatment are lacking. Quality registers might underestimate the risk of permanent hypoparathyroidism. Approximately one-quarter of all patients with low PTH levels immediately after surgery developed permanent hypoparathyroidism.
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Affiliation(s)
- Matilda Annebäck
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Jesper Arlebrink
- Department of Surgery, Karlstad Central Hospital, Karlstad, Sweden
| | | | | | - Göran Wallin
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Ola Hessman
- Department of Surgery, Västerås Central Hospital, Västerås, Sweden
| | - Maria Annerbo
- Department of Surgery, Falu Hospital, Karlstad, Sweden
| | - Olov Norlén
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Fields T, Ramonell K, Fazendin J, Gillis A, Buczek E, Porterfield J, Chen H, Lindeman B. The Obesity Paradox in Thyroid Surgery: Is Higher BMI Protective Against Hypoparathyroidism? Am Surg 2024; 90:9-14. [PMID: 37497666 DOI: 10.1177/00031348231192065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND With a demonstrated association between adiposity and parathyroid hormone (PTH) levels, we hypothesized that patients with a higher body mass index (BMI) would have lower rates of postoperative hypoparathyroidism following total thyroidectomy. METHODS retrospective review of patients undergoing total thyroidectomy from 2015 to 2021. Demographics, BMI, surgical indications, and laboratory data including pre- and postoperative PTH values were examined. RESULTS Of the 352 patients with complete clinicopathologic data, most were female (n = 272, 77.3%) with an average age of 42.7 (SD+/-19.4). Obese (BMI 30-39.99) was most common BMI group (n = 108, 30.8%), with 11.7% (n = 41) morbidly obese (BMI > 40). Morbidly obese patients had significantly higher postoperative PTH levels than BMI < 18.5 (46.0 vs 19.3 pg/mL, P = .004). Patient race was significantly associated with pre- and postoperative PTH (P = .03, P = .004.) On multivariable analysis, preoperative PTH, race, and BMI were independent predictors of higher postoperative PTH (P < .05 for all). DISCUSSION Patients with higher BMI and non-white race have relative protection from postoperative hypoparathyroidism.
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Affiliation(s)
- Tyler Fields
- Department of Surgery, Wellstar Atlanta Medical Center, Atlanta, GA, USA
| | - Kimberly Ramonell
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin Buczek
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Porterfield
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Abuduwaili M, Baidula W, Xia B, Wu Z, Chen Z, Xing Z, Su A. The Effects of Radioiodine Therapy on the Recovery of Parathyroid Function in Patients with Protracted Hypoparathyroidism after Total Thyroidectomy for Papillary Thyroid Carcinoma. J INVEST SURG 2023; 36:1-9. [PMID: 36410743 DOI: 10.1080/08941939.2022.2146239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND To determine the effect of 131I treatment on postoperative parathyroid function and the timing of recovery of parathyroid function (RPF) in patients with protracted hypoPT. METHODS 260 patients with papillary thyroid cancer (PTC) were retrospectively analyzed, including 166 patients treated with radioactive iodine-131 (131I) classified into the 131I group and 94 patients without 131I treatment classified into the control group. Data on clinicopathological characteristics, demographics, dose and interval time of 131I treatment, number of parathyroid glands remaining in situ (PGRIS), occurrence of hypoPT, duration of RPF, preoperative and postoperative levels of Ca and PTH were collected. RESULTS The patients in the 131I group showed a higher persistent hypoPT rate than those in the control group (p = 0). The PGRIS and total number of PG were significantly higher in patients who recovered from protracted HypoPT (p = 0.02; p = 0.03). PGRIS and 131I treatment [1 ∼ 2 VS 0, p = 0.03, OR 3.19; 3 ∼ 4 VS 0, p = 0.02, OR3.62; p = 0.02, OR 1.98, respectively] were independent factors influencing postoperative persistent hypoPT. The timing of RPF differed significantly for patients in the control group compared to those in the 131I group [p = 0.00]. CONCLUSIONS We found that 131I treatment significantly prolonged the RPF of patients with protracted hypoPT and caused late RPF (even beyond 12 months). The diagnosis of "permanent" hypoPT should be cautiously made at least 12 months after surgery, especially in patients who receive 131I treatment.
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Affiliation(s)
- Munire Abuduwaili
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wusiman Baidula
- Department of Basic Medical College, Xinjiang Uygur Medical College, Ürümqi, China
| | - Baoying Xia
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhujuan Wu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ziwei Chen
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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Qin X, Luo J, Ma J, Cao X, Zhao J, Jiang J, Zhang Y, Zeng L, Fan L. Prospective cohort study of parathyroid function and quality of life after total thyroidectomy for thyroid cancer: robotic surgery vs. open surgery. Int J Surg 2023; 109:3974-3982. [PMID: 37755372 PMCID: PMC10720820 DOI: 10.1097/js9.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To compare robot-assisted thyroidectomy (RT) and open thyroidectomy (OT) through a prospective cohort study focusing on the rate of postoperative hypoparathyroidism, efficacy, and quality of life (QoL). SUMMARY BACKGROUND DATA Hypoparathyroidism is a frequent complication after thyroidectomy. Reducing the risk of hypoparathyroidism after total thyroidectomy is a crucial and difficult task for thyroid surgeons. METHODS We prospectively enroled 306 patients with papillary thyroid carcinoma into an RT group and OT group. The former used "super-meticulous" capsular dissection) and the latter used traditional meticulous capsular dissection. Patients were evaluated by scales [Short Form (SF)-36, Visual Impairment Scale (VIS), Swallowing Impairment Scale (SIS), Neck Impairment Scale (NIS), Scar questionnaire (SCAR-Q)]. RESULTS The rates of transient hypoparathyroidism, permanent hypoparathyroidism, and transient hypocalcemia after surgery in the OT group and RT group were significantly different ( P <0.001). SIS and VIS scores in the two groups were significantly different ( P <0.001). SF-36 showed significant differences ( P <0.001) in the subsections of "physiological function", "body pain", "general health", "vitality", "social function", "role emotional", and "mental health" between the two groups. SCAR-Q showed that the length and appearance of scars showed significant differences between the two groups. CONCLUSIONS RT with Super-meticulous capsular dissection can protect parathyroid function and improve postoperative QoL, and could be a new option for robot-assisted surgery against thyroid cancer.
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Affiliation(s)
| | | | | | | | | | | | | | - Lingjuan Zeng
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Gaotanyan Street 29, Shapingba District, Chongqing, 400038, China
| | - Linjun Fan
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Gaotanyan Street 29, Shapingba District, Chongqing, 400038, China
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Roberts SL, El-Shikh M, Alam P, Borumandi F. Incidence of post-surgical hypoparathyroidism (POSH) after total thyroidectomy. Br J Oral Maxillofac Surg 2023; 61:679-685. [PMID: 38126158 DOI: 10.1016/j.bjoms.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 10/04/2023] [Indexed: 12/23/2023]
Abstract
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.
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Affiliation(s)
- Simon L Roberts
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Mahmoud El-Shikh
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Peyman Alam
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK; Worthing Hospital, Lyndhurst Rd, Worthing BN11 2DH, UK.
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Santa Rosa RG, Polonine S, Pichone A, Gomes CP, Lima LFC, de Paula Paranhos Neto F, de Mendonça LMC, Farias MLF, Madeira M. Chronic hypoparathyroidism is associated with increased cortical bone density evaluated using high-resolution peripheral quantitative computed tomography. Endocrine 2023; 82:673-680. [PMID: 37624475 DOI: 10.1007/s12020-023-03495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This cross-sectional study aimed to assess bone mineral density (BMD), bone microarchitecture and fracture prevalence in women with chronic postsurgical hypoparathyroidism (hypoPT). METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Renata Gervais Santa Rosa
- Endocrinology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
- Nephrology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Simone Polonine
- Endocrinology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alinie Pichone
- Nephrology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Perez Gomes
- Nephrology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Miguel Madeira
- Endocrinology Division, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Takatani R, Kubota T, Minagawa M, Inoue D, Fukumoto S, Ozono K, Nakamura Y. Prevalence of Pseudohypoparathyroidism and Nonsurgical Hypoparathyroidism in Japan in 2017: A Nationwide Survey. J Epidemiol 2023; 33:569-573. [PMID: 36123043 PMCID: PMC10518380 DOI: 10.2188/jea.je20220152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/29/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pseudohypoparathyroidism (PHP) and nonsurgical hypoparathyroidism (NS-HypoPT) are rare diseases with hypocalcemia, hyperphosphatemia, and high and low parathyroid hormone levels, respectively. In Japan, over 20 years have passed since the last survey on these diseases. We carried out a nationwide cross-sectional survey to estimate the prevalence of these diseases in 2018. METHODS We conducted a nationwide mail-based survey targeting hospitals in 2018. From a total of 13,156 departments throughout Japan, including internal medicine, pediatrics, neurology, and psychiatry, 3,501 (27%) departments were selected using a stratified random sampling method. We asked each included department to report the number of patients with PHP and NS-HypoPT in 2017. RESULTS The overall survey response rate was 52.0% (1,807 departments). The estimated number of patients with PHP and NS-HypoPT was 1,484 (95% confidence interval [CI], 1,143-1,825) and 2,304 (95% CI, 1,189-3,419), respectively; the prevalence per 100,000 population was 1.2 and 1.8, respectively. CONCLUSION In this study, we generated estimates of the national prevalence of PHP and NS-HypoPT in Japan during 2017, which were found to be higher than those previously reported.
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Affiliation(s)
- Rieko Takatani
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Daisuke Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Seiji Fukumoto
- Department of Molecular Endocrinology, Fujii Memorial Institute of Medical Sciences, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
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Gronemeyer K, Fuss CT, Hermes F, Plass A, Koschker AC, Hannemann A, Völzke H, Hahner S. Renal complications in chronic hypoparathyroidism - a systematic cross-sectional assessment. Front Endocrinol (Lausanne) 2023; 14:1244647. [PMID: 38027217 PMCID: PMC10654620 DOI: 10.3389/fendo.2023.1244647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Context Although renal long-term complications are acknowledged in chronic hypoparathyroidism (HPT), standardized investigations are scarce. Objective To systematically investigate renal complications and their predictors in hypoparathyroid patients compared to matched individuals. Design Prospective observational study in 161 patients with chronic HPT. Methods Patients received renal ultrasound, clinical and laboratory assessments. An individual 1:3 matching with participants from the German population-based Study of Health in Pomerania was performed. Results Of 161 patients (92% postoperative HPT), prevalence of eGFR <60ml/min/1.73m2 was 21%, hypercalciuria 41%. Compared to healthy individuals, HPT patients had a significantly lower eGFR (74.2 vs. 95.7 ml/min/1.73m², p<0.01). Renal ultrasound revealed calcifications in 10% (nephrocalcinosis in 7% and calculi in 3%). Patients with renal calcifications had higher levels of 24-hour urine calcium excretion (8.34 vs. 5.08 mmol/d, p=0.02), spot urine calcium excretion (4.57 vs. 2.01 mmol/L, p=0.01) and urine calcium-to-creatinine ratio (0.25 vs. 0.16, p<0.01) than patients without calcifications. Albumin-corrected calcium, phosphate, calcium-phosphate product, 25-hydroxyvitamin D in serum, eGFR, daily calcium intake or disease duration were not significantly different between these two groups. Including patients receiving rhPTH therapy, a lower serum phosphate concentration (odds ratio 1.364 [95% confidence interval (CI) 1.049-1.776], p<0.05) and a longer disease duration of HPT (odds ratio 1.063 [95% CI 1.021-1.106], p<0.01) were significant predictors for renal calcifications. Excluding patients receiving rhPTH therapy, a higher 24-hour urine calcium excretion (odds ratio 1.215 [95% CI 1.058-1.396], p<0.01) was a significant predictor for renal calcifications but not serum magnesium or disease duration. Conclusions Prevalence of impaired renal function among patients with chronic HPT is increased and independent from visible renal calcifications. Depending on exclusion of patients with rhPTH therapy, regression analysis revealed disease duration and serum phosphate or disease duration and 24-hour urinary calcium excretion as predictors for renal calcifications. Clin Trials Identifier NCT05585593.
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Affiliation(s)
- Karen Gronemeyer
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Carmina Teresa Fuss
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Franca Hermes
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Armin Plass
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Ann-Cathrin Koschker
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefanie Hahner
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
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13
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Büttner M, Krogh D, Siggelkow H, Singer S. Impairments in quality of life and predictors of symptom burden in patients with hypoparathyroidism: results from a population-based survey. Endocrine 2023; 82:419-426. [PMID: 37450218 PMCID: PMC10543843 DOI: 10.1007/s12020-023-03443-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To investigate the quality of life (QoL) in patients with hypoparathyroidism (hypoPT) compared to the general population and to identify sociodemographic and clinical factors that are associated with symptom burden. METHODS Patients with a diagnosis of hypoPT participated in an online survey. Information regarding the survey was distributed by treating physicians or a self-help organization. Quality of life was assessed using the EORTC QLQ-C30 and symptom burden using the Hypoparathyroid Patient Questionnaire (HPQ28). Multivariate linear regression analysis was used to compare QoL of hypoPT patients with the general population (adjusted for age, sex, education)and to identify factors associated with symptom burden. RESULTS Altogether, 264 hypoPT patients provided information on QoL and symptom burden. HypoPT was associated with worse cognitive (β = -15.9; p < 0.01) and emotional functioning (β = -12.3; p = 0.04) compared to the general population. The highest symptom burden in hypoPT patients was observed for the domains loss of vitality (mean: 61.4; SD: 21.9), pain and cramps (mean: 43.7; SD: 26.5), and numbness and tingling sensations (mean: 38.9; SD: 30.0). Female gender was associated with a higher symptom burden across all nine domains of the HPQ28, while longer disease duration was associated with a lower symptom burden in neurovegetative symptoms, loss of vitality, depression and anxiety, and depressive symptoms. CONCLUSION HypoPT patients have impaired QoL compared to the general population. Being female is strongly associated with high symptom burden.
