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Larrán B, López-Alonso M, Miranda M, Graña A, Rigueira L, Orjales I. Influence of haemolysis on blood biochemistry profiles in cattle. Res Vet Sci 2024; 171:105203. [PMID: 38432158 DOI: 10.1016/j.rvsc.2024.105203] [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: 11/17/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 03/05/2024]
Abstract
Although haemolysis is the most common source of preanalytical error in clinical laboratories, its influence on cattle biochemistry remains poorly understood. The effect of haemolysis and its clinical relevance were investigated in 70 samples in which haemolysis was artificially induced (by spiking with increasing amounts of haemolysate, yielding 0.0%, 0.2%, 0.5%, 1.0%, 2.5%, 5.0% and 10% haemolysis degree (HD)), focusing on key parameters for bovine metabolic health assessment, including albumin, alkaline phosphatase (ALP), aspartate aminotransferase (AST), blood urea nitrogen (BUN), calcium (Ca), cholesterol, creatinine, creatine kinase (CK), gamma-glutamyl transferase (GGT), globulins, magnesium (Mg), phosphorus (P), total bilirubin (TBIL) and total proteins (TP). Preanalytical haemolysis significantly affected most (8 of 14) of the biochemical parameters analysed, leading to significant increases in concentrations of albumin (starting at 5% HD), cholesterol (at 5% HD) and P (at 10% HD) and to significant decreases in Ca (at 2.5% HD), creatinine (at 5% HD), globulins (at 10% HD), TBIL (at 2.5% HD) and TP (at 10% HD). Comparison of the present and previous data indicated that, for each parameter, the HD required to produce significant bias and the clinical relevance of over- and underestimation are variable and appear to depend on the analytical technique used. Therefore, different laboratories should evaluate the influence of haemolysis in their analytical results and provide advice to clinicians accordingly. Affected parameters should be interpreted together with clinical signs and other analytical data to minimize misinterpretations (false or masked variations). Finally, due to the significant impact on numerous parameters and the limited potential for correction, we recommend rejection of samples with >10% HD.
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Affiliation(s)
- Belén Larrán
- Department of Animal Pathology, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain; Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain
| | - Marta López-Alonso
- Department of Animal Pathology, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain.
| | - Marta Miranda
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain; Department of Anatomy, Animal Production and Clinical Veterinary Sciences, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain
| | - Almudena Graña
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain
| | - Lucas Rigueira
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain; Department of Anatomy, Animal Production and Clinical Veterinary Sciences, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain
| | - Inmaculada Orjales
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain; Department of Anatomy, Animal Production and Clinical Veterinary Sciences, Faculty of Veterinary, Campus Terra, University of Santiago de Compostela, 27002 Lugo, Spain
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Rushton TJ, Tian DH, Baron A, Hess JR, Burns B. Hypocalcaemia upon arrival (HUA) in trauma patients who did and did not receive prehospital blood products: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02454-6. [PMID: 38319350 DOI: 10.1007/s00068-024-02454-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Hypocalcaemia upon arrival (HUA) to hospital is associated with morbidity and mortality in the trauma patient. It has been hypothesised that there is an increased incidence of HUA in patients receiving prehospital transfusion as a result of citrated blood products. This research aimed to determine if there was a difference in arrival ionised calcium (iCa) levels in trauma patients who did and did not receive prehospital transfusion. METHODS We conducted a systematic review and meta-analysis of patients with an Injury Severity Score (ISS) > / = 15 and an iCa measured on hospital arrival. We then derived mean iCa levels and attempted to compare between-group variables across multiple study cohorts. RESULTS Nine studies reported iCa on arrival to ED, with a mean of 1.08 mmol/L (95% CI 1.02-1.13; I2 = 99%; 2087 patients). Subgroup analysis of patients who did not receive prehospital transfusion had a mean iCa of 1.07 mmol/L (95% CI 1.01-1.14; I2 = 99%, 1661 patients). Transfused patients in the 3 comparative studies had a slightly lower iCa on arrival compared to those who did not receive transfusion (mean difference - 0.03 mmol/L, 95% CI - 0.04 to - 0.03, I2 = 0%, p = 0.001, 561 patients). CONCLUSION HUA is common amongst trauma patients irrespective of transfusion. Transfused patients had a slightly lower initial iCa than those without transfusion, though the clinical impact of this remains to be clarified. These findings question the paradigm of citrate-induced hypocalcaemia alone in trauma. There is a need for consensus for the definition of hypocalcaemia to provide a basis for future research into the role of calcium supplementation in trauma.
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Affiliation(s)
- Timothy J Rushton
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia.
| | - David H Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, NSW, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Aidan Baron
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - John R Hess
- Transfusion Service, Harborview Medical Center, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian Burns
- Trauma Service, Royal North Shore Hospital, Reserve Rd, St Leonards, Sydney, NSW, 2065, Australia.
- Aeromedical Operations, NSW Ambulance, Sydney, NSW, Australia.
- Sydney Medical School, Sydney University, Sydney, NSW, Australia.
- Faculty of Medicine, Macquarie University, Sydney, NSW, Australia.
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Prusty N, Peela SY, Manaf H, Thakkar S, Yanamadala Y, Shashank C. Vitamin D Levels Assessment among the Neonates with and without Seizures: A Single Center Cross-Sectional Study. J Pharm Bioallied Sci 2024; 16:S293-S295. [PMID: 38595514 PMCID: PMC11000918 DOI: 10.4103/jpbs.jpbs_497_23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction The impact that vitamin D (vit D) has on a variety of medical conditions like diabetes, cardiovascular, oncological, and central nervous system disorders has been a topic of interest for many years now. It is well-known that vit D deficiency is substantially more common in epileptics than in healthy subjects. The current research was piloted to analyse the vit D levels of the blood in newborns with seizures, as well as mothers' vit D status included subjects. Materials and Methods A cross-sectional examination was piloted at a tertiary care center, which had a neonatal intensive care unit (NICU). The subjects were neonates and their mothers. The levels of vit D were measured in term and late preterm newborns who had been brought to the NICU with convulsions. Term or late preterm infants who were healthy and hospitalized in the same hospital's postnatal unit as their mothers served as the controls for the study. Demographics, as well as the vit D levels of both the neonate and the mother, were estimated and compared and evaluated for any significance, keeping significance at less than 0.05. Results Of the 72 neonates included, they were similarly distributed between the epileptic (37) and healthy subjects. (40) The mothersy subjects.cluded, they were sim D levels averaged 15.11 ded, they were similarly distributed b D levels of their newborns were 13.26 ± 5.12 ng/mL (P = 0.77). There was no significant variance between the healthy and epileptic neonates (P = 0.212). Conclusion The current studyficant variance between the healthy and epileptic neonates (eptic with convulsions. Termserum vit D levels and epileptic activity in neonates. Nevertheless, the levels of the vitamin were < 20 ng/mL among all the neonates. Interventions to improve the vit D levels have to be implemented.
