457 The Effect of Biochemical Adversity of Primary Hyperparathyroidism on Preoperative Imaging (SPECT-CT and US Parathyroids)

Aim

Primary hyperparathyroidism (PHPT) is a common endocrine disorder, with an estimated incidence of 1/500 women and 1/2000 men older than 40 years. Several factors influence the positivity of preoperative scans including serum calcium, PTH and vitamin D levels, and gland size. The aim of our study is to examine the effect of biochemical adversity of primary hyperparathyroidism on preoperative imaging (SPECT-CT and US parathyroids).

Method

Retrospective study of 176 parathyroidectomies (2017-2020) in a tertiary referral centre with biochemistry, SPECT-CT, US parathyroids and histology outcomes being recorded. Failed parathyroidectomies were excluded.

Results

Patients were divided into 4 groups based on the preoperative calcium levels (normocalcemia <2.6, 3.4%; mild 2.60-2.79, 51.1%; moderate 2.80-2.99, 31.2%; severe >3.0 mmol/l, 14.2% of patients). Age (p-0.0297), preoperative vitamin D (p-0.03) and PTH levels (p-0.0001) were different while SPECT-CT positivity (p-0.29) weight of gland (p-0.015) and US positivity (p-0.09) were similar within the subgroups. Looking at the whole group, patients with positive SPECT-CT have a larger weight (p < 0.0001) while preoperative PTH levels was higher for the positive SPECT-CT patients (p-0.0289). No relation was identified between calcium levels and SPECT-CT positivity (p-0.18). No significance between preoperative vitamin D and positivity of US and SPECT-CT within the study group were noted.

Conclusions

Serum PTH levels and weight of the gland are directly correlated with positivity of preoperative imaging. Preoperative calcium and vitamin D levels correlates indirectly with the severity of the disease but did not influence the preoperative imaging positivity.

FIRST DAY SERUM CALCIUM AND PARATHYROID HORMONE LEVELS AS PREDICTIVE FACTORS FOR SAFE DISCHARGE AFTER THYROIDECTOMY

Context

Permanent hypocalcemia is a rare but significant complication of thyroid surgery.

Objective

The aim of this study was to identify predictive factors of hypocalcemia and hypoparathyroidism after thyroidectomy.

Design

Study included 134 total patients submitted to thyroidectomy from two endocrine units (January 2015 - August 2016).

Methods

We measured total serum calcium (sCa) and intact PTH (iPTH) on postoperative day one and 1 month after surgery.

Results

118 patients were women with F/M ratio of 7.3/1 and a mean age of 51.8 years. 64 patients were included in group A (iPTH <12 pg/mL) and 70 patients in group B (iPTH >12 pg/mL). sCa and hypocalcemia symptoms were correlated with iPTH, measured 24 hours after surgery. The cut-off value was for sCa 8.05 mg/dL with a sensitivity of 85.29% and a specificity of 88.0% and for iPTH 11.2 pg/mL, with a sensitivity of 82.3% and a specificity of 71.0%. SCa (< 8.05 mg/dL) was a predictive factor with a 99 (IC95%:12.86-761.58) and iPTH (<11.2 pg/mL) with a 10.77 higher risk (CI95%: 3.83-30.30) to be associated with symptoms.

Conclusion

SCa and iPTH represent good predictive factors of early and safe hospital discharge and can predict the risk of prolonged and permanent hypoparathyroidism.

[Colectomy in emergency surgery]

Unlike the standardised surgery of the right sided colic emergencies there is still a matter of debate on the emergency approach of the left colon and rectum. Between 1998 - 2007 on 32 patients (15 males, 17 females) we performed the single stage radical procedure total or subtotal colectomy. In the same period we performed 372 emergency operations for low intestinal occlusion. The patients had ages between 24 - 86 years, the admittance diagnosis was intestinal occlusion. The postoperative diagnosis was left colic carcinoma (n=23), strangulated hernia (n=2) strangulated incisional hernia (n=2), sigmoid volvulus (n=3) and synchronous colic carcinoma (n=2). All cases were submitted to surgery in the first 24 h of admission. Despite the presence of liver metastasis at the time of surgery in 2 patients, this had not contraindicate the radical procedure. 21 patients (65.62%) had a good evolution. The others 11 (34.38%) had postoperative complications: 2 anastomotic leakage (6.25%), 7 parietal infections (21.87%) and 2 death (6.25%). The total colectomy offers oncological radicality and satisfactory functional results. The disadvantage consists in postoperative diarrhea, gradually decreased with time.