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Affiliation(s)
- Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany.
- University Cancer Centre, Mainz, Germany.
| | - Dieter Krogh
- Netzwerk Hypopara im Bundesverband Schilddrüsenkrebs-Ohne Schilddrüse leben e.V, Berlin, Germany
| | - Heide Siggelkow
- Clinic of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany
- MVZ Endokrinologikum Göttingen, Göttingen, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
- University Cancer Centre, Mainz, Germany
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14
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Mayer AW, Sharp A, Aziz S, Balasubramanian SP. Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism. J Laryngol Otol 2023; 137:1226-1232. [PMID: 36876328 DOI: 10.1017/s002221512300035x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To evaluate the incidence of inadvertent parathyroidectomy, identify risk factors, determine the location of inadvertently excised glands, review pathology reporting in inadvertent parathyroidectomy, and explore relationships between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia. METHODS A retrospective cohort study of 899 thyroidectomies between 2015 and 2020 was performed. Histopathology slides of patients who had an inadvertent parathyroidectomy and a random sample of patients without a reported inadvertent parathyroidectomy were reviewed. RESULTS Inadvertent parathyroidectomy occurred in 18.5 per cent of thyroidectomy patients. Central neck dissection was an independent risk factor (inadvertent parathyroidectomy = 49.4 per cent with central neck dissection, 12.0 per cent without central neck dissection, p < 0.001). Most excised parathyroid glands were extracapsular (53.3 per cent), followed by subcapsular (29.1 per cent) and intrathyroidal (10.9 per cent). Parathyroid tissue was found in 10.2 per cent of specimens where no inadvertent parathyroidectomy was reported. Inadvertent parathyroidectomy was associated with a higher incidence of six-month post-surgical hypoparathyroidism or hypocalcaemia (19.8 per cent who had an inadvertent parathyroidectomy, 7.7 per cent without inadvertent parathyroidectomy). CONCLUSION Inadvertent parathyroidectomy increases the risk of post-surgical hypoparathyroidism or hypocalcaemia. The proportion of extracapsular glands contributing to inadvertent parathyroidectomy highlights the need for preventative measures.
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Affiliation(s)
- A W Mayer
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A Sharp
- Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S Aziz
- Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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15
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Paladino NC, Remde H, Guerin C, Morange I, Taïeb D, Sebag F. Accidental parathyroidectomy during total thyroidectomy and hypoparathyroidism in a large series of 766 patients: incidence and consequences in a referral center. Langenbecks Arch Surg 2023; 408:393. [PMID: 37817055 DOI: 10.1007/s00423-023-03130-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Transient hypoparathyroidism is the most common complication after total thyroidectomy, and accidental parathyroidectomy (AP) may be a cause. The aim of this study was to investigate the incidence of AP and its impact on postoperative calcemia. MATERIALS AND METHODS From February 2016 to May 2018, 766 patients undergoing total thyroidectomy were prospectively included. Surgical indications, hormonal status, definitive histology, and postoperative calcium and PTH levels were analyzed. RESULTS 578/(75.45%) were women and 188/(24.55%) men with mean age of 53.4 years. Parathyroid tissue on the thyroid specimen was observed in 40 (5.2%) patients: 30 APs and 10 parathyroid fragments. Among the 30 APs, 12 glands were intrathyroid and 18 (2.3%) in eutopic location. 97 (12.6%) patients were treated for postoperative hypocalcemia: 90 (11.7%) had transient and 5 (0.6%) definitive hypoparathyroidism; 2 were lost in follow-up. 13/30 (43.3%) with AP had transient hypoparathyroidism. A strong correlation was found (p < 0.0001) between AP and postoperative hypocalcemia. 1/30 (3.3%) patient with APs had definitive hypoparathyroidism. Transient and persistent nerve palsies were found in 10 (1.3%) and 3 (0.4%) patients, respectively. DISCUSSION A careful examination of the thyroid gland after resection help to identify an AP that could be autotransplanted. Surgeon and hospital activity volume per years seem to reduce the risk of hypoparathyroidism. CONCLUSION Total thyroidectomy and intrathyroid localization of parathyroid glands are risk factors for the AP. The incidence of AP was 2.3%, and this remains low due to our longstanding experience in thyroid and parathyroid surgery.
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Affiliation(s)
- Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France.
| | - Hanna Remde
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France
| | - Carole Guerin
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France
| | - Isabelle Morange
- Department of Endocrinology, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, 264, Rue Saint Pierre, 13385, Marseille, France
| | - Frédéric Sebag
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005, Marseille, France
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Rejnmark L, Underbjerg L. Fracture Risk in Patients with Hypoparathyroidism. Curr Osteoporos Rep 2023; 21:632-636. [PMID: 37542005 DOI: 10.1007/s11914-023-00790-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE OF REVIEW To summarize the recently published scientific evidence on fracture risk in hypoparathyroidism. RECENT FINDINGS 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.
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Affiliation(s)
- Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Line Underbjerg
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Aarhus, Denmark
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Melot C, Deniziaut G, Menegaux F, Chereau N. Incidental parathyroidectomy during total thyroidectomy and functional parathyroid preservation: a retrospective cohort study. BMC Surg 2023; 23:269. [PMID: 37674156 PMCID: PMC10481605 DOI: 10.1186/s12893-023-02176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative transient hypocalcemia and permanent hypoparathyroidism are still debated. The aims of this study were to assess the clinical relevance of avoidable IP for transient hypocalcemia and permanent hypoparathyroidism, and to describe the risk factors for IP. METHODS This retrospective cohort study included 1,537 patients who had a one-step total thyroidectomy in a high-volume endocrine surgery center between 2018 and 2019. Pathology reports were reviewed for incidentally removed parathyroid glands. Intrathyroidal parathyroid glands were excluded from the study. Demographic characteristics, potential risk factors, and postoperative calcium and PTH levels were compared between IP and control groups. RESULTS Avoidable IP occurred in 234 (15.2%) patients. Patients with IP had a higher risk of transient hypocalcemia (17.9% vs. 11.5%, p = 0.006; odds ratio [OR] 1.68, 95% confidence interval [95% CI]1.16-2.45) and permanent hypoparathyroidism (4.7% vs. 1.6%, p = 0.002; OR 3.01, 95% CI 1.29-6.63) than patients without IP. Multivariate analysis showed that central lymph node dissection (CLND) and incidental removal of thymus tissue were independent risk factors for IP (OR 4.83, 95% CI 2.71-8.86, p < 0.001 and OR 1.72, 95% CI 1.02-2.82, p = 0.038). CONCLUSIONS Patients with IP were more likely to develop transient hypocalcemia and permanent hypoparathyroidism, indicating the clinical significance of avoidable IP for patients and the need for raising awareness among surgeons. Patients undergoing CLND are at a higher risk for IP, and should be adequately informed and treated. Any removal of thymus tissue should be avoided during CLND.
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Affiliation(s)
- Charlotte Melot
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de L'Hôpital, Paris, 75013, France.
| | - Gabrielle Deniziaut
- Department of Pathology, Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
| | - Fabrice Menegaux
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de L'Hôpital, Paris, 75013, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
| | - Nathalie Chereau
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de L'Hôpital, Paris, 75013, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
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Ahn SH, Lee YJ, Hong S, Park JW, Jeon YJ, Yoo BN, Ha YC, Bak JK, Kim HY, Lee YK. Risk of Fractures in Thyroid Cancer Patients With Postoperative Hypoparathyroidism: A Nationwide Cohort Study in Korea. J Bone Miner Res 2023; 38:1268-1277. [PMID: 37338940 DOI: 10.1002/jbmr.4871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 06/03/2023] [Accepted: 06/16/2023] [Indexed: 06/21/2023]
Abstract
Postoperative hypoparathyroidism (PO-hypoPT) is an uncommon complication of total thyroidectomy in thyroid cancer patients. Although long-term hypoPT causes characteristic changes in bone metabolism, the risk of fractures in hypoPT remains inconclusive. We investigated the risk of fractures in Korean thyroid cancer patients with PO-hypoPT. This was a retrospective cohort study using data from the Korea Central Cancer Registry and Korean National Health Insurance Service. We analyzed 115,821 thyroid cancer patients aged ≥18 years, who underwent total thyroidectomy between 2008 and 2016. The risk of any fractures, including vertebral, hip, humerus, and wrist fractures, according to parathyroid function after total thyroidectomy, was analyzed using the multivariable Cox proportional hazard model. The PO-hypoPT and preserved parathyroid function groups included 8789 (7.6%) and 107,032 (92.4%) patients, respectively. Over a mean follow-up duration of 4.8 years, 159 (1.8%) and 2390 (2.2%) fractures occurred in the PO-hypoPT and preserved parathyroid function groups, respectively. The risk of any fractures was significantly lower in the PO-hypoPT group than in the preserved parathyroid function group (hazard ratio [HR] = 0.83; 95% confidence interval [CI] 0.70-0.98; p = 0.037) after adjusting for confounders. Regarding the fracture site, only the risk of vertebral fractures was significantly lower in the PO-hypoPT group compared with the preserved parathyroid function group (HR = 0.67; 95% CI 0.47-0.96; p = 0.028) after adjusting for confounders. Subgroup analyses showed that bone mineral density measurements and calcium supplementation interacted with the relationship between PO-hypoPT and the risk of any fractures (p for interactions = 0.010 and 0.017, respectively). PO-hypoPT was associated with a lower risk of fractures in thyroid cancer patients, especially at the vertebra. The relatively low bone turnover caused by PO-hypoPT and appropriate management for PO-hypoPT with active vitamin D and calcium may prevent the deterioration of skeletal health in thyroid cancer patients who can easily be exposed to long-term overtreatment with levothyroxine. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - You Jin Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, South Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Jung Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ye Jhin Jeon
- Department of Statistics, Yonsei University, Seoul, South Korea
| | - Bit-Na Yoo
- National Evidence-based Healthcare Collaboration Agency (NECA), Seoul, South Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, BUMIN Hospital, Seoul, South Korea
| | - Jean Kyung Bak
- National Evidence-based Healthcare Collaboration Agency (NECA), Seoul, South Korea
| | - Ha Young Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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Büttner M, Krogh D, Führer D, Fuß CT, Willenberg HS, Luster M, Singer S, Siggelkow H. Hypoparathyroidism - management, information needs, and impact on daily living from the patients' perspective: results from a population-based survey. Hormones (Athens) 2023; 22:467-476. [PMID: 37380916 PMCID: PMC10449945 DOI: 10.1007/s42000-023-00459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE Hypoparathyriodism (hypoPT) is a rare endocrine disorder. It is not known how hypoPT is managed in Germany or whether patients have unmet information needs or impairments in their daily living. METHODS HypoPT patients at a minimum of 6 months' post-diagnosis were invited to participate in an online survey through their treating physician or through patient organizations. An extensive questionnaire, which was developed and pilot-tested with hypoPT patients, was administered. RESULTS A total of 264 patients with a mean age of 54.5 years (SD: 13.3), 85.2% female and 92% with postsurgical hypoPT, participated in the study. In total, 74% of the patients reported regular monitoring of serum calcium at least every 6 months, with lower control frequencies for phosphate (47%), magnesium (36%), creatinine (54%), and parathyroid hormone (50%), and 24-h urine calcium excretion (36%) on a yearly basis. Information on symptoms of hypo- and hypercalcemia was available in 72 and 45% of the patients. Information needs were related to the disease and its treatment as well as to nutrition, physical activities/sports, and support opportunities. Statistically significant differences for all information needs in association with symptom burden were observed. Hospitalization for hypocalcemia was reported by 32%, nutritional impairments (38%) or impact on work ability (52%) was available among patients with hypoPT. CONCLUSION HypoPT patients experience impairments in daily living and report unmet information needs. Patient and physician education regarding hypoPT is one of the key concepts for improving the management of patients with hypoPT.
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Affiliation(s)
- Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany.