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Affiliation(s)
| | - Sai Y. Peela
- MBBS, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | - Haifa Manaf
- St John’s Health Services, Trivandrum, Kerala, India
| | - Smit Thakkar
- Shri M P Shah Government Medical College, Jamnagar, Gujarat, India
| | | | - Chapala Shashank
- Department of Radio-Diagnosis, Maheshwara Medical College, Hyderabad, Telangana, India
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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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Akpalu J, Ampong C, Adiiboka JG, Nikoi E, Atiase Y, Yorke E. Parathyroid Hormone Resistance: An Uncommon Cause of Hypocalcaemia in an Adult Ghanaian Female. West Afr J Med 2023; 40:1131-1134. [PMID: 37906970] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Parathyroid hormone (PTH) resistance, the main biochemical feature of a rare group of disorders known as Pseudohypoparathyroidism (PHP) is an uncommon cause of hypocalcaemia. In addition to the biochemical abnormalities, some individuals with PHP may have features of Albright Hereditary Osteodystrophy (AHO). Being a rare disorder with a significant level of variation and overlap in its clinical presentation, diagnosis of PHP may be challenging in some clinical settings. This case report highlights the diagnosis of this rare disorder. CASE REPORT A 20-year-old Ghanaian female who had been involved in a road traffic accident (RTA) was referred to the endocrine clinic after a computer tomography (CT) scan of her head revealed an incidental finding of multiple basal ganglia calcifications. Investigations revealed hypocalcaemia, hyperphosphatemia, and elevated intact PTH in the presence of normal levels of 25-hydroxyvitamin D and magnesium, and a normal kidney function. She also had phenotypic features of AHO. Findings suggested a diagnosis of PHP, however, the type could not be identified due to the unavailability of further testing. CONCLUSION This report of a Ghanaian female with PTH resistance and features of AHO diagnosed at the age of 20 years, is expected to add to the existing literature and assist in increasing the level of awareness and facilitate the diagnosis of this disorder in our setting.
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Affiliation(s)
- J Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana
| | - C Ampong
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Ghana
| | - J G Adiiboka
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Ghana
| | - E Nikoi
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Ghana
| | - Y Atiase
- Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana
| | - E Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana
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Rajaeerad A, Ghorbani GR, Khorvash M, Sadeghi-Sefidmasgi A, Mahdavi AH, Boroumand Jazi M, Wilkens MR. Comparison of two different anionic supplements and a low calcium diet fed to transition cows prepartum on DM intake, mineral homoeostasis and performance. Animal 2023; 17:100961. [PMID: 37703628 DOI: 10.1016/j.animal.2023.100961] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023] Open
Abstract
This study evaluates the effects of two rations with a positive dietary cation-anion difference (DCAD) and varying Ca content and two anionic diets on mineral homoeostasis and performance in early lactation cows. For this purpose, 48 pregnant dairy cows stratified for mature equivalent milk production, parity, body condition score (BCS), and BW were randomly assigned to four treatment groups and fed the following rations during the last 3 weeks of gestation: LC: low Ca (0.24% Ca, 1.14% K, DCAD: +86 mEq/kg DM), HC: high Ca (1.23% Ca, 1.17% K, DCAD: +95 mEq/kg DM), AS: Anionic salt (1.21% Ca, 1.21% K, DCAD: -112 mEq/kg DM, and SC: SoyChlor (1.28% Ca, 1.16% K, DCAD: -115 mEq/kg DM). After parturition, all animals were fed a common postpartum diet. Data were collected until 21 days in milk. Urinary pH was significantly decreased with the AS and SC treatment in comparison to the LC and HC groups. The highest prepartum DM intake (DMI) was found in the LC group, while DMI in AS cows was lowest. Postpartum, DMI was significantly greater in LC and SC cows than in animals fed the HC and AS rations. Prepartum serum concentrations of Ca, P, and Mg as well as postpartum serum concentrations of P and Mg did not differ, while postpartum Ca was lower in the HC group, especially 24 and 48 h after parturition. The greatest energy-corrected milk (ECM) yield was observed in cows fed the LC ration prepartum. Interestingly, milk protein production was lower in SC cows compared to LC, HC and AS. This study indicates that a ration containing a restricted Ca content fed prepartum is as suitable as a low DCAD diet to improve Ca balance without compromising DMI and performance.
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Affiliation(s)
- A Rajaeerad
- Department of Animal Sciences, College of Agriculture, Isfahan Bo, Isfahan 84156-83111, Iran
| | - G R Ghorbani
- Department of Animal Sciences, College of Agriculture, Isfahan Bo, Isfahan 84156-83111, Iran
| | - M Khorvash
- Department of Animal Sciences, College of Agriculture, Isfahan Bo, Isfahan 84156-83111, Iran
| | | | - A H Mahdavi
- Department of Animal Sciences, College of Agriculture, Isfahan Bo, Isfahan 84156-83111, Iran
| | - M Boroumand Jazi
- Department of Animal Science Research, Agricultural Research, Isfahan Agricultural and Natural Resources Research and Education Center, Education and Extension Organization (AREEO), Isfahan 84321-65458, Iran
| | - M R Wilkens
- Institute of Animal Nutrition, Nutrition Diseases and Dietetics, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 9, 04103 Leipzig, Germany.