- University Cancer Centre, Mainz, Germany.
| | - Dieter Krogh
- Netzwerk Hypopara im Bundesverband Schilddrüsenkrebs - Ohne Schilddrüse leben e.V., Berlin, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carmina Teresa Fuß
- Division of Endocrinology and Diabetes, Department of Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Holger Sven Willenberg
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany
- University Cancer Centre, Mainz, Germany
| | - Heide Siggelkow
- Clinic of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University of Göttingen, Göttingen, Germany
- MVZ Endokrinologikum Göttingen, Göttingen, Germany
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Jeong JY, Song CM, Ji YB, Park JH, Kim DS, Tae K. Incidence and risk factors of hypoparathyroidism and hypocalcemia after hemithyroidectomy. Langenbecks Arch Surg 2023; 408:298. [PMID: 37548797 DOI: 10.1007/s00423-023-03038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE The incidence and risk factors for hypoparathyroidism after total thyroidectomy is well-known. However, the characteristics of hypoparathyroidism and hypocalcemia after hemithyroidectomy have not been investigated well. In this study, we aimed to evaluate the incidence, characteristics, and risk factors of hypoparathyroidism and hypocalcemia after hemithyroidectomy. METHOD We retrospectively analyzed the medical data of 321 patients who underwent hemithyroidectomy, with or without central neck dissection, from January 2012 to April 2019. We analyzed the serum intact parathyroid hormone (iPTH), calcium, and ionized calcium (iCa) levels serially (preoperatively and postoperatively on the operation day; days 1 and 3; and months 1, 3, 6, and 12) and evaluated risk factors for postoperative hypoparathyroidism and hypocalcemia. RESULTS The mean iPTH and calcium levels decreased significantly after hemithyroidectomy on the operation day and postoperative days 1 and 3, and returned to the preoperative level at the postoperative 1-month follow-up. The mean iCa level decreased significantly on the operation day and postoperative day 1. Transient hypoparathyroidism and transient hypocalcemia occurred in 16 (5%) and 250 (78%) participants, and they recovered to normal levels postoperatively by 1 month. Eight (2.5%) patients had mild symptoms of hypocalcemia necessitating oral calcium supplementation. No permanent hypoparathyroidism or hypocalcemia was observed. Preoperatively low serum iPTH and calcium levels were associated with transient hypoparathyroidism and hypocalcemia after hemithyroidectomy. CONCLUSION Approximately 5% and 2.5% of participants showed transient hypoparathyroidism and mild symptomatic hypocalcemia after hemithyroidectomy. The risk factors for transient hypoparathyroidism and hypocalcemia include preoperative low serum iPTH and calcium levels.
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Affiliation(s)
- Jae Yeong Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Jung Hwan Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Dong Sun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea.
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Cisco R, Arnow K, Barreto N, Lin D, Kebebew E, Seib C. Increased Risk of Complications Associated With Concurrent Parathyroidectomy in Patients Undergoing Total Thyroidectomy. J Surg Res 2023; 288:275-281. [PMID: 37043874 DOI: 10.1016/j.jss.2023.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/03/2023] [Accepted: 02/17/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION We sought to investigate the association of concurrent parathyroidectomy (PTX) with risks of total thyroidectomy (TTX) through analysis of Collaborative Endocrine Surgery Quality Improvement Program data. TTXis a common operation with complications including recurrent laryngeal nerve injury, neck hematoma, and hypoparathyroidism. A subset of patients undergoing thyroidectomy undergoes planned concurrent PTX for treatment of primary hyperparathyroidism. There are limited data on the risk profile of TTX with concurrent PTX (TTX + PTX). METHODS We queried the Collaborative Endocrine Surgery Quality Improvement Program database for patients who underwent TTX or TTX + PTX from January 2014 through April 2020. Multivariable logistic regression was performed to predict hypoparathyroidism, vocal cord dysfunction, neck hematoma, and postoperative emergency department visit. Covariates included patient demographics, patient body mass index, indication for surgery, central neck dissection, anticoagulation use, and surgeon volume. RESULTS Thirteen thousand six hundred forty seven patients underwent TTX and 654 patients underwent TTX + PTX. Unadjusted rates of hypoparathyroidism were higher in TTX + PTX patients at 30 d (9.6% versus 7.4%, P = 0.04) and 6 mo (7.9% versus 3.1%, P < 0.001). On multivariable regression, TTX + PTX was associated with an increased risk of hypoparathyroidism at 30 d (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.57-2.79) and 6 mo (OR 4.63, 95% CI 3.06-7.00) and an increased risk of postoperative emergency department visit (OR 1.66, 95% CI 1.20-2.31). TTX + PTX was not associated with recurrent laryngeal nerve injury or neck hematoma. CONCLUSIONS Concurrent PTX in patients undergoing TTX is associated with increased risk of immediate and long-term hypoparathyroidism, which should be considered in informed consent discussions and operative decision-making.
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Affiliation(s)
- Robin Cisco
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Katherine Arnow
- Stanford-Surgery Policy Improvement Research & Education Center (S-SPIRE), Stanford, California
| | - Nicolas Barreto
- Stanford-Surgery Policy Improvement Research & Education Center (S-SPIRE), Stanford, California
| | - Dana Lin
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Electron Kebebew
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Carolyn Seib
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California; Stanford-Surgery Policy Improvement Research & Education Center (S-SPIRE), Stanford, California
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Benmiloud F, Le Bihan C, Rebaudet S, Marino P, Bousquet PJ, Bouée-Benhamiche E. Hypoparathyroidism-related health care utilization and expenditure during the first postoperative year after total thyroidectomy for cancer: a comprehensive national cohort study. Front Endocrinol (Lausanne) 2023; 14:1193290. [PMID: 37448467 PMCID: PMC10338088 DOI: 10.3389/fendo.2023.1193290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/09/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives Hypoparathyroidism is the most common complication of total thyroidectomy for cancer, and requires calcium and/or vitamin D supplementation for an unpredictable period of time. The additional cost associated with this complication has not hitherto been assessed. The aim of this study was to assess the economic burden of postoperative hypoparathyroidism after total thyroidectomy for cancer in France. Methods Based on the French national cancer cohort, which extracts data from the French National Health Data System (SNDS), all adult patients who underwent a total thyroidectomy for cancer in France between 2011 and 2015 were identified, and their healthcare resource use during the first postoperative year was compared according to whether they were treated postoperatively with calcium and/or vitamin D or not. Univariate and multivariate cost analyses were performed with the non-parametric Wilcoxon test and generalized linear model (gamma distribution and log link), respectively. Results Among the 31,175 patients analyzed (75% female, median age: 52y), 13,247 (42%) started calcium and/or vitamin D supplementation within the first postoperative month, and 2,855 patients (9.1%) were still treated at 1 year. Over the first postoperative year, mean overall and specific health expenditures were significantly higher for treated patients than for untreated patients: €7,233 vs €6,934 per patient (p<0.0001) and €478.6 vs €332.7 per patient (p<0.0001), respectively. After adjusting for age, gender, Charlson Comorbidity index, ecological deprivation index, types of thyroid resection, lymph node dissection and complications, year and region, the incremental cost of overall health care utilization was €142 (p<0.004). Conclusion Our study found a significant additional cost in respect of health expenditures for patients who had hypoparathyroidism after thyroidectomy for cancer, over the first postoperative year. Five-year follow-up is planned to assess the impact of more severe long-term complications on costs.
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Affiliation(s)
- Fares Benmiloud
- Department of Endocrine Surgery, Hôpital Privé de Provence, Aix-en-Provence, France
- Department of Endocrine Surgery, Hôpital Européen Marseille, Marseille, France
| | - Christine Le Bihan
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
| | - Stanislas Rebaudet
- Department of Endocrine Surgery, Hôpital Européen Marseille, Marseille, France
- Aix-Marseille Institute of Public Health, Institut des sciences de la santé publique d’Aix-Marseille (ISSPAM), Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM), Aix-Marseille Univ, Institut national de la santé et de la recherche médicale (INSERM), Institut de recherche pour le développement (IRD), Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM UMR) 1252, Institut national de la santé et de la recherche (INSERM), Institut de recherche pour le développement (IRD), Aix Marseille University, Marseille, France
| | - Philippe-Jean Bousquet
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
- Institut Paoli-Calmettes Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM UMR) 1252, Institut national de la santé et de la recherche (INSERM), Institut de recherche pour le développement (IRD), Aix Marseille University, Marseille, France
| | - Elsa Bouée-Benhamiche
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
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Cheng X, Li Y, Chen L. Efficacy of parathyroid autotransplantation in endoscopic total thyroidectomy with CLND. Front Endocrinol (Lausanne) 2023; 14:1193851. [PMID: 37441504 PMCID: PMC10334188 DOI: 10.3389/fendo.2023.1193851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose To evaluate the safety and efficacy of autologous parathyroid transplantation in laparoscopic total thyroidectomy combined with central lymph node dissection (CLND). Methods Retrospective analysis of clinical data of 152 patients admitted to the General Surgery Department of Gansu Provincial People's Hospital who underwent endoscopic total thyroidectomy combined with CLND from June 2018 to December 2021. The intraoperative parathyroid glands were divided into the orthotopic preservation group (non-transplantation group) and the immediate active autologous transplantation group (transplantation group) according to the different treatment management of parathyroid glands during operation. The levels of Ca2+ in parathyroid blood and the incidence of hypoparathyroidism were compared between the two groups before operation and 1 day, 3 day, 1 week, 1 month, 3 months and 6 months after operation. Results There was no significant difference in PTH between the preoperative transplantation group compared and the non-transplantation group (P>0.05); The PTH in the transplantation group was lower than that of the non-transplantation group 1 and 3 d after surgery, and the difference was statistically significant (P<0.05); No statistically significant difference in PTH between patients in the transplantation group compared with those in the non-transplantation group at 1 week postoperatively (P>0.05); PTH was significantly higher in the transplant group than in the non-transplant group at 1, 3 and 6 months after surgery, with statistically significant differences (P<0.05); there was no statistically differences (P>0.05) in serum Ca2+ between the preoperative, 1d, 3d and 1 week postoperative transplantation group and the non-transplantation group; Blood Ca2+ was significantly higher in the transplant group than in the non-transplant group at 1, 3 and 6 months after surgery, with statistically significant differences (P<0.05); The rate of temporary hypoparathyroidism in the transplantion group was higher than that in the non-transplantion group, and the rate of permanent hypoparathyroidism was lower than that in the non-transplantion group (P=0.044); There was no significant difference in the concentration of PTH in the cephalic vein of the elbow between the transplanted side and the non-transplanted side at 1 day and 3 days postoperatively (P>0.05); the concentration of PTH in cephalic vein of the elbow was significantly higher than that in non-transplanted side at 1 week, 1 month, 3 months and 6 months postoperatively (P<0.001); the number central area dissection and metastasis dissection in the transplantation group were significantly higher than those in the non-transplantation group (P<0.05). Conclusions Most autologous parathyroid glands, having functional parathyroid autograft, is helpful to the occurrence of hypoparathyroidism after endoscopic total thyroidectomy with CLND, and it is an effective strategy to prevent permanent hypoparathyroidism, and more thorough area dissection is beneficial to the disease prognosis.
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Affiliation(s)
- Xiaozhou Cheng
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Yaping Li
- Department of Anesthesiology, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Lijun Chen
- Department of Radiology, Gansu Provincial People’s Hospital, Lanzhou, China
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Pradhan S, Fernando DT, Tien A, Wong SL, Yew MK. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): initial experience in Australia. ANZ J Surg 2023; 93:545-549. [PMID: 36524584 DOI: 10.1111/ans.18185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Thyroidectomy is traditionally an open procedure. The potential for and unpredictability of patients developing an unsightly anterior neck scar has led many investigators to develop various 'scarless' thyroidectomy techniques. Here we report on our initial experience, and to our knowledge, the first and largest series of this technique in Australia and New Zealand. METHODS Across two centres in Western Australia, three Endocrine surgeons utilized the Transoral Endoscopic Thyroidectomy vestibular approach (TOETVA). Key endpoints such as operating time, blood loss, pain scores, recurrent laryngeal nerve injury and hypoparathyroidism was collected. Data was analysed using R statistical program. RESULTS One hundred and two TOETVAs were performed between March 2018 and May 2021. There were 66 hemithyroidectomies, 34 total thyroidectomies (four converted to open), and two isthmusectomies. We noted a trend in median operating time decreasing over the study period. There were no cases of permanent recurrent laryngeal nerve palsy, wound infection, seroma or haematoma. We had four instances of open conversion; one temporary RLN palsy, and 12 cases of temporary hypoparathyroidism. CONCLUSION This is the first series of TOETVA reported in Australia and New Zealand. Our results demonstrate that with appropriate surgeon experience, training, collaboration, and in well selected patients, this is a feasible and safe thyroidectomy technique. We hope that our work will build confidence in Endocrine Surgical units seeking to develop this technique in Australia.
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Affiliation(s)
- Sharin Pradhan
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Dhanushke T Fernando
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Alan Tien
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sze Ling Wong
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ming K Yew
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of General Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia
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García Pascual L, García González L, Lao Luque X, Palomino Meneses L, Viscasillas Pallàs G. Evaluation of an early detection protocol, intensive treatment and control of post-surgical hypoparathyroidism in the first month after total thyroidectomy. Endocrinología, Diabetes y Nutrición (English ed ) 2023; 70:202-211. [PMID: 37002121 DOI: 10.1016/j.endien.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/29/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND OBJECTIVE Hypoparathyroidism is the most common complication of total thyroidectomy and usually requires monitoring of calcaemia, whereby it is one of the factors that most contributes to hospital stay. The objective of the study is to evaluate the clinical usefulness of the application of our protocol for early detection, intensive treatment and control of hypoparathyroidism in the first month after thyroidectomy. PATIENTS AND METHOD Retrospective observational cross-sectional study of 79 patients who underwent total thyroidectomy in whom parathormone (PTH) and calcemia determinations were performed at 6-8 h and 18-24 h post-surgery. When the PTH value was lower than inferior limit of the reference (15 pg/ml), oral treatment was started with 1000 mg of calcium and 0.25 μg of calcitriol every 8 h followed by calcemia controls. RESULTS Twenty-six cases (32.9%) of normocalcemic hypoparathyroidism were detected in whom treatment prevented their progression to hypocalcaemia, except for 3 cases that had an episode of mild asymptomatic hypocalcaemia. There were no cases of moderate/severe hypocalcaemia and only one case of asymptomatic mild hypercalcaemia. There were no readmissions due to calcium abnormalities. No case with PTH > 15 pg/ml had hypocalcaemia. The protocol allowed a hospital stay of 24 h. The prevalence of permanent hypoparathyroidism was 5.1%. CONCLUSIONS The application of our protocol during the first month after thyroidectomy is very useful because it avoids the appearance of moderate/severe hypocalcaemia and hypercalcaemia, allows a short hospital stay and is associated with a low prevalence of permanent hypoparathyroidism.
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Affiliation(s)
- Luis García Pascual
- Servei d'Endocrinologia, Hospital Universitari Mútua de Terrasa, Terrassa, Barcelona, Spain.
| | - Lluís García González
- Servei de Cirurgia General i Aparell Digestiu, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Xavier Lao Luque
- Servei d'Otorrinolaringologia, Hospital Universitari Mútua de Terrasa, Terrassa, Barcelona, Spain
| | - Laura Palomino Meneses
- Servei d'Otorrinolaringologia, Hospital Universitari Mútua de Terrasa, Terrassa, Barcelona, Spain
| | - Guillem Viscasillas Pallàs
- Servei d'Otorrinolaringologia, Althaia, Xarxa Assistencial Universitaria de Manresa, Manresa, Barcelona, Spain
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Seib CD, Meng T, Cisco RM, Lin DT, McAninch EA, Chen J, Tamura MK, Trickey AW, Kebebew E. Risk of Permanent Hypoparathyroidism Requiring Calcitriol Therapy in a Population-Based Cohort of Adults Older Than 65 Undergoing Total Thyroidectomy for Graves' Disease. Thyroid 2023; 33:223-229. [PMID: 36416252 PMCID: PMC9963476 DOI: 10.1089/thy.2022.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Total thyroidectomy for Graves' disease (GD) is associated with rapid treatment of hyperthyroidism and low recurrence rates. However, it carries the risk of surgical complications including permanent hypoparathyroidism, which contributes to long-term impaired quality of life. The objective of this study was to determine the incidence of permanent hypoparathyroidism requiring calcitriol therapy among a population-based cohort of older adults undergoing total thyroidectomy for GD in the United States. Methods: We performed a population-based cohort study using 100% Medicare claims from beneficiaries older than 65 years with GD who underwent total thyroidectomy from 2007 to 2017. We required continuous enrollment in Medicare Parts A, B, and D for 12 months before and after surgery to ensure access to comprehensive claims data. Patients were excluded if they had a preoperative diagnosis of thyroid cancer or were on long-term preoperative calcitriol. Our primary outcome was permanent hypoparathyroidism, which was identified based on persistent use of calcitriol between 6 and 12 months following thyroidectomy. We used multivariable logistic regression to identify characteristics associated with permanent hypoparathyroidism, including patient age, sex, race/ethnicity, neighborhood disadvantage, Charlson-Deyo Comorbidity Index, urban or rural residence, and frailty. Results: We identified 4650 patients who underwent total thyroidectomy for GD during the study period and met the inclusion criteria (mean age = 72.8 years [standard deviation = 5.5], 86% female, and 79% white). Among this surgical cohort, 104 (2.2% [95% confidence interval, CI = 1.8-2.7%]) patients developed permanent hypoparathyroidism requiring calcitriol therapy. Patients who developed permanent hypoparathyroidism were on average older (mean age 74.1 vs. 72.8 years) than those who did not develop permanent hypoparathyroidism (p = 0.04). On multivariable regression, older age was the only patient characteristic associated with permanent hypoparathyroidism (odds ratio age ≥76 years = 1.68 [CI = 1.13-2.51] compared with age 66-75 years). Conclusions: The risk of permanent hypoparathyroidism requiring calcitriol therapy among this national, U.S. population-based cohort of older adults with GD treated with total thyroidectomy was low, even when considering operations performed by a heterogeneous group of surgeons. These findings suggest that the risk of hypoparathyroidism should not be a deterrent to operative management for GD in older adults who are appropriate surgical candidates.
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Affiliation(s)
- Carolyn Dacey Seib
- Stanford–Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Division of General Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California, USA
| | - Tong Meng
- Stanford–Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Robin M. Cisco
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dana T. Lin
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Elizabeth A. McAninch
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Palo Alto, California, USA
| | - Julie Chen
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Palo Alto, California, USA
| | - Manjula Kurella Tamura
- Geriatric Research, Education and Clinical Center, Veterans Affairs Palo Alto, Palo Alto, California, USA
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amber W. Trickey
- Stanford–Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Electron Kebebew
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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Edafe O, Tan ET, Jackson R, Sionis S, Balasubramanian SP, Beasley N. Evaluation of hypoparathyroidism following laryngectomy. Ann R Coll Surg Engl 2023; 105:62-67. [PMID: 35132880 PMCID: PMC9773242 DOI: 10.1308/rcsann.2021.0276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypoparathyroidism is a recognised complication following laryngectomy; it is associated with significant short-and long-term morbidity. This study aimed to further characterise this condition, identify risk factors and describe preventative and management strategies in a large cohort. MATERIALS AND METHODS This was a retrospective study at a tertiary referral centre for head and neck cancers. All consecutive patients who had total laryngectomy over an eight-year period were included. RESULTS A total of 140 patients were included. Rates of transient and long-term hypoparathyroidism were 14.3% and 10.1%, respectively. The following factors were significantly associated with transient post-surgical hypocalcaemia or hypoparathyroidism: total thyroidectomy (relative risk, RR, 4.33; 95% confidence interval, CI, 1.86-10.10), oesophagectomy (RR 6.05; 95% CI 2.92-12.53) and female sex (RR 3.23; 95% CI 1.45-7.19). In addition, total thyroidectomy (RR 5.89; 95% CI 1.94-17.86), central neck dissection (RR 3.97; 95% CI 1.42-11.10), oesophagectomy (RR 9.38; 95% CI 4.13-21.3), pharyngectomy (RR 7.14; 95% CI 2.08-24.39) and female sex (RR 5.52; 95% CI 1.95-15.63) were risk factors for long-term hypoparathyroidism. There was variability in the use of preventative measures, monitoring and management of hypocalcaemia and hypoparathyroidism following total laryngectomy. CONCLUSIONS Transient hypocalcaemia and long-term hypoparathyroidism occur in a significant proportion of patients after laryngectomy. A standard protocol is required to improve care.
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Affiliation(s)
- O Edafe
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - ET Tan
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - R Jackson
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - S Sionis
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - N Beasley
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
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Xu W, Teng C, Ding G, Zhao N. Oncologic safety and surgical outcomes of the different surgical approaches of endoscopic thyroidectomy for papillary thyroid carcinoma. Surg Today 2022; 53:554-561. [PMID: 36542138 DOI: 10.1007/s00595-022-02630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the oncologic safety and surgical outcomes of endoscopic thyroidectomy (ET) performed via different surgical approaches for papillary thyroid carcinoma (PTC). METHODS We reviewed the medical records of PTC patients who underwent ET between May 2015 and May 2021, at the Department of General Surgery, Beijing Friendship Hospital (affiliated with Capital Medical University). The patients were divided into three groups: the ET via breast approach (ETBA) group, the transoral ET vestibular approach (TOETVA) group, and the ET via transaxillary approach (ETTA) group. We evaluated the safety and surgical outcomes of each of these ET approaches. RESULTS A total of 490 patients were included in the analysis: 416 in the ETBA group, 57 in the TOETVA group, and 17 in the ETTA group. There were no significant differences among the groups in clinicopathologic characteristics or surgical procedures, or in the incidences of complications such as hematoma, subcutaneous emphysema, infection, and chyle. The incidences of transient and permanent recurrent laryngeal nerve (RLN) injury were 1.4% and 4.3%, respectively, with no significant difference among the three groups. The incidences of transient and permanent postoperative hypoparathyroidism were 13.7% and 1.4%, respectively. The incidence of transient hypoparathyroidism in the TOETVA group was 1.7%, which was significantly lower than that in the ETBA group. The postoperative 1-, 3- and 5-year rates of disease-free survival were 99.5%, 96.8%, and 95.9%, respectively. Univariate and multivariate analyses showed that ET was not a significant risk factor for recurrence or metastasis (p = 0.83 and p = 0.49, respectively), regardless of the surgical approach. CONCLUSIONS TOETVA may be associated with a lower incidence of temporary hypoparathyroidism than ETBA. Apart from this difference, ETBA, ETTA and TOETVA showed comparable oncologic safety and surgical outcomes.
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Affiliation(s)
- Wei Xu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research, National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China
| | - Changsheng Teng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research, National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China
| | - Guoqian Ding
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research, National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China
| | - Ning Zhao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research, National Clinical Research Center for Digestive Diseases, Beijing, People's Republic of China.
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Swartling O, Evans M, Spelman T, Kamal W, Kämpe O, Mannstadt M, Trolle Lagerros Y, Björnsdottir S. Kidney Complications and Hospitalization in Patients With Chronic Hypoparathyroidism: A Cohort Study in Sweden. J Clin Endocrinol Metab 2022; 107:e4098-e4105. [PMID: 35907259 PMCID: PMC9516192 DOI: 10.1210/clinem/dgac456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Kidney complications may be considerably higher in patients with chronic hypoparathyroidism (hypoPT) treated with activated vitamin D and calcium supplementation. OBJECTIVE We aimed to investigate the risk of chronic kidney disease (CKD), urolithiasis, and hospitalization in patients with chronic hypoPT. METHODS In this population-based cohort study in Sweden, national registries (Swedish National Patient Register, Swedish Prescribed Drug Register, and Total Population Register, 1997-2018) were used to identify patients with chronic hypoPT and controls matched by sex, age, and county of residence. We determined time to CKD and urolithiasis diagnosis, and incidence rates of hospitalization. RESULTS A total of 1562 patients with chronic hypoPT without preexisting CKD and 15 620 controls were included. The risk of developing CKD was higher in patients with chronic hypoPT compared with controls (hazard ratio [HR] 4.45; 95% CI, 3.66-5.41). In people without prior urolithiasis (n = 1810 chronic hypoPT and n = 18 100 controls), the risk of developing urolithiasis was higher in patients with chronic hypoPT (HR 3.55; 95% CI, 2.84-4.44) compared with controls. Patients with chronic hypoPT had higher incidence rates for all-cause hospitalization (49.59; 95% CI, 48.50-50.70, per 100 person-years vs 28.43; 95% CI, 28.15-28.71, respectively) and for CKD (3.46; 95% CI, 3.18-3.76, per 100 person-years vs 0.72; 95% CI, 0.68-0.77, respectively), compared with controls. Men with hypoPT appear to have a higher risk of CKD than women. CONCLUSION Patients with chronic hypoPT had an increased risk of CKD, urolithiasis, and hospitalization compared with controls.
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Affiliation(s)
- Oskar Swartling
- Correspondence: Oskar Swartling, MD, Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Maria Aspmans gata 30A, 171 77 Stockholm, Sweden.
| | - Marie Evans
- Renal unit, Department of Clinical Sciences, Interventions and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm 141 52, Sweden
- Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping 551 11, Sweden
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Wafa Kamal
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 76, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm 171 76, Sweden
| | - Olle Kämpe
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm 171 76, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm 171 76, Sweden
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen 5021, Norway
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Ylva Trolle Lagerros
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm 171 77, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm 113 65, Sweden
| | - Sigridur Björnsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 76, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm 171 76, Sweden
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Polonine S, de Santa Rosa RG, Farias MLF, Garcia MI, Gomes CP, Gottlieb I, Madeira M. Hyperphosphatemia is associated with cardiac valve calcification in chronic hypoparathyroidism. J Endocrinol Invest 2022; 45:1359-1366. [PMID: 35235195 DOI: 10.1007/s40618-022-01770-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the association between metabolic abnormalities and cardiovascular risk factors in patients with chronic hypoparathyroidism (HPP). PATIENTS AND METHODS Patients 18 years and older, glomerular filtration > 30 mL/min/1.73 m2 and no documented coronary artery disease were selected. Serum calcium, phosphorus, glucose, lipids, PTH, 25(OH)D and FGF23 were measured. Cardiovascular risk was estimated by the European Society of Cardiology (ESC) calculator. Transthoracic echocardiogram and carotid ultrasound were performed to detect carotid plaques (CP), carotid intima-media thickness (IMT), cardiac valve calcification (CVC), and left ventricular hypertrophy (LVH). RESULTS Thirty-seven patients (94.6% female), aged 56.0 ± 13.5 years and HPP duration 7.0 (4.0; 11.3) years, were included. Fifteen were classified as low cardiovascular risk, 9 as intermediate risk, 9 as high risk and none as very high risk. The prevalence of CP, CVC and LVH was 24.3%, 24.3% and 13.5%, respectively. IMT values were within normal ranges in all cohort. FGF23 were not associated with CP, IMT, CVC or LVH. After logistic regression, phosphorus was the only significant metabolic variable impacting CVC in univariate analysis (OR 2.795; 95% CI 1.132-6.905; p = 0.026), as well as in the multivariate analysis (OR 3.572; 95% CI 1.094-11.665; p = 0.035). Analysis by ROC curve showed serum phosphorus > 5.05 mg/dL (AUC 0.748; CI 0.584-0.877; p = 0.05) as the best cutoff point associated with valve heart calcification (sensitivity 78%; negative predictive value 91.3%). CONCLUSION Hyperphosphatemia was associated with CVC in HPP patients. Further studies are needed to investigate whether the control of hyperphosphatemia may reduce cardiovascular risk in this population.