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Dugani P, Sharma PV, Krishna SM, Reddy KK. Serum Parathyroid Hormone and Vitamin D Levels as Predictors of Hypocalcemia after Total/ Near Total Thyroidectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:1502-1510. [PMID: 37636752 PMCID: PMC10447850 DOI: 10.1007/s12070-023-03599-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Post-operative Hypocalcaemia is the most-common complication of total and near-total thyroidectomy which is a selective treatment for benign and malignant thyroid diseases. Incidence ranges from 0.5-50%. OBJECTIVES The role of vitamin-D and Parathyroid hormone(PTH) in incidence of Hypocalcemia after thyroidectomy has been taken into consideration. METHODS This is a prospective interventional study is conducted in Kasturba Medical College and hospital, Manipal after taking written informed consent from the participants. It aimed at surveying the serum level of preoperative Vitamin D, PTH and calcium before total-thyroidectomy surgery and its relationship with the incidence of postoperative hypocalcemia after the surgery. The study was done on 70 patients who were-planned for total/near total thyroidectomy. Preoperative Vitamin D, PTH, calcium and Postoperative 4 hours-PTH, Calcium were measured on POD-1, POD-2-4, the results obtained were then analysed. RESULTS Considering the cut-off of calcium as 8.6mg/dl, 42 patients developed hypocalcemia on POD-1, 28 patients on POD-2. Preoperative calcium and postoperative PTH levels in people having hypocalcaemia where significantly less compared to the patients having normal calcium. 4-hours post-operative PTH measurements showed 51% sensitivity, 100% specificity and strong co-relation between postoperative hypocalcemia and drop in PTH levels- (p=<0.001). Out of 42 patients who developed hypocalcemia 28- (65%) patients had vitamin-D deficiency(p=0.5) on POD-1 and out of 51 patients with hypocalcemia on POD 2-4, 33(78%) had-vitamin-D-deficiency(p=0.3852). Which was not statically significant. CONCLUSION 4 hours post-operative PTH level is a predictor of early postoperative hypocalcemia, by detecting this we can effectively manage postoperative hypocalcemia.
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Affiliation(s)
- Priya Dugani
- Department of General Surgery, Kasturba medical college and Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Poorvi V Sharma
- Department of ENT, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sunil M Krishna
- Department of General surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Miñones-Suarez L, Pérez de Nanclares G, Marín-Del Barrio S, Alcázar Villar MJ, de Sotto-Esteban D, Mogas E, Rey Cordo L, Riaño-Galán I, Lumbreras Fernández J, Leis R. Nutrition recommendations for patients with pseudohypoparathyroidism. An Pediatr (Barc) 2023; 99:129-135. [PMID: 37481364 DOI: 10.1016/j.anpede.2023.05.007] [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: 05/01/2023] [Accepted: 05/22/2023] [Indexed: 07/24/2023] Open
Abstract
Pseudohypoparathyroidism (PHP) is a spectrum of diseases characterized by insensitivity of target tissues to the action of parathyroid hormone and, consequently, by the presence of hyperphosphatemia and hypocalcaemia of varying severity. Early-onset obesity is a feature of PHP type 1A. This article discusses the need to establish uniform criteria to guide the nutritional management of patients with PHP. A decrease in energy expenditure calls for an adjustment of the energy content of the diet. Reducing the intake of foods rich in inorganic phosphorus helps to manage hyperphosphataemia. Targeted nutrition should be part of the treatment plan of children and adolescents with PHP, since it contributes to modulating the calcium and phosphorus metabolism imbalances characteristic of these patients.
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Affiliation(s)
- Lorena Miñones-Suarez
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital Reina Sofía, Tudela, Navarra, Spain
| | - Guiomar Pérez de Nanclares
- Laboratorio de (epi)Genética Molecular, Instituto de Investigación Sanitaria Bioaraba, Hospital Universitario Araba, Vitoria, Spain
| | - Silvia Marín-Del Barrio
- Servicio de Endocrinología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - María José Alcázar Villar
- Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Diego de Sotto-Esteban
- Endocrinología Pediátrica, Servicio de Pediatría, Clínica Rotger, Palma, Baleares, Spain; Department of Medicine, University of the Balearic Islands, Palma, Baleares, Spain
| | - Eduard Mogas
- Endocrinología Pediátrica, Hospital Universitario Maternoinfantil Vall d'Hebron, Barcelona, Spain
| | - Lourdes Rey Cordo
- Endocrinología Pediátrica, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Isolina Riaño-Galán
- Endocrinología Pediátrica, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, CIBER de Epidemiología y Salud Pública (CIBERESP), Oviedo, Asturias, Spain.
| | - Javier Lumbreras Fernández
- Nefrología Pediátrica, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma, Baleares, Spain
| | - Rosaura Leis
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), CIBERObn, Santiago de Compostela, La Coruña, Spain
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Van den Eynde F, Van Den Heede K, Brusselaers N, Van Slycke S. Thyroid surgery in the elderly: a surgical cohort. Langenbecks Arch Surg 2023; 408:254. [PMID: 37386199 DOI: 10.1007/s00423-023-02982-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE The need for thyroid surgery in the elderly is rising due to an ageing population, the liberal use of imaging studies, and the increasing prevalence of thyroid nodules and cancer with age. Data on surgical outcomes in this population are scarce and conflicting, but essential to assess safety of short-stay surgery. This study aims to compare surgical outcomes by age. METHODS All consecutive patients undergoing thyroid surgery from January 2010 to July 2021 in a large tertiary referral centre for endocrine surgery were included in this surgical cohort. The indication for surgery, surgical morbidity (hypocalcaemia, bleeding, recurrent laryngeal nerve (RLN) palsy), and length of hospital stay were assessed in three age groups (young: 18-64y, older: 65-74y, and the elderly: 75 years and older). RESULTS A total of 2,030 patients (1,499 young, 370 older, and 161 elderly) were included. The indication for surgery was significantly different, with the main indications in the elderly being multinodular goitre (70.2% vs. 47.7% in young patients) and thyroid cancer (9.9% vs. 7.0%). Reintervention for bleeding was more often required in the older (4.6%) and the elderly (2.5%) patients (vs. 1.4%). There was no difference in the proportion of hypocalcaemia or RLN palsy. The length of hospital stay was significantly longer in the elderly (length of stay longer than one day 43.5% vs. 9.8%). CONCLUSION Thyroid surgery in patients aged 75 years and older is a safe procedure with morbidity comparable to younger patients. However, the risk of reintervention for bleeding is higher, rendering ambulatory surgery not advisable. TRIAL REGISTRATION Researchregistry6182 on October 29th 2020, retrospectively registered.