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Affiliation(s)
- S Polonine
- Division of Endocrinology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil.
| | - R G de Santa Rosa
- Division of Nephrology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
| | - M L F Farias
- Division of Endocrinology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
| | - M I Garcia
- Division of Cardiology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
| | - C P Gomes
- Division of Nephrology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
| | - I Gottlieb
- Casa de Saúde São José, Rua Macedo Sobrinho 21, Rio de Janeiro, RJ, 22271-080, Brazil
| | - M Madeira
- Division of Endocrinology, Clementino Fraga Filho Hospital, UFRJ, Avenida Professor Rodolpho Paulo Rocco 255, Rio de Janeiro, RJ, 21941-913, Brazil
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Tramontano S, Sarno G, Calabrese P, Schiavo L, Spagnuolo M, Pilone V. Does Time Matter in Deficit of Calcium after Total Thyroidectomy in Subjects with Previous Bariatric Surgery? Nutrients 2022; 14:1805. [PMID: 35565776 PMCID: PMC9105554 DOI: 10.3390/nu14091805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Hypoparathyroidism-related hypocalcemia is a common complication after total thyroidectomy (TT), particularly if there is a history of prior bariatric surgery. However, it is still unknown if it is the surgery timing or the type of bariatric intervention that increases the risk of developing this complication. Methods: We compared the risk of hypocalcemia (serum calcium levels < 8 mg/dL) and hypoparathyroidism (both transient and permanent) between patients with restrictive procedures (LSG and GB) and patients without a history of obesity surgery in the immediate post-operative period and after 12 months. Hypoparathyroidism was considered permanent if the plasma parathyroid hormone (PTH) levels at 6 months were less than 15 pg/mL and the patient still required oral calcium (calcium carbonate) and vitamin D supplementation, in addition to the supplements that were taken routinely before thyroidectomy. Results: From the 96 patients who underwent TT, 50% had a history of bariatric surgery: 36 LSG and 12 GB. The risk of hypocalcemia was similar in patients with a history of restrictive procedures (31.35%) and in controls (25%) (p = 0.49). Furthermore, hypocalcemia risk was similar between patients with a history of LSG (30.5%) and GB (33%) (p = 0.85). The prevalences of transient and permanent hypoparathyroidism were similar between patients with a history of restrictive procedures and in controls; similarly, no differences were detected between subjects undergoing LSG and GB. Conclusions: Restrictive bariatric surgery (LSG and GB) is not a risk factor for post-thyroidectomy hypocalcemia and hypoparathyroidism and thus did not require a different perioperative supplementation protocol compared to subjects without history of bariatric surgery undergoing TT.
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Affiliation(s)
- Salvatore Tramontano
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggid’Aragona, P.O. Gaetano FucitoMercato San Severino, 84085 Salerno, Italy; (S.T.); (P.C.); (L.S.); (M.S.); (V.P.)
| | - Gerardo Sarno
- General Surgery and Kidney Transplantation Unit, “San Giovanni di Dio e Ruggi D’Aragona” University Hospital, Scuola Medica Salernitana, 84125 Salerno, Italy
| | - Pietro Calabrese
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggid’Aragona, P.O. Gaetano FucitoMercato San Severino, 84085 Salerno, Italy; (S.T.); (P.C.); (L.S.); (M.S.); (V.P.)
| | - Luigi Schiavo
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggid’Aragona, P.O. Gaetano FucitoMercato San Severino, 84085 Salerno, Italy; (S.T.); (P.C.); (L.S.); (M.S.); (V.P.)
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Maria Spagnuolo
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggid’Aragona, P.O. Gaetano FucitoMercato San Severino, 84085 Salerno, Italy; (S.T.); (P.C.); (L.S.); (M.S.); (V.P.)
| | - Vincenzo Pilone
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggid’Aragona, P.O. Gaetano FucitoMercato San Severino, 84085 Salerno, Italy; (S.T.); (P.C.); (L.S.); (M.S.); (V.P.)
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Baronissi, 84081 Salerno, Italy
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Li Z, Fei Y, Li Z, Wei T, Zhu J, Su A. Outcome of parathyroid function after total thyroidectomy when calcium supplementation is administered routinely versus exclusively to symptomatic patients: A prospective randomized clinical trial. Endocrine 2022; 75:583-592. [PMID: 34748169 DOI: 10.1007/s12020-021-02921-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/19/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Current guidelines for calcium supplementation for parathyroid function recovery after thyroidectomy are based on low-quality evidence. The present trial compared the effects of oral calcium and vitamin D supplementation on the recovery of parathyroid function when administered routinely or exclusively to symptomatic patients. METHODS This prospective, randomized, open-label clinical trial analyzed 203 patients who underwent total thyroidectomy and developed hypoparathyroidism on postoperative day 1 (POD1) with median age of 41 years and proportion of women of 77.8%. Participants were randomized to group A (calcium and vitamin D supplementation administered only to symptomatic patients) and group B (routine supplementation). The primary outcome was the incidence of protracted hypoparathyroidism in the two groups. Secondary outcomes included risk factors for postoperative protracted hypoparathyroidism and the incidence of symptomatic hypocalcemia. RESULTS The incidence of protracted hypoparathyroidism was not significantly different between group A and group B (11 of 99 vs. 17 of 104, P = 0.280). Parathyroid hormone (PTH) in group B exhibited a better recovery tendency. The incidence of postoperative symptomatic hypocalcemia in group B was significantly lower than group A (26.92% vs. 42.42%, P = 0.020). Independent factors predicting protracted hypoparathyroidism included sex, preoperative serum calcium, and POD1 PTH. CONCLUSION Calcium and vitamin D supplementation administered exclusively to symptomatic patients achieved the same effect on protracted hypoparathyroidism as routine supplementation. However, routine supplementation significantly reduced postoperative hypocalcemia. Extra attention is necessary in female patients with high preoperative serum calcium and patients with low POD1 PTH. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), ChiCTR1900022194. Registered March 30, 2019.
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Affiliation(s)
- Zhe Li
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Fei
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhihui Li
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Wei
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anping Su
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Konca Degertekin C, Gogas Yavuz D, Pekkolay Z, Saygili E, Ugur K, Or Koca A, Unubol M, Topaloglu O, Aydogan BI, Ozdemir Kutbay N, Hekimsoy Z, Yilmaz N, Balci MK, Tanrikulu S, Aydogan Unsal Y, Ersoy C, Omma T, Keskin M, Yalcin MM, Yetkin I, Soylu H, Karakose M, Yilmaz M, Karakilic E, Piskinpasa H, Batman A, Akbaba G, Elbuken G, Tura Bahadir C, Kilinc F, Bilginer MC, Turhan Iyidir O, Canturk Z, Aktas Yilmaz B, Sayiner ZA, Eroglu M. Identifying Clinical Characteristics of Hypoparathyroidism in Turkey: HIPOPARATURK-NET Study. Calcif Tissue Int 2022; 110:204-214. [PMID: 34495356 DOI: 10.1007/s00223-021-00908-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5-10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients.
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Affiliation(s)
- Ceyla Konca Degertekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ufuk University, Ankara, Turkey.
- Endokrinoloji BD, Ufuk Üniversitesi Hastanesi, Mevlana Bulvarı (Konya Yolu) No:86-88 Balgat, Ankara, Turkey.
| | - Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Emre Saygili
- Endocrinology and Metabolism Clinic, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Kader Ugur
- Department of Endocrinology and Metabolism, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Arzu Or Koca
- Endocrinology and Metabolism Clinic, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Mustafa Unubol
- Department of Endocrinology and Metabolism, Faculty of Medicine, Aydın Adnan Menderes University, Aydin, Turkey
| | - Omercan Topaloglu
- Endocrinology and Metabolism Clinic, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Berna Imge Aydogan
- Endocrinology and Metabolism Clinic, Batman Training and Research Hospital, Batman, Turkey
| | - Nilufer Ozdemir Kutbay
- Department of Endocrinology and Metabolism, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Zeliha Hekimsoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Nusret Yilmaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mustafa Kemal Balci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Seher Tanrikulu
- Endocrinology and Metabolism Clinic, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Aydogan Unsal
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Canan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Tulay Omma
- Endocrinology and Metabolism Clinic, Ankara Training and Research Hospital, Ankara, Turkey
| | - Muge Keskin
- Endocrinology and Metabolism Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ilhan Yetkin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hikmet Soylu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kırsehir Ahi Evran University, Kirsehir, Turkey
| | - Melia Karakose
- Department of Endocrinology and Metabolism, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Merve Yilmaz
- Endocrinology and Metabolism Clinic, Samsun Gazi Training and Research Hospital, Samsun, Turkey
| | - Ersen Karakilic
- Department of Endocrinology and Metabolism, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Hamide Piskinpasa
- Endocrinology and Metabolism Clinic, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Adnan Batman
- Endocrinology and Metabolism Clinic, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gulhan Akbaba
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Gulsah Elbuken
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Cigdem Tura Bahadir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Faruk Kilinc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Muhammet Cuneyt Bilginer
- Endocrinology and Metabolism Clinic, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ozlem Turhan Iyidir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Zeynep Canturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Banu Aktas Yilmaz
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Zeynel Abidin Sayiner
- Department of Endocrinology and Metabolism, Faculty of Medicine, Nigde University, Nigde, Turkey
| | - Mustafa Eroglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Balıkesir University, Balikesir, Turkey
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García-García E, Gómez-Gila AL, Romero-Lluch AR, Conde-Sánchez M, Domínguez-Pascual I, Fernández Pineda I, Cabello-Laureano R. Hypoparathyroidism after thyroidectomy: A 20-year experience at a children's hospital. ENDOCRINOL DIAB NUTR 2022; 69:92-97. [PMID: 35256064 DOI: 10.1016/j.endien.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/09/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Hypoparathyroidism (HP) is the most common complication of total thyroidectomy and can be an emergency. OBJECTIVES To describe the prevalence of HP after total thyroidectomy in children under 14 years of age, the variables related to its appearance and its clinical expression. PATIENTS AND METHODS Retrospective study at a children's hospital in the last 20 years. HP was defined by the need to supplement calcium after the intervention and was considered permanent if it could not be suspended within 12 months. Fisher's statistical method of comparison of proportions. RESULTS Thirty-nine children and adolescents (26 females) with an age range of 3.67-14.00 years. In 25 patients, the intervention was prophylactic and in 14 it was therapeutic; 14 suffered accidental excision of some parathyroid gland, but none more than two of them; 12 presented HP, of which 3 were permanent; 5 presented clinical symptoms; 1 of them was an emergency. The frequency of HP was 4/4 when 2 parathyroids were dissected, 2/10 when one was dissected, and 6/25 when none were dissected (p = 0.02). In the prophylactic interventions, it was 6/25 compared to 6/14 in the therapeutic ones (p = 0.29). The three cases of permanent HP were in children under 6 years of age, and it did not occur in any older children (p = 0.09). CONCLUSIONS HP is a common and sometimes serious complication in children after total thyroidectomy. It can occur, and even be permanent, even if the intervention is prophylactic and parathyroid glands remain in situ. Younger age could be a risk factor.
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Affiliation(s)
| | - Ana L Gómez-Gila
- Unidad de Endocrinología Pediátrica, Hospital Virgen del Rocío, Sevilla, Spain
| | - Ana R Romero-Lluch
- Servicio de Endocrinología y Nutrición, Hospital Virgen del Rocío, Sevilla, Spain
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Lin HY, Tsai WY, Tung YC, Liu SY, Lee NC, Chien YH, Hwu WL, Lee CT. Endocrine and Growth Disorders in Taiwanese Children With 22q11.2 Deletion Syndrome. Front Endocrinol (Lausanne) 2022; 13:771100. [PMID: 35432203 PMCID: PMC9008307 DOI: 10.3389/fendo.2022.771100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endocrine disorders are common in patients with 22q11.2 deletion syndrome (22q11.2DS). This study aimed to elucidate the clinical manifestations of endocrine disorders, including parathyroid, thyroid and growth disorders, in Taiwanese patients with 22q11.2DS. METHODS From 1994 to 2020, the medical records of 138 patients with 22q11.2DS diagnosed at a tertiary referral medical center in Taiwan were thoroughly reviewed retrospectively. RESULTS Hypocalcemia was detected in 57 of 135 patients (42%); 33 of 104 patients (32%) had hypoparathyroidism, and in 87% of them, hypocalcemia was detected before the age of one. Most patients had precipitating stressors during symptomatic hypocalcemic episodes. Eighteen of 29 patients had overt hypoparathyroidism at the last visit: 11 had persistent hypoparathyroidism and the other seven had recurrent hypoparathyroidism. Four of 84 patients had thyroid disorders, including thyroid developmental anomalies in two, dyshormonogenesis in one and Graves' disease in one. Fifty of 126 patients (40%) had short stature. Age (odds ratio (OR) 0.91; 95% confidence interval (CI) 0.86-0.96; P<0.001) and airway anomalies (OR 2.75; 95% CI 1.04-7.31; P<0.05) were significant risk factors for short stature in multivariate logistic regression model. Twenty-eight of the 30 patients with airway anomalies were associated with severe congenital heart disease. Adult height standard deviation score (SDS) in 19 patients was significantly lower than target height SDS (-1.15 ± 0.90 vs -0.08 ± 0.65, P<0.001). CONCLUSIONS Hypoparathyroidism is a common endocrine disorder in patients with 22q11.2DS. It is prudent to assess parathyroid function at diagnosis and during follow-up, especially in the presence of stress, to prevent symptomatic hypocalcemia. Although thyroid disorders are not so common as hypoparathyroidism, screening of thyroid dysfunction is justified in these patients. Patients with 22q11.2DS demonstrate a retarded growth pattern with a tendency of catch-up and regular monitoring of growth is indicated.