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Affiliation(s)
- Fien Van den Eynde
- Group of Biomedical Sciences, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium.
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institute, Tomtebodavagen 16, 17165, Stockholm, Sweden
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
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10
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Casey C, Hopkins D. The role of preoperative vitamin D and calcium in preventing post-thyroidectomy hypocalcaemia: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:1555-1563. [PMID: 36542113 DOI: 10.1007/s00405-022-07791-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The thyroid gland plays an important endocrine function regulating metabolism, growth and development. A variety of benign and malignant conditions necessitate surgical removal of the thyroid gland, either in its entirety, or partially. Thyroidectomy is the most commonly undertaken endocrine surgery. Hypocalcaemia, occurring at a rate of approximately 25%, is the most common complication following total thyroidectomy. Hypocalcaemia can increase healthcare costs requiring further investigations, treatment and delaying discharge. Severe hypocalcaemia can be potentially life threatening. It has been demonstrated that routine post-operative supplementation with Vitamin D and calcium, can reduce post-operative hypocalcaemia, at present it is unclear whether preoperative supplementation has a similar effect. METHODS This systematic review includes randomised controlled trials on human adult subjects, who received preoperative Vitamin D and/or calcium, and which studied the effect on post-operative hypocalcaemia following total or near total thyroidectomy. There were no restrictions in respect of post-operative supplementation regimen. Studies were limited to those published in English. RESULT Seven of the eleven trials demonstrated a reduction in either laboratory or clinical hypocalcaemia with preoperative supplementation. This benefit was most likely to be seen when postoperative supplementation was performed on an as needed basis. IV calcium was required to treat resistant or severe hypocalcaemia, in five of the eleven trials, in each of these five trials, rates of IV replacement were lower in the preoperative supplementation group. CONCLUSION The use of preoperative Vitamin D, with or without calcium, may provide a modest reduction in the incidence of laboratory and clinic hypocalcaemia following total or near total thyroidectomy. There is a trend toward a reduced requirement for IV calcium with preoperative supplementation. Larger robust randomised trials are needed to provide a definitive answer. Preoperative supplementation can be considered in patients undergoing total or near total thyroidectomy.
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Affiliation(s)
- Cian Casey
- Department of Surgery, National University of Ireland Galway, University Road, Galway, Ireland.
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11
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Ling AOL, Toong LY, Omar TASBTD, Ghauth S. Effectiveness of Direct Transcricothyroid Electromyographic Monitoring in Thyroidectomy Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:193-199. [PMID: 37007880 PMCID: PMC10050275 DOI: 10.1007/s12070-022-03336-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/30/2022] [Indexed: 02/07/2023] Open
Abstract
Thyroid surgeries are associated with complications of vocal cord palsy and hypocalcemia which can be debilitating. The usage of intraoperative nerve monitoring is a useful adjunct to direct nerve visualization in thyroidectomies. We advocate the usage of direct transcricothyroid electromyographic monitoring in identifying recurrent laryngeal nerve. We retrospectively collected data of all patients who underwent thyroidectomies (total thyroidectomy, hemithyroidectomy, isthmusdectomy) using direct transcricothyroid electromyographic monitoring from April 2020 to August 2021. Data was analysed based on patient's demographics, comorbidities, complications post thyroidectomy such as vocal cord palsy, transient and permanent hypocalcemia. 50 thyroidectomies were performed, 10 developed unilateral vocal cord palsy. Out of 22 total thyroidectomies, 7 developed transient hypocalcemia and 4 permanently. 1 patient developed vocal cord hematoma secondary to direct insertion of intraoperative nerve monitor's electrode. Direct transcricothyroid electromyographic monitoring is a feasible and effective method in intraoperative monitoring of recurrent laryngeal nerve during thyroid surgeries.
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Affiliation(s)
- Amy Oon Li Ling
- Otorhinolaryngology (ENT) Department, Faculty of Medicine, Universiti Malaya, Jalan Universiti, 59100 Kuala Lumpur, Malaysia
| | - Liew Yew Toong
- Otorhinolaryngology (ENT) Department, Faculty of Medicine, Universiti Malaya, Jalan Universiti, 59100 Kuala Lumpur, Malaysia
| | | | - Sakina Ghauth
- Otorhinolaryngology (ENT) Department, Faculty of Medicine, Universiti Malaya, Jalan Universiti, 59100 Kuala Lumpur, Malaysia
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12
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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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Qi Y, Chai J, Zhang L, Chen Y. Preoperative vitamin D level is significantly associated with hypocalcemia after total thyroidectomy. BMC Musculoskelet Disord 2022; 23:1118. [PMID: 36550431 PMCID: PMC9773437 DOI: 10.1186/s12891-022-05977-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate the association of preoperative vitamin D levels with postoperative hypocalcaemia after total thyroidectomy. METHODS The medical records of patients who underwent total thyroidectomy between May 2020 and January 2022 and who had a documented preoperative serum 25-hydroxyvitamin D (25-OHD) concentration were retrospectively reviewed. Vitamin D levels were categorized into four groups: <10 ng/mL (severe vitamin D deficiency), 10-20 ng/mL (vitamin D deficiency), 20-30 ng/mL (vitamin D insufficiency), and > 30 ng/mL (vitamin D sufficiency). Multivariate logistic regression was performed to analyse the association of vitamin D levels with the risk of hypocalcaemia after controlling for potential confounding factors. RESULTS A total of 196 patients were included in this study. Of these, 47 (24.0%) had preoperative 25-OHD < 10 ng/mL, 62 (31.6%) had 25-OHD of 10-20 ng/mL, 51 (26.0%) had 25-OHD of 20-30 ng/mL and the remaining 36 (18.4%) had 25-OHD > 30 ng/mL. The incidence of postoperative hypocalcemia was highest in the group of patients with severe vitamin D deficiency (42.6% and 23.4% for postoperative laboratory and symptomatic hypocalcaemia, respectively), followed by the group with vitamin D deficiency (29.0% and 16.1%), the group with vitamin D insufficiency (19.6% and 5.9%) and the group with vitamin D sufficiency (5.6% and 2.8%). Multivariate logistic regression indicated that the odds of postoperative laboratory hypocalcaemia for patients with severe vitamin D deficiency and vitamin D deficiency were 13.20 times (95% CI: 2.69-64.79, P < 0.01) and 6.32 times (95% CI: 1.32-30.28, P = 0.02) greater than for those with vitamin D sufficiency, respectively; while the odds of symptomatic hypocalcaemia for patients with severe vitamin D deficiency was 10.18 times (95% CI: 1.14-90.86, P = 0.04) greater than for those with vitamin D sufficiency. CONCLUSION Preoperative vitamin D deficiency (< 20 ng/mL), especially severe vitamin D deficiency (< 10 ng/mL), is an independent predictive factor of postoperative hypocalcaemia after total thyroidectomy.
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Affiliation(s)
- Yantao Qi
- grid.413851.a0000 0000 8977 8425Department of Thyroid Surgery, The Affiliated Hospital of Chengde Medical University, No.36, Nanyingzi Street, 067000 Chengde, Hebei Province China
| | - Jixin Chai
- grid.413851.a0000 0000 8977 8425Department of Thyroid Surgery, The Affiliated Hospital of Chengde Medical University, No.36, Nanyingzi Street, 067000 Chengde, Hebei Province China
| | - Liuyang Zhang
- grid.413851.a0000 0000 8977 8425Department of Thyroid Surgery, The Affiliated Hospital of Chengde Medical University, No.36, Nanyingzi Street, 067000 Chengde, Hebei Province China
| | - Yong Chen
- grid.413851.a0000 0000 8977 8425Department of Thyroid Surgery, The Affiliated Hospital of Chengde Medical University, No.36, Nanyingzi Street, 067000 Chengde, Hebei Province China
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14
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Vendrig LM, Mooij CF, Derikx JP, Fischer JC, van Trotsenburg AP, Zwaveling-Soonawala N. The Effect of Pre-Thyroidectomy Calcitriol Prophylaxis on Post-Thyroidectomy Hypocalcaemia in Children. Horm Res Paediatr 2022; 95:423-429. [PMID: 35724644 PMCID: PMC9808645 DOI: 10.1159/000525626] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/10/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Transient or persistent hypoparathyroidism is one of the most well-known complications of total thyroidectomy and may lead to symptomatic hypocalcaemia. In children, treatment of post-thyroidectomy hypocalcaemia usually consists of postoperative calcium and/or vitamin D supplementation. In 2013, we implemented prophylactic pre-thyroidectomy calcitriol supplementation for all children undergoing total thyroidectomy at the Amsterdam UMC. The objective of this study was to evaluate the efficacy of this prophylactic calcitriol supplementation in preventing post-thyroidectomy hypocalcaemia in children. METHODS In a retrospective case study, we included all children (age <18 years), who underwent a total or completion thyroidectomy in the Amsterdam UMC, between 2000 and 2020. Patients were divided into two groups, patients with preoperative calcitriol supplementation and those without (controls). Hypocalcaemia was defined as total serum calcium concentration of <2.0 mmol/L. The primary outcome measure was the occurrence of hypocalcaemia in the first 72 h after surgery. Secondary outcome measures were occurrence of symptomatic hypocalcaemia, need for medical intervention within the first 72 h after surgery, and length of hospitalization. RESULTS A total of 51 patients were included; 26 with calcitriol prophylaxis and 25 controls. There was no significant difference in occurrence of hypocalcaemia (17/26 prophylaxis group; 18/25 control group). Median postoperative calcium concentrations in the first 72 h were significantly higher in the group with prophylaxis at 30-35 h (2.26 vs. 2.01 mmol/L) and 36-41 h (2.17 vs. 1.92 mmol/L). Occurrence of symptomatic hypocalcaemia, need for medical intervention, and length of hospitalization were not significantly different between the groups. CONCLUSION Calcitriol prophylaxis resulted in somewhat higher postoperative calcium concentrations but did not reduce the occurrence of hypocalcaemia or affect clinical outcome measures such as occurrence of symptomatic hypocalcaemia and length of postoperative hospitalization.
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Affiliation(s)
- Lisanne M. Vendrig
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christiaan F. Mooij
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep P.M. Derikx
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes C. Fischer
- Department of Clinical Chemistry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A.S. Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nitash Zwaveling-Soonawala
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands,*Nitash Zwaveling-Soonawala,
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15
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Loro VL, Wood CM. The roles of calcium and salinity in protecting against physiological symptoms of waterborne zinc toxicity in the euryhaline killifish (Fundulus heteroclitus). Comp Biochem Physiol C Toxicol Pharmacol 2022. [PMID: 35908640] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
In fresh water, environmental Ca ameliorates Zn toxicity because Ca2+ and Zn2+ compete for uptake at the gills. Zn toxicity is also lower in sea water, but it is unclear whether this is due to increased Ca2+ concentration, and/or to the other ions present at higher salinity. Using the euryhaline killifish, we evaluated the relative roles of Ca2+ (as CaNO3) versus the other ions contributing to salinity in protecting against physiological symptoms of Zn2+ toxicity. Killifish were exposed to a sublethal level of Zn (500 μg/L, as ZnSO4) for 96 h in either fresh water (0 % salinity) at low (1 mmol/L) and High Ca (10 mmol/L) or 35 ppt sea water (100 % salinity) at low (1 mmol/L) and High Ca (10 mmol/L). At 0 % salinity, High Ca partly or completely protected against the following effects of Zn seen at Low Ca: elevated plasma Zn, hypocalcaemia, inhibited unidirectional Ca2+ influx, inhibited branchial Na+/K+ATPase and Ca2+ATPase activities, and oxidative stress in gills, liver, intestine, and muscle. At 100 % salinity, in the presence of 1 mmol/L (Low Ca), Zn caused no disturbances in most of these same parameters, showing that the "non-Ca" components of sea water alone provided complete protection. However, for a few endpoints (inhibited intestinal Ca2+ATPase activity, oxidative stress in gill and liver), High Ca (10 mmol/L) was needed to provide full protection against Zn in 100 % salinity. There was no instance where the combination of 100 % salinity and High Ca failed to provide complete protection against Zn-induced disturbances in sea water.