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Affiliation(s)
- Han-Yi Lin
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Yu Tsai
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Tung
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shih-Yao Liu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wuh-Liang Hwu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Ting Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- *Correspondence: Cheng-Ting Lee,
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Yin S, Pan B, Yang Z, Tang M, Mo H, Li Y, Yi Z, Yin T, Shao C, Yan C, Mo L, Yuan Y, Sun Y, Zhang F. Combined Use of Autofluorescence and Indocyanine Green Fluorescence Imaging in the Identification and Evaluation of Parathyroid Glands During Total Thyroidectomy: A Randomized Controlled Trial. Front Endocrinol (Lausanne) 2022; 13:897797. [PMID: 35784544 PMCID: PMC9243533 DOI: 10.3389/fendo.2022.897797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/02/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Accurate identification and evaluation of the parathyroid glands (PGs) intraoperatively is critical to reduce the incidence of postoperative hypoparathyroidism after total thyroidectomy. Near-infrared fluorescence imaging (NIFI), including the autofluorescence (AF) and indocyanine green fluorescence (ICGF) imaging, is a promising technique to protect PGs. This study aimed to assess whether the combined use of AF and ICGF could reduce the incidence of postoperative hypoparathyroidism and improve the identification and evaluation of PGs during total thyroidectomy. METHODS This randomized controlled trial enrolled 180 patients who were randomized into two groups and underwent total thyroidectomy with unilateral or bilateral central lymph node dissection. In the control group, the PGs were identified and evaluated by the naked eye. In the NIFI group, AF was used to identify the PGs and ICGF was applied to assess the blood perfusion of the PGs in situ. The primary outcome was the incidence of postoperative hypoparathyroidism. The secondary outcomes included the number of identified PGs, autotransplanted PGs, and known preserved PGs in situ. RESULTS The incidence of postoperative transient hypoparathyroidism was significantly lower in the NIFI group than in the control group (27.8% vs. 43.3%, P = 0.029). More PGs were identified in the NIFI group than in the control group (3.6 ± 0.5 vs. 3.2 ± 0.4, P < 0.001). No significant difference was observed in the number of autotransplanted PGs between the two groups (P = 0.134). Compared with the control group, a greater number of known PGs were preserved in situ in the NIFI group (1.3 ± 0.6 vs. 1.0 ± 0.5, P < 0.001). In the NIFI group, only 4.5% of the patients with at least one well-perfused PG (ICG score of 2) developed postoperative hypoparathyroidism, which was significantly lower than that of the control group (34.6%, P < 0.001). CONCLUSION Combined use of AF and ICGF during total thyroidectomy reduces the risk of transient postoperative hypoparathyroidism, enhances the ability to identify and preserve PGs, and improves the accuracy of evaluating the perfusion of PGs during surgery. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Register (www.chictr.org.cn), identifier ChiCTR2100045320. Registered on April 12, 2021.
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Affiliation(s)
- Supeng Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Bin Pan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Zeyu Yang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Mi Tang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Hongbiao Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Yao Li
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Ziying Yi
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Tingjie Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cong Shao
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cunye Yan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Linlong Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Yuquan Yuan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Yiceng Sun
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- *Correspondence: Fan Zhang, ; Yiceng Sun,
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- *Correspondence: Fan Zhang, ; Yiceng Sun,
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d’Alva CB, Barreto ARF, Nogueira-Barbosa MH, Arruda CCC, Albuquerque ÁM, Praciano DMC, Viana RP, Gadelha DD, Viana Jr AB, Moreira IM, de Moura Filho FJR, Junqueira AFTDA, Montenegro Jr RM. Morphometric vertebral fracture risk in women with postsurgical hypoparathyroidism. Front Endocrinol (Lausanne) 2022; 13:948435. [PMID: 36619538 PMCID: PMC9816127 DOI: 10.3389/fendo.2022.948435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Hypoparathyroidism (HP) is a rare endocrine disease and there are little data available on the risk of fragility fractures in these patients. PTH deficiency results in a positive bone balance with higher bone mass in all skeletal sites. However, whether these structural and dynamic skeletal changes have a negative impact on the fracture risk, it is not known. METHODS Aiming to investigate the risk of insufficiency vertebral fractures in HP, defined using morphometric criteria, a consecutive sampling of 44 women with chronic postsurgical HP was compared to a control group of 44 adult healthy women, matched by age with patients. Vertebral fractures were analyzed by the semiquantitative Genant's method followed by quantitative vertebral morphometry. RESULTS Morphometric vertebral fractures were identified in 5/44 (11.4%) patients and in 3/44 (6.8%) controls (p=0.731). Most fractures were classified as Genant II and III grades in HP patients, whereas most were Genant I in controls. A logistic regression multivariate analysis was conducted in which age, BMI and parathyroid status were the independent variables, and morphometric vertebral fracture was the dependent variable, but none of these factors was a significant predictor of fracture in this population (OR 1.01, 95% CI 0.96-1.07, p=0.634 for age; OR 2.24, 95%CI 0.47-10.50, p=0.306 for the presence/absence of HP and OR 0.92, 95% CI 0.76-1.10, p=0.369 for BMI). CONCLUSION The results of this study cannot ensure a higher risk of fragility vertebral fractures in postsurgical HP patients. Instead, we only observed higher Genant grade classification of the deformed vertebrae in our sample.
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Affiliation(s)
- Catarina Brasil d’Alva
- Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Depto. de Medicina Clínica da Universidade Federal do Ceara, Fortaleza, Brazil
- *Correspondence: Catarina Brasil d’Alva,
| | | | | | | | - Áurea Maíla Albuquerque
- Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Depto. de Medicina Clínica da Universidade Federal do Ceara, Fortaleza, Brazil
| | - Débora Mota Cordeiro Praciano
- Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Depto. de Medicina Clínica da Universidade Federal do Ceara, Fortaleza, Brazil
| | - Rodrigo Ponte Viana
- Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Depto. de Medicina Clínica da Universidade Federal do Ceara, Fortaleza, Brazil
| | - Daniel Duarte Gadelha
- Unidade de Pesquisa Clínica, Hospital Universitário Walter Cantídio, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Antônio Brazil Viana Jr
- Unidade de Pesquisa Clínica, Hospital Universitário Walter Cantídio, Universidade Federal do Ceara, Fortaleza, Brazil
| | - Ilana Marques Moreira
- Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Depto. de Medicina Clínica da Universidade Federal do Ceara, Fortaleza, Brazil
| | | | | | - Renan Magalhães Montenegro Jr
- Unidade de Pesquisa Clínica, Hospital Universitário Walter Cantídio, Universidade Federal do Ceara, Fortaleza, Brazil
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Kovaleva EV, Eremkina AK, Elfimova AR, Krupinova JA, Bibik EE, Maganeva IS, Gorbacheva AM, Dobreva EA, Melnichenko GA, Mokrysheva NG. The Russian Registry of Chronic Hypoparathyroidism. Front Endocrinol (Lausanne) 2022; 13:800119. [PMID: 35250859 PMCID: PMC8889095 DOI: 10.3389/fendo.2022.800119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/13/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Chronic hypoparathyroidism is a relatively rare disease associated with multicomponent medical therapy and various complications. The analysis of large databases of patients with chronic hypoparathyroidism is a necessary tool to enhance quality of medical care, as well as to determine the optimal clinical and therapeutic approaches, and prognostic markers of the disease. THE AIM of this study is to estimate the clinical and biochemical profile, long-term complications, medical therapy and disease control of the patients with chronic postsurgical and non-surgical hypoparathyroidism. MATERIALS AND METHODS the cross-sectional, observational, continuous study was based on the Russian Registry of patients with hypoparathyroidism. 544 patients from 63 regions of the Russian Federation were included in this study. RESULTS The majority of cases had postsurgical etiology (88.4%). Postsurgical hypoparathyroidism prevailed in females (р<0.001). About a half of patients had blood calcium and phosphorus targets, 56 and 52% respectively. Nephrolithiasis was confirmed in 32.5%, nephrocalcinosis - in 12.3% of cases. The risk of nephrocalcinosis/nephrolithiasis increased by 1.85 times with disease duration more than 4.5 years. The cataract was found in 9.4%. The cut-off point for the development of cataracts was 9.5 years, with a 6.96-fold increased risk. The longer duration of hypoparathyroidism of any etiology was associated with more frequent cataract (p=0.0018).We found brain calcification in 4%, arrhythmias in 7.2% and neuropsychiatric symptoms in 5.15% of cases. Generally, the BMD in the studied group corresponded to age values, and there was no evidence for the phenomenon of high bone density. TBS was consistent with normal bone microarchitectonics. In our study, the majority of patients (83.5%) was treated with standard therapy of calcium and vitamin D supplements. 5 patients with severe disease course were treated with rhPTH (1-34). CONCLUSIONS Analysis of the presented database indicates insufficient diagnosis of the complications associated with chronic hypoparathyroidism. Overall, hypoparathyroidism is associated with higher risks of renal stone formation, decreased GFR, cataract especially in patients with longer duration of disease.
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Scappaticcio L, Maiorino MI, Iorio S, Camponovo C, Piccardo A, Bellastella G, Docimo G, Esposito K, Trimboli P. Thyroid surgery during the COVID-19 pandemic: results from a systematic review. J Endocrinol Invest 2022; 45:181-188. [PMID: 34282552 PMCID: PMC8288414 DOI: 10.1007/s40618-021-01641-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE During the COVID-19 pandemic, elective thyroid surgery is experiencing delays. The problem is that the COVID-19 pandemic is ongoing. The research purposes were to systematically collect the literature data on the characteristics of those thyroid operations performed and to assess the safety/risks associated with thyroid surgery during the COVID-19 pandemic. METHODS We used all the procedures consistent with the PRISMA guidelines. A comprehensive literature in MEDLINE (PubMed) and Scopus was made using ''Thyroid'' and "coronavirus" as search terms. RESULTS Of a total of 293 articles identified, 9 studies met the inclusion criteria. The total number of patients undergoing thyroid surgery was 2217. The indication for surgery was malignancy in 1347 cases (60.8%). Screening protocols varied depending on hospital protocol and maximum levels of personal protection equipment were adopted. The hospital length of stay was 2-3 days. Total thyroidectomy was chosen for 1557 patients (1557/1868, 83.4%), of which 596 procedures (596/1558, 38.3%) were combined with lymph node dissections. Cross-infections were registered in 14 cases (14/721, 1.9%), of which three (3/721, 0.4%) with severe pulmonary complications of COVID-19. 377 patients (377/1868, 20.2%) had complications after surgery, of which 285 (285/377, 75.6%) hypoparathyroidism and 71 (71/377, 18.8%) recurrent laryngeal nerve injury. CONCLUSION The risk of SARS-CoV-2 transmission after thyroid surgery is relatively low. Our study could promote the restart of planned thyroid surgery due to COVID-19. Future studies are warranted to obtain more solid data about the risk of complications after thyroid surgery during the COVID-19 era.
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Affiliation(s)
- L. Scappaticcio
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - M. I. Maiorino
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Department of Medical and Advanced Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - S. Iorio
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - C. Camponovo
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - A. Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Genoa, Italy
| | - G. Bellastella
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Department of Medical and Advanced Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - G. Docimo
- Division of Thyroid Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - K. Esposito
- Department of Medical and Advanced Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - P. Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Lu D, Tang E, Yin S, Zhu J, Mo H, Yi Z, Chai F, Sun Y, Li Y, Yin T, Yang Z, Zhang F. Factors in the occurrence and restoration of hypoparathyroidism after total thyroidectomy for thyroid cancer patients with intraoperative parathyroid autotransplantation. Front Endocrinol (Lausanne) 2022; 13:963070. [PMID: 35937810 PMCID: PMC9353036 DOI: 10.3389/fendo.2022.963070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Postoperative hypoparathyroidism (POH) is the most common and important complication for thyroid cancer patients who undergo total thyroidectomy. Intraoperative parathyroid autotransplantation has been demonstrated to be essential in maintaining functional parathyroid tissue, and it has clinical significance in identifying essential factors of serum parathyroid hormone (PTH) levels for patients with parathyroid autotransplantation. This retrospective cohort study aimed to comprehensively investigate influential factors in the occurrence and restoration of POH for patients who underwent total thyroidectomy with intraoperative parathyroid autotransplantation (TTIPA). METHOD This study was conducted in a tertiary referral hospital, with a total of 525 patients who underwent TTIPA. The postoperative serum PTH levels were collected after six months, and demographic characteristics, clinical features and associated operative information were analyzed. RESULTS A total of 66.48% (349/525) of patients who underwent TTIPA were diagnosed with POH. Multivariate logistic regression indicated that Hashimoto's thyroiditis (OR=1.93, 95% CI: 1.09-3.42), P=0.024), the number of transplanted parathyroid glands (OR=2.70, 95% CI: 1.91-3.83, P<0.001) and postoperative blood glucose levels (OR=1.36, 95% CI: 1.06-1.74, P=0.016) were risk factors for POH, and endoscopic surgery (OR=0.39, 95% CI: 0.22-0.68, P=0.001) was a protective factor for POH. Multivariate Cox regression indicated that PTG autotransplantation patients with same-side central lymph node dissection (CLND) (HR=0.50; 95% CI: 0.34-0.73, P<0.001) demonstrated a longer time for increases PTH, and female patients (HR=1.35, 95% CI: 1.00-1.81, P=0.047) were more prone to PTH increases. Additionally, PTG autotransplantation with same-side CLND (HR=0.56, 95% CI: 0.38-0.82, P=0.003) patients had a longer time to PTH restoration, and patients with endoscopic surgery (HR=1.54, 95% CI: 1.04-2.28, P=0.029) were more likely to recover within six months. CONCLUSION High postoperative fasting blood glucose levels, a large number of transplanted PTGs, open surgery and Hashimoto's thyroiditis are risk factors for postoperative POH in TTIPA patients. Elevated PTH levels occur earlier in female patients and patients without CLND on the transplant side. PTH returns to normal earlier in patients without CLND and endoscopic surgery on the transplant side.
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Affiliation(s)
- Dengwei Lu
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
| | - Enjie Tang
- Epidemiology Department, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Supeng Yin
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Junping Zhu
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Hongbiao Mo
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Ziying Yi
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Fan Chai
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Yizeng Sun
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Yao Li
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Tingjie Yin
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Zeyu Yang
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
- *Correspondence: Fan Zhang, ; Zeyu Yang,
| | - Fan Zhang
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
- *Correspondence: Fan Zhang, ; Zeyu Yang,
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Pal R, Bhadada SK, Mukherjee S, Banerjee M, Kumar A. Fracture risk in hypoparathyroidism: a systematic review and meta-analysis. Osteoporos Int 2021; 32:2145-2153. [PMID: 34021765 DOI: 10.1007/s00198-021-05966-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022]
Abstract
UNLABELLED In this meta-analysis, we analyzed 7 observational studies for assessing the fracture risk in patients with hypoparathyroidism (hypoPT). We found that the risk of vertebral fractures is increased by almost 2-fold, especially those with nonsurgical hypoPT. PURPOSE Patients with hypoPT have higher bone mineral density than age- and sex-matched controls. This would theoretically translate into a lower risk of fractures, although available clinical evidence is contradictory. Hence, the present systematic review and meta-analysis was undertaken to collate and provide a precise summary of fracture risk in hypoPT. METHODS PubMed, Scopus, and Web of Science databases were systematically searched using appropriate keywords till March 8, 2021, to identify observational studies reporting the rate of occurrence of fractures among hypoPT patients (nonsurgical and/or postsurgical) compared to non-hypoPT subjects (controls). Study quality was assessed using Newcastle-Ottawa Scale. Pooled odds ratio (OR) with 95% confidence intervals (CI) was calculated. Subgroup analyses of nonsurgical and postsurgical hypoPT patients were also conducted. RESULTS We identified 7 observational studies of high-quality pooling data retrieved from 1470 patients with hypoPT. When stratified based on the skeletal site, pooled analyses showed that hypoPT patients were at an increased risk of vertebral fractures compared to non-hypoPT controls (OR 2.22, 95% CI: 1.23, 4.03, p = 0.009, I2 = 49%, random-effects model). The increased risk of vertebral fractures was seen only in patients with nonsurgical hypoPT (OR 2.31, 95% CI: 1.32, 4.03, p = 0.003, I2 = 3%, random-effects model) but not in those with postsurgical hypoPT. hypoPT patients were not at an increased or decreased risk of any, humerus, or proximal femur/hip fractures than controls. CONCLUSIONS Nonsurgical hypoPT patients are at an almost 2-fold increased risk of vertebral fractures and thus need to be actively screened irrespective of the underlying BMD.
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Affiliation(s)
- R Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - S K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - S Mukherjee
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - M Banerjee
- Department of Endocrinology, Institute of Postgraduate Medical Education and Research, Kolkata, 700007, India
| | - A Kumar
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Hamdy NAT, Decallonne B, Evenepoel P, Gruson D, van Vlokhoven-Verhaegh L. Burden of illness in patients with chronic hypoparathyroidism not adequately controlled with conventional therapy: a Belgium and the Netherlands survey. J Endocrinol Invest 2021; 44:1437-1446. [PMID: 33128157 PMCID: PMC8195792 DOI: 10.1007/s40618-020-01442-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the burden of illness in patients with not adequately controlled chronic hypoparathyroidism receiving conventional therapy in Belgium and the Netherlands. METHODS Data were generated from a cross-sectional, two-part online survey where endocrinologists from both countries and nephrologists from Belgium were invited by phone to participate. Part 1 included collecting data on general management of patients with hypoparathyroidism. In Part 2, physicians were requested to provide data on one or two current cases of patients with chronic hypoparathyroidism not adequately controlled on conventional therapy. Data collected included aetiology of hypoparathyroidism, clinical manifestations, comorbidities, results of laboratory and other investigations used for diagnosis and screening for complications, therapy received, and physician's perception of impaired quality of life (QoL). RESULTS Thirty-six endocrinologists and 29 nephrologists from Belgium and 28 endocrinologists from the Netherlands participated in the survey. Data included clinical symptoms, biochemical parameters, and QoL for 97 current patients with not adequately controlled chronic hypoparathyroidism on conventional therapy. Median duration of not adequately controlled hypoparathyroidism was 2.2 years, range 0.17-20.0. Most patients had neuromuscular (85%) and/or neurological (67%) symptoms, 71% had abnormal biochemical parameters, 10% were overweight, and physicians perceived that 71% had impaired QoL. Most frequently reported comorbidities included hypertension (25%), renal comorbidity (20%), diabetes mellitus (12%), and dyslipidaemia (11%). CONCLUSION Patients with chronic hypoparathyroidism not adequately controlled on conventional therapy experience a substantial burden of illness, mainly due to persistence of symptoms and presence of multiple comorbidities.
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Affiliation(s)
- N A T Hamdy
- Department of Medicine, Division of Endocrinology, and Centre for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - B Decallonne
- Department of Endocrinology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - P Evenepoel
- Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - D Gruson
- Department of Clinical Biochemistry, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - L van Vlokhoven-Verhaegh
- Department of Medical Affairs, Shire Netherlands BV, a Takeda company, Amsterdam, The Netherlands
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Koimtzis GD, Stefanopoulos L, Giannoulis K, Papavramidis TS. What are the real rates of temporary hypoparathyroidism following thyroidectomy? It is a matter of definition: a systematic review. Endocrine 2021; 73:1-7. [PMID: 33651345 DOI: 10.1007/s12020-021-02663-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Post-operative hypoparathyroidism is the most encountered complication of thyroid surgery and is classified as temporary or permanent. However, its incidence varies greatly in the literature ranging from 0.5% to 65%. This can be mainly attributed to the different definition of hypoparathyroidism used in each study and especially to the different time cutoff applied to distinguish temporary from permanent hypoparathyroidism. METHODS We conducted a systematic literature search in PubMed, Scopus, Cochrane and GoogleScholar databases, as well as grey literature. Ultimately, 45 articles with 23,164 patients in total were included in this review. These articles used either the cutoff of six or twelve post-operative months to distinguish temporary from permanent hypoparathyroidism. RESULTS The overall incidence of permanent hypoparathyroidism diagnosed at 6 months post-operatively was 4.11% and 4.08% at 12 months post-operatively. There was no statistically significant difference between the two groups (p = 0.92). CONCLUSIONS We suggest that adhering to the current guidelines that recommend diagnosing temporary hypoparathyroidism when recovery is made within 6 months after surgery is important when conducting future research in order to narrow the gap that exists currently in the literature, as well as when deciding to put patients on long-term calcium supplements.
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Affiliation(s)
- Georgios D Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Heath Park Way, Cardiff, CF14 4XW, UK.
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Kleanthis Giannoulis
- 1st Surgical Department, Papageorgiou General Hospital of Thessaloniki, Taskou Papageorgiou, 54631, Thessaloniki, Greece
| | - Theodosios S Papavramidis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 1st St. Kiriakidi Street, 54621, Thessaloniki, Greece
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Lee YA, Yun HR, Lee J, Moon H, Shin CH, Kim SG, Park YJ. Trends in Pediatric Thyroid Cancer Incidence, Treatment, and Clinical Course in Korea During 2004-2016: A Nationwide Population-Based Study. Thyroid 2021; 31:902-911. [PMID: 33107409 DOI: 10.1089/thy.2020.0155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: The incidence of thyroid cancer has increased worldwide. We investigated nationwide trends in the incidence and treatment course of pediatric thyroid cancer in South Korea. Methods: Using the National Health Information Database, we analyzed 1580 patients (324 males) <20 years of age diagnosed with thyroid cancer during 2004-2016 in South Korea. The annual percentage change (APC) in the age-standardized incidence rate (ASR) was calculated by joinpoint regression analysis. The initial treatment modality was categorized as either surgery only or surgery with radioactive-iodine treatment (surgery+RAIT), and we defined new treatment events as reoperations or additional RAITs among 1464 patients followed up for ≥12 months. Results: During 2004-2016, the mean ASR per 100,000 person-years increased from 0.6 [confidence interval; CI 0.5-0.8] to 0.9 [CI 0.8-1.1], with a mean APC of 4.0% [CI 1.8-6.2]. The ASRs (APCs) among 0-9-, 10-14-, 15-17-, and 18-19-year olds were 0.07 (9.9% [CI 0.08-20.7]), 0.6 (4.6% [CI 0.2-9.2]), 2.2 (3.9 [CI 1.7-6.0]), and 4.2 (3.5% [CI 0.9-6.2]), respectively. The lobectomy and lymph-node-dissection rates increased (from 18.5% to 33.6%, p = 0.0014; and from 29.6% to 84.5%, p < 0.001; respectively), but the RAIT rate decreased (67.9-39.7%, p < 0.001) during the study period. During a median 6.3-year follow-up, two patients died. New treatment events occurred in 56 (10.7%) of patients in the initial surgery-only group (n = 523). In the initial surgery+RAIT group (n = 941), 316 patients received two or more RAITs within 2 years, and 80 (12.8%) of the remaining 625 patients underwent new treatment events. In the surgery+RAIT subgroup, the event-free survival rate was lower in 0-14-year olds than in 18-19-year olds (hazard ratio 2.5 [CI 1.4-4.4]). Conclusions: The pediatric thyroid cancer incidence increased from 2004 to 2012 in South Korea. The lobectomy and lymph-node-dissection rates increased, but the RAIT rate decreased. The higher risk for new treatment events in patients younger than 15 years requiring initial RAIT may be linked to advanced stage at diagnosis, and it needs to be further evaluated.
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Affiliation(s)
- Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo Ri Yun
- Department of Biostatistics, College of Medicine, Korea University, Seoul, South Korea
| | - Juneyoung Lee
- Department of Biostatistics, College of Medicine, Korea University, Seoul, South Korea
- BK21FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Hyemi Moon
- Department of Biostatistics, College of Medicine, Korea University, Seoul, South Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Sin Gon Kim
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Gosmanova EO, Houillier P, Rejnmark L, Marelli C, Bilezikian JP. Renal complications in patients with chronic hypoparathyroidism on conventional therapy: a systematic literature review : Renal disease in chronic hypoparathyroidism. Rev Endocr Metab Disord 2021; 22:297-316. [PMID: 33599907 PMCID: PMC8087595 DOI: 10.1007/s11154-020-09613-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
A systematic literature review was performed to summarize the frequency and nature of renal complications in patients with chronic hypoparathyroidism managed with conventional therapy. Methodology was consistent with the recommendations outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Peer-reviewed journal articles with specified medical subject heading terms were identified using the PubMed, EMBASE, and Cochrane databases. Data were extracted from eligible articles based on prespecified parameters for clinical outcomes of renal calcifications and disease. Because of the heterogeneity of the data, a meta-analysis could not be conducted. From 1200 potentially relevant articles, data were extracted from 13 manuscripts that reported data for ≥1 of the 19 predefined renal outcomes for ≥10 adult patients (n = 11 manuscripts) or pediatric patients (n = 2 manuscripts). The collective data provide evidence that adult and pediatric patients with chronic hypoparathyroidism and treated with conventional therapy (oral calcium and active vitamin D) had an increased risk of renal complications. The reported rate of nephrolithiasis was up to 36%, with the lowest rates in studies reporting shorter duration of disease. The rate of nephrocalcinosis was up to 38%. Some studies reported a combined nephrolithiasis/nephrocalcinosis outcome of 19% to 31%. Data for renal disease that encompassed a range of renal insufficiency to chronic kidney disease were reported in 10 articles; the reported rates ranged from 2.5% to 41%. In patients who receive long-term treatment with oral calcium and active vitamin D, chronic hypoparathyroidism may be associated with an increased risk of renal complications compared with the general population.
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Affiliation(s)
| | - Pascal Houillier
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lars Rejnmark
- Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Claudio Marelli
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - John P Bilezikian
- Division of Endocrinology, College of Physicians and Surgeons, Columbia University, 630 W 168th Street, Room 864, New York, NY, 10032, USA.