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Affiliation(s)
- Vania Lucia Loro
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Santa Maria (UFSM), Av. Roraima 1000, 97105-900 Santa Maria, RS, Brazil; Dept. of Zoology, University of British Columbia, 6270 University Boulevard, Vancouver V6T1Z4, BC, Canada; Dept. of Biology. McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada.
| | - Chris M Wood
- Dept. of Zoology, University of British Columbia, 6270 University Boulevard, Vancouver V6T1Z4, BC, Canada; Dept. of Biology. McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada
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Prete FP, Panzera PC, Di Meo G, Pasculli A, Sgaramella LI, Calculli G, Dimonte R, Ferrarese F, Testini M, Gurrado A. Risk factors for difficult thyroidectomy and postoperative morbidity do not match: retrospective study from an endocrine surgery academic referral centre. Updates Surg 2022. [PMID: 36063287 DOI: 10.1007/s13304-022-01371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51-310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (p = 0.005), BMI (p < 0.001), thyroiditis (p < 0.05), hypervascular goiter (p = 0.003) and thyroid adhesions to surrounding anatomical structures (p < 0.001) were associated with longer operating time. At multivariable analysis male male sex (p = 0.01), obesity (p = 0.001) and thyroid adhesions (p = 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (p < 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.
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Dabas A, Dabas V, Dabla PK, Marwaha RK, Yadav S, Bharadwaj M, Tyagi V, Agrawal S. Daily v. weekly oral vitamin D 3 therapy for nutritional rickets in Indian children: a randomised controlled open-label trial. Br J Nutr 2022; 129:1-8. [PMID: 35550679 DOI: 10.1017/s0007114522001477] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of the study was to compare the efficacy of daily v. weekly oral vitamin D3 therapy in radiological healing of nutritional rickets. Children 6 months to 12 years (n 132) diagnosed with nutritional rickets were randomised into three groups (n 44): group A - 2000 IU daily vitamin D3 for 12 weeks, B - 60 000 IU weekly for 3 weeks, C - 60 000 IU weekly for 6 weeks. Serum calcium, phosphorus, 25-hydroxyvitamin D (25(OH)D), parathyroid hormone and X-ray score were estimated at baseline and 12 weeks (endline). The proportion of children who achieved complete radiological healing at endline was compared between three groups by χ2 and delta change in laboratory parameters by ANOVA (parametric data) or Kruskal Wallis test (non-parametric data), respectively. Baseline 25(OH)D ≤ 20 ng/ml was seen in 119 (90·2 %), hyperparathyroidism in 90 (68·8 %) and hypocalcaemia in 96 (72·7 %). A total of 120/132 children completed the study. Complete radiological healing seen in 30 (75 %) in group A, 23 (60·5 %) in group B and 26 (61·9 %) in group C; P = 0·15, with comparable endline X-ray scores; P = 0·31. The median (interquartile range (IQR)) delta X-ray score (baseline-endline) was 7 (4,9), 5 (2·25, 6) and 6 (4,7) in groups A, B and C, respectively; P = 0·019. Median (IQR) 25(OH)D endline levels in groups A, B and C were 50·0 (26·5, 66·5), 42·1 (28·4, 54·4) and 53·5 (33·7, 71·2) ng/ml, respectively; P = 0·045. Radiological scores were comparable at endline among daily and weekly vitamin D groups with greater change from baseline in daily supplemented group.
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Affiliation(s)
- Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Vineet Dabas
- Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Pradeep Kumar Dabla
- Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Raman Kumar Marwaha
- Consultant Endocrinologist and President, Society for Endocrine Health of Elderly, Adolescents and Children, New Delhi, India
| | - Sangeeta Yadav
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Madhavi Bharadwaj
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Vernika Tyagi
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Shipra Agrawal
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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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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Barbier MP, Mingote E, Sforza N, Morosán Allo Y, Lotartaro M, Serrano L, Fossati MP, Meroño T, Faingold C, Sedlinsky C, Brenta G. Incidence and predictive factors of postoperative hypocalcaemia according to type of thyroid surgery in older adults. Endocrine 2022; 75:276-283. [PMID: 34350564 DOI: 10.1007/s12020-021-02840-9] [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: 06/06/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Transient hypocalcaemia after thyroid surgery and its possible predictors have not been extensively described in the elderly. This study aimed to establish the frequency of postsurgical transient hypocalcaemia according to the extent of thyroid surgery in older adults and to assess mineral metabolism biochemical parameters as its predictors. METHODS All patients ≥60 years undergoing thyroid surgery were prospectively included. Type of surgery (hemithyroidectomy(HT) or total thyroidectomy(TT)); and preoperative 25OH Vitamin D (25OHD) and pre and 6 (only TT), 24 h and 6 months postsurgical serum levels of calcium, magnesium, phosphate and parathormone (PTH) were considered. Postsurgical hypoparathyroidism (hPTpost) was defined at PTH levels ≤11 pg/mL. RESULTS Out of 46 patients (87% female), age (mean ± SD) 70.1 ± 6.2 years, 24 h postsurgical hypocalcaemia was found in ten patients (22%). In 25 (54%) TT patients, 36% and 16% had postsurgical hypocalcaemia at 6 and 24 h respectively; 28% hPTpost but no definitive hPT was recorded and 44% had 25OHD deficiency. Lower 24 h magnesium levels were found in those TT patients with 24 h hypocalcaemia (1.6 ± 0.1 vs 1.9 ± 0.1 mg/dL (p = 0.005)). Among 21 (46%) HT patients, 28.6% had 24 h postsurgical hypocalcaemia; 9.5% had hPTpost. A positive correlation was observed between preoperative 25OHD and 24 h calcaemia (r:0.51,p = 0.02). 43% of the patients were 25OHD deficient, in whom 55% had 24 h hypocalcaemia vs only 9% in the 25OHD sufficient group (p = 0.049). CONCLUSION Postsurgical hypocalcaemia was common in elderly thyroidectomized patients. After TT, lower magnesium levels were found in those patients with 24 h hypocalcaemia. In the HT group, preoperative 25OHD deficiency predicted lower postsurgical calcium levels.
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Affiliation(s)
- María Paz Barbier
- Servicio de Endocrinología y Metabolismo, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Evelin Mingote
- Servicio de Endocrinología y Metabolismo, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Noelia Sforza
- Servicio de Endocrinología y Metabolismo, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Yanina Morosán Allo
- Servicio de Endocrinología y Metabolismo, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Maximiliano Lotartaro
- Servicio de Cirugía General, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Leonardo Serrano
- Servicio de Cirugía General, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - María Pía Fossati
- Laboratorio Central, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Tomas Meroño
- Laboratorio de Biomarcadores y Nutrimetabolómica, Departamento de Nutrición, Ciencias de la Alimentación y Gastronomía, Red de Referencia en Tecnología de Alimentos (XaRTA), Instituto de Nutrición y Seguridad Alimentaria (INSA), Facultad de Farmacia y Ciencias de la Alimentación, Universidad de Barcelona, Barcelona, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Faingold
- Servicio de Endocrinología y Metabolismo, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Claudia Sedlinsky
- Servicio de Endocrinología y Metabolismo, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Gabriela Brenta
- Servicio de Endocrinología y Metabolismo, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina.
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Acharya R, Kopczynska M, Goodmaker C, Mukherjee A, Doran H. Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: a retrospective cohort study. Ann R Coll Surg Engl 2021; 104:41-47. [PMID: 34727512 DOI: 10.1308/rcsann.2021.0078] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Vitamin D deficiency co-exists with and can confuse the diagnosis of primary hyperparathyroidism (PHPT). Vitamin D replete (VDR) status may prevent significant postparathyroidectomy hypocalcaemia; however, reports from previous studies are conflicting. This study aimed to assess differences in early and/or late postoperative hypocalcaemia and length of stay (LOS) postparathyroidectomy between VDR and vitamin D non-replete (VDNR) PHPT patients. METHODS This was a retrospective cohort study of a prospectively maintained single surgeon operative database. All records of patients who underwent parathyroidectomy over a four-year period (July 2014 to December 2018) were extracted. Data were collected on vitamin D and corrected calcium levels pre- and postoperatively as well as postoperative complications and LOS. RESULTS On presentation, there were 91 (47.9%) VDR and 99 (52.1%) VDNR patients. Following vitamin D therapy there were 148 (77.9%) VDR and 42 (22.1%) VDNR. The multivariate analysis showed that vitamin D status was the only significant factor impacting on the hypocalcaemia symptoms (OR 4.9, 95% CI 1.8-13.7, p = 0.002) and the most significant factor for the calcium supplementation (OR 6.5, 95% CI 2.1-19.4, p = 0.001). Bilateral neck exploration was associated with increased likelihood of transient hypocalcaemia (p = 0.007) but no other post-op complication. Median LOS was significantly shorter for VDR (1 day) versus VDNR (1.5 days) patients (p = 0.001). CONCLUSION There is a statistically significant increased likelihood of postoperative hypocalcaemia symptoms, requirement for calcium supplements and increased LOS in VDNR patients. This study suggests optimising preoperative vitamin D status improves patient experience and could reduce healthcare costs.
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Affiliation(s)
- R Acharya
- Salford Royal NHS Foundation Trust, UK
| | | | | | | | - H Doran
- Salford Royal NHS Foundation Trust, UK
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21
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Oyibo I, Oyibo PG, Osie-Efetie B. Prevalence and Predictors of Hypocalcaemia among Adolescent Girls in Rural Public Secondary Schools in South-South Nigeria. Ethiop J Health Sci 2021; 31:1185-1192. [PMID: 35392355 PMCID: PMC8968367 DOI: 10.4314/ejhs.v31i6.13] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescent girls are at risk of developing skeletal inadequacy due to an imbalance between calcium intake and high requirements of calcium during this period of increased modeling and skeletal consolidation. This study assessed the prevalence and predictors of hypocalcaemia among adolescent girls in rural public secondary schools in south-south Nigeria. METHODS This was a cross-sectional study conducted to assess the prevalence and predictors of hypocalcaemia among 238 adolescent girls selected by a multi-stage sampling technique. Data was collected using a semi-structured questionnaire which was interviewer-administered. Descriptive and inferential analysis of data collected was carried out using the IBM SPSS version 22 software. RESULTS Over half (53.3%) and 75.2% of the participants were in their late adolescence period (17-19 years) and belonged to the lower social class level. Over one-quarter (30.7%) of the participants had hypocalcaemia. Participants who were in their mid-adolescence period (14-16 years) (OR= 2.38; 95% CI: 1.23-4.57), who skipped lunch (OR= 2.92; 95% CI: 1.35-6.34), who skipped breakfast (OR= 3.60; 95% CI: 1.65-7.83) and were in senior secondary 1 class (OR= 4.76; 95% CI: 1.21-18.75) had 2, 3, 4, and 5 times higher likelihood respectively of having hypocalcaemia. Participants who consume milk daily, who consume milk weekly and who had normal weight had 81.0%, 60.0% and 72.0% decreased odds respectively of having hypocalcaemia. CONCLUSION The study brings to the fore a high prevalence of hypocalcaemia among the participants. Educational interventions targeted at parents to support adolescent girls to take calcium-supplements and calcium-rich meals should be implemented.
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Affiliation(s)
- Iyabo Oyibo
- Department of Paediatrics, Princess of Wales Hospital, Bridgend, UK
| | - Patrick Gold Oyibo
- Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Delta State University, Abraka, Nigeria
| | - Blessing Osie-Efetie
- Department of Health and Safety Education, Delta State University, Abraka, Nigeria
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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 2021; 69:S2530-0164(21)00157-9. [PMID: 34272207 DOI: 10.1016/j.endinu.2021.03.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
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 to 14.00 years. In 25 patients, the intervention was prophylactic and in 14 it was therapeutic. Fourteen suffered accidental excision of some parathyroid gland, but none more than t2 of them. Twelve presented HP, of which 3 were permanent; 5 presented clinical symptoms; one 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=.02). In the prophylactic interventions, it was 6/25 compared to 6/14 in the therapeutic ones (P=.29). The 3 cases of permanent HP were in children under 6 years of age, and it did not occur in any older children (P=.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)
- Emilio García-García
- Unidad de Endocrinología Pediátrica, Hospital Virgen del Rocío, Sevilla, España.