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Khan AA, AbuAlrob H, Punthakee Z, Shrayyef M, Werfalli RE, Kassem HA, Braga M, Millar A, Hussain S, Iqbal S, Khan T, Paul T, Van Uum S, Young JEM. Canadian national hypoparathyroidism registry: an overview of hypoparathyroidism in Canada. Endocrine 2021; 72:553-561. [PMID: 33655415 DOI: 10.1007/s12020-021-02629-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/09/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the epidemiology, presentation and management of hypoparathyroidism in Canada. Hypoparathyroidism is associated with significant morbidity and poor quality of life. We present baseline results from the Canadian National Hypoparathyroidism Registry, a prospective observational study evaluating hypoparathyroidism in Canada. METHODS Our study enrolled 130 patients with hypoparathyroidism. Patients were followed every 6 months with clinical and lab assessments. We present baseline data in this manuscript. RESULTS Seventy percent (91/130) of patients had postsurgical hypoparathyroidism, 30% (39/130) of patients had nonsurgical hypoparathyroidism due to autoimmune, genetic or idiopathic causes, and a molecular diagnosis was confirmed in 11 of these 39 patients. Pseudohypoparathyroidism was confirmed in 4/39 patients, DiGeorge syndrome in 2/39 patients, Barakat syndrome with a mutation in the GATA3 gene in 1/39, and activating mutations of the CASR gene in 3/39 patients with nonsurgical hypoparathyroidism. Renal complications with nephrocalcinosis or nephrolithiasis were present in 27% (14/52) of patients with postsurgical disease and 17% (4/24) of patients with nonsurgical hypoparathyroidism. Basal ganglia calcification was noted on imaging in 15% (n = 5/34) of patients with postsurgical hypoparathyroidism and 37% (n = 7/19) of patients with nonsurgical hypoparathyroidism. CONCLUSIONS Hypercalciuria was more commonly seen in those with renal complications of nephrocalcinosis, nephrolithiasis or CKD, and hyperphosphatemia was more commonly seen in those with basal ganglia calcification. Hospitalization occurred in 28% of those with postsurgical hypoparathyroidism and 46% of those with nonsurgical hypoparathyroidism. Hypoparathyroidism is associated with significant morbidity. Effective strategies to reduce the short-and long-term complications of hypoparathyroidism need to be developed and evaluated.
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Affiliation(s)
- Aliya A Khan
- McMaster University, Hamilton, ON, Canada.
- Bone Research and Education Centre, Oakville, ON, Canada.
| | | | | | | | | | | | | | | | | | - Salman Iqbal
- Bone Research and Education Centre, Oakville, ON, Canada
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Cipriani C, Minisola S, Bilezikian JP, Diacinti D, Colangelo L, Piazzolla V, Angelozzi M, Nieddu L, Pepe J, Diacinti D. Vertebral Fracture Assessment in Postmenopausal Women With Postsurgical Hypoparathyroidism. J Clin Endocrinol Metab 2021; 106:1303-1311. [PMID: 33567075 PMCID: PMC8063231 DOI: 10.1210/clinem/dgab076] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Hypoparathyroidism is a rare endocrine disorder whose skeletal features include suppression of bone turnover and greater volume and width of the trabecular compartment. Few and inconsistent data are available on the prevalence of vertebral fractures (VF). OBJECTIVE To evaluate the prevalence of VF assessed by vertebral fracture assessment (VFA) in postmenopausal women with chronic postsurgical hypoparathyroidism. DESIGN Cross-sectional study. SETTING Ambulatory referral center. PATIENTS OR OTHER PARTICIPANTS Fifty postmenopausal women (mean age 65.4 ± 9 years) with chronic postsurgical hypoparathyroidism and 40 age-matched healthy postmenopausal women (mean age 64.2 ± 8.6). MAIN OUTCOME MEASURES Lumbar spine, femoral neck, and total hip bone mineral density were measured by dual X-ray absorptiometry (Hologic Inc., USA) in all subjects. Site-matched spine trabecular bone score was calculated by TBS iNsight (Medimaps, Switzerland). Assessment of VF was made by VFA (iDXA, Lunar GE, USA) using the semiquantitative method and the algorithm-based qualitative assessment. RESULTS All-site BMD values were higher in the hypoparathyroid vs the control group. By VFA, we observed a 16% prevalence of VF in hypoparathyroid women vs 7.5% in control subjects. Among those with hypoparathyroidism who fractured, 5 (62.5%) had grade 1 wedge, 2 (25%) had grade 2 wedge, and 1 (12.5%) had grade 2 wedge and grade 2 biconcave VF. In the hypoparathyroid group, 57% with VFs and 32% without VFs had symptoms of hypoparathyroidism. CONCLUSION We demonstrate for the first time that in postmenopausal women with chronic postsurgical hypoparathyroidism, VFs are demonstrable by VFA despite normal BMD.
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Affiliation(s)
- Cristiana Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
- Corresponding Author: Cristiana Cipriani, Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. E-mail:
| | - Salvatore Minisola
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - John P Bilezikian
- Division of Endocrinology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Davide Diacinti
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
- Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Tor Vergata, Rome, Italy
| | - Luciano Colangelo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Italy
| | - Valentina Piazzolla
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Maurizio Angelozzi
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Luciano Nieddu
- Faculty of Economics, UNINT University, Via Cristoforo Colombo, Rome, Italy
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Viale Regina Elena, Rome, Italy
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Ketteler M, Chen K, Gosmanova EO, Signorovitch J, Mu F, Young JA, Sherry N, Rejnmark L. Risk of Nephrolithiasis and Nephrocalcinosis in Patients with Chronic Hypoparathyroidism: A Retrospective Cohort Study. Adv Ther 2021; 38:1946-1957. [PMID: 33704680 PMCID: PMC8004511 DOI: 10.1007/s12325-021-01649-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Introduction Chronic hypoparathyroidism managed with conventional treatment, comprising oral administration of calcium and active vitamin D, has been associated with renal complications, including nephrolithiasis and nephrocalcinosis. Further larger-scale studies are needed to examine these risks. This study evaluated the risk of nephrolithiasis and nephrocalcinosis in patients with chronic hypoparathyroidism. Methods A retrospective cohort study using a managed care claims database in the United States from January 2007 to June 2017. Included patients were those with chronic hypoparathyroidism (excluding those receiving parathyroid hormone) and randomly selected patients without hypoparathyroidism over a maximum of 5-year follow-up. The main outcome measures were nephrolithiasis, identified by diagnosis codes or procedure codes for removing kidney stones, and nephrocalcinosis, identified by diagnosis codes. Results The nephrolithiasis analyses included 8097 adult patients with hypoparathyroidism and 40,485 adult patients without hypoparathyroidism. After excluding patients with a diagnosis of nephrocalcinosis at baseline, nephrocalcinosis analyses included 8051 patients with hypoparathyroidism and 40,466 patients without hypoparathyroidism. During 5 years of follow-up, patients with chronic hypoparathyroidism had significantly increased risk of nephrolithiasis and nephrocalcinosis in Kaplan–Meier analysis compared with patients without hypoparathyroidism (both P < 0.001). In the adjusted analyses, chronic hypoparathyroidism was associated with higher risks of nephrolithiasis (hazard ratio [HR], 1.81; 95% confidence interval [CI] 1.60–2.04) and nephrocalcinosis (HR, 6.94; 95% CI 4.41–10.92). A sensitivity analysis restricted to patients with at least one kidney imaging examination showed that 2.6% of patients (n = 59) with hypoparathyroidism and 0.5% of patients (n = 20) without hypoparathyroidism (ratio, 5.5; P < 0.001) developed nephrocalcinosis. Conclusions This large retrospective cohort study showed a statistically significant and clinically meaningful increased risk of nephrolithiasis and nephrocalcinosis in patients who have chronic hypoparathyroidism compared with those who do not have chronic hypoparathyroidism. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01649-2.
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Affiliation(s)
- Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
- University of Split School of Medicine (USSM), Split, Croatia.
| | - Kristina Chen
- Shire Human Genetic Therapies, Inc., A Takeda Company, Lexington, MA, USA
| | - Elvira O Gosmanova
- Division of Nephrology and Hypertension, Albany Medical College, Albany, NY, USA
| | | | - Fan Mu
- Analysis Group, Inc., Boston, MA, USA
| | | | - Nicole Sherry
- Shire Human Genetic Therapies, Inc., A Takeda Company, Lexington, MA, USA
| | - Lars Rejnmark
- Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Gosmanova EO, Chen K, Rejnmark L, Mu F, Swallow E, Briggs A, Ayodele O, Sherry N, Ketteler M. Risk of Chronic Kidney Disease and Estimated Glomerular Filtration Rate Decline in Patients with Chronic Hypoparathyroidism: A Retrospective Cohort Study. Adv Ther 2021; 38:1876-1888. [PMID: 33687651 PMCID: PMC8004481 DOI: 10.1007/s12325-021-01658-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Chronic hypoparathyroidism, treated with conventional therapy of oral calcium supplements and active vitamin D, may increase the risk of kidney complications. This study examined risks of development and progression of chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) decline in patients with chronic hypoparathyroidism. METHODS A retrospective cohort study using a managed care claims database in the United States from January 2007 to June 2017 included patients with chronic hypoparathyroidism (excluding those receiving parathyroid hormone) and randomly selected patients without hypoparathyroidism followed for up to 5 years. Main outcome measures were (1) development of CKD, defined as new diagnosis of CKD stage 3 and higher or ≥ 2 eGFR measurements < 60 ml/min/1.73 m2 ≥ 3 months apart, (2) progression of CKD, defined as increase in baseline CKD stage, (3) progression to end-stage kidney disease (ESKD), and (4) eGFR decline ≥ 30% from baseline. Time-to-event analyses included Kaplan-Meier analyses with log-rank tests, and both unadjusted and adjusted Cox proportional hazards models were used to compare outcomes between cohorts. RESULTS The study included 8097 adults with and 40,485 without chronic hypoparathyroidism. In Kaplan-Meier analyses, patients with chronic hypoparathyroidism had higher risk of developing CKD and CKD progression and higher rates of eGFR decline (all P < 0.001). In multivariable Cox models adjusted for baseline characteristics, hazard ratios (95% confidence intervals [CIs]) were 2.91 (2.61-3.25) for developing CKD, 1.58 (1.23-2.01) for CKD stage progression, 2.14 (1.51-3.04) for progression to ESKD, and 2.56 (1.62-4.03) for eGFR decline (all P < 0.001) among patients with chronic hypoparathyroidism compared with those without hypoparathyroidism. CONCLUSION Patients with chronic hypoparathyroidism have increased risk of development and progression of CKD and eGFR decline compared with those without hypoparathyroidism. Further studies are warranted to understand underlying mechanisms for the associations between chronic hypoparathyroidism and kidney disease.
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Affiliation(s)
- Elvira O Gosmanova
- Division of Nephrology and Hypertension, Albany Medical College, Albany, NY, USA.
| | - Kristina Chen
- Shire Human Genetic Therapies, Inc., a Takeda Company, Lexington, MA, USA
| | - Lars Rejnmark
- Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Fan Mu
- Analysis Group, Inc., Boston, MA, USA
| | | | | | - Olulade Ayodele
- Shire Human Genetic Therapies, Inc., a Takeda Company, Lexington, MA, USA
| | - Nicole Sherry
- Shire Human Genetic Therapies, Inc., a Takeda Company, Lexington, MA, USA
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
- University of Split School of Medicine (USSM), Split, Croatia
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Vaitsi KD, Anagnostis P, Veneti S, Papavramidis TS, Goulis DG. Preoperative Vitamin D Deficiency is a Risk Factor for Postthyroidectomy Hypoparathyroidism: A Systematic Review and Meta-Analysis of Observational Studies. J Clin Endocrinol Metab 2021; 106:1209-1224. [PMID: 33484571 DOI: 10.1210/clinem/dgab039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Whether preoperative vitamin D deficiency (VDD) contributes to postoperative hypoparathyroidism (hypoPT) risk is unknown. OBJECTIVE This work aimed to meta-analyze the best available evidence regarding the association between preoperative vitamin D status and hypoPT risk. METHODS A comprehensive literature search was conducted in PubMed, CENTRAL, and Scopus databases, up to October 31, 2020. Study selection included patients undergoing thyroidectomy with preoperative vitamin D status and postoperative hypoPT data. Two researchers independently extracted data from eligible studies. Data were expressed as risk ratio (RR) with 95% CI. The I2 index was employed for heterogeneity. RESULTS Thirty-nine studies were included in the quantitative analysis (61 915 cases with transient and 5712 with permanent hypoPT). Patients with VDD demonstrated a higher risk for transient hypoPT compared with those with preoperative vitamin D sufficiency (RR 1.92, 95% CI, 1.50-2.45, I2 = 85%). These results remained significant for patients with preoperative 25-hydroxyvitamin D concentrations less than or equal to 20 ng/mL (mild VDD; RR 1.46, 95% CI, 1.10-1.94, I2 = 88%) and less than or equal to 10 ng/mL (severe VDD; RR 1.98, 95% CI 1.42-2.76, I2 = 85%). The risk of permanent hypoPT was increased only in cases with severe VDD (RR 2.45, 95% CI, 1.30-4.63, I2 = 45%). No difference was evident in subgroup analysis according to study design or quality. CONCLUSION Patients with preoperative VDD are at increased risk of transient hypoPT following thyroidectomy. The risk for permanent hypoPT is increased only for those with severe VDD.
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Affiliation(s)
- Konstantina D Vaitsi
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Endocrinology, Police Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Endocrinology, Police Medical Center of Thessaloniki, Thessaloniki, Greece
| | - Stavroula Veneti
- 1st Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Theodosios S Papavramidis
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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