| | - Ana L Gómez-Gila
- Unidad de Endocrinología Pediátrica, Hospital Virgen del Rocío, Sevilla, España
| | - Ana R Romero-Lluch
- Servicio de Endocrinología y Nutrición, Hospital Virgen del Rocío, Sevilla, España
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da Silva Santos T, de Carvalho AC. Hypocalcemic cardiomyopathy - A rare and reversible entity. Am J Emerg Med 2021; 51:426.e1-426.e3. [PMID: 34244009 DOI: 10.1016/j.ajem.2021.06.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
Calcium plays a vital key role in cardiac automatism and excitation-contraction coupling, with low serum levels associated with myocardial contractility compromise especially if myocardial sarcoplasmic reticulum is unable to maintain enough calcium content to initiate normal cardiac contraction. We present a 42-year-old woman with postsurgical untreated hypoparathyroidism and severe hypocalcaemia manifested as acute heart failure, without underlying known cardiac disease. Hypocalcaemia is a rare and potentially reversible cause of cardiomyopathy, with very few cases reported in the literature. Restoration to normal serum calcium levels usually leads to a rapid improvement of cardiac function. This rare case report highlights the importance of considering hypocalcaemia as a potentially reversible cause of severe cardiac dysfunction. Exclusion of hypocalcemia due to surgical hypoparathyroidism is mandatory in any individual with acute heart failure previously subjected to thyroidectomy.
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Affiliation(s)
- Tiago da Silva Santos
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal.
| | - André Couto de Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
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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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Van Den Heede K, Van Slycke S, Brusselaers N. Reply to "Commentary on: Risk factors for postoperative morbidity after thyroid surgery in a PROSPECTIVE cohort of 1500 patients (Int. J. Surg. 2021, Epub ahead of print)". Int J Surg 2021; 91:105994. [PMID: 34118442 DOI: 10.1016/j.ijsu.2021.105994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Klaas Van Den Heede
- Department of Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden; Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium.
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, OLV Clinic Aalst, Aalst, Belgium; Department of Head and Skin, University Hospital Ghent, Ghent, Belgium; Department of General Surgery, AZ Damiaan, Ostend, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Global Health Institute, University of Antwerp, Wilrijk, Belgium
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Isgandarova K, Molatta S, Sommer P. Late diagnosed DiGeorge syndrome in a 44-year-old female: a rare cause for recurrent syncopes in adulthood-a case report. Eur Heart J Case Rep 2021; 5:ytab166. [PMID: 34013163 PMCID: PMC8117462 DOI: 10.1093/ehjcr/ytab166] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/14/2020] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Abstract
Background DiGeorge syndrome, also known as ‘CATCH 22’, is the most common deletion in humans and is one of the velocardiofacial syndromes. It is characterized by a specific facial phenotype, and structural and functional abnormalities in the cardiac and endocrine systems. One form of endocrine system dysfunction is hypocalcaemia, which causes arrhythmic events and can result in a transient loss of consciousness. We present a case highlighting the late diagnosis of DiGeorge syndrome in a patient with recurrent episodes of syncope due to suspected arrhythmic events secondary to hypocalcaemia. Case summary A 44-year-old woman was referred for further investigation of recurrent syncope episodes and documented transient QT-prolongation with hypocalcaemia. Previous detailed cardiological examination, including invasive procedures such as coronary angiography and cardiac magnetic resonance tomography, was unremarkable. Slight characteristic facial dysmorphia and transient hypocalcaemia were strongly suggestive of DiGeorge syndrome. The diagnosis was confirmed by genetic testing. Calcium substitution was initiated and no recurrent episodes of syncope or arrhythmic events were reported during 12 months of follow-up. Discussion Clinical presentation and time of manifestation of the DiGeorge syndrome varies widely depending on the mutation expression extent. An atypical disease course may delay the diagnosis and appropriate management of affected patients. In this case, confirmation of the diagnosis allowed the initiation of appropriate treatment, reducing the risk for further events. Given that syncope and arrhythmia can be the first and only manifestation of late-onset DiGeorge syndrome, specialists in adult cardiology need to be aware of this presentation.
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Affiliation(s)
- Khuraman Isgandarova
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Stephan Molatta
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
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Sardella A, Bellone F, Morabito N, Minisola S, Basile G, Corica F, Catalano A. The association between hypoparathyroidism and cognitive impairment: a systematic review. J Endocrinol Invest 2021; 44:905-919. [PMID: 32926396 DOI: 10.1007/s40618-020-01423-1] [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: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 12/01/2022]
Abstract
CONTEXT AND PURPOSE Hypocalcemia and low parathyroid hormone levels have been commonly suggested as factors able to induce central nervous system disturbances. However, evidences on the occurrence of cognitive impairment are limited or underestimated. The aim of this review is, therefore, to systematically summarize the available evidence concerning the occurrence of cognitive impairment among subjects suffering from idiopathic or secondary hypoparathyroidism. METHODS A systematic selection of the available literature was performed by searching the online databases PubMed, Scopus and Web of Knowledge. RESULTS The present systematic review included sixteen case report articles and one cross-sectional controlled study. Case reports were the most representative literature sources and involved ten women and seven men. The presence of cognitive impairment was mostly discussed in association with idiopathic hypoparathyroidism (HPT); five articles described the occurrence of cognitive impairment following postsurgical HPT. The case-controlled study reported a significant presence of peculiar cognitive deficits (e.g. reduced inhibitory control, impairment in visuo-spatial functioning among, and psychomotor retardation) among HPT subjects compared to healthy controls, with serum total calcium and its product with phosphorus as independent predictors of neuropsychological dysfunctions. CONCLUSION Even though mostly based on single case reports, the presence of neuropsychological dysfunctions in the context of HPT appears to be a consistent core finding.
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Affiliation(s)
- A Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - N Morabito
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - S Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza" Rome University, Rome, Italy
| | - G Basile
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F Corica
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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Tanaka S, Mizutani H, Tsuruya E, Fukuda R, Kuge K, Okubo N. Long-term safety and effectiveness of denosumab in Japanese patients with osteoporosis: 3-year post-marketing surveillance study. J Bone Miner Metab 2021; 39:463-473. [PMID: 33387064 DOI: 10.1007/s00774-020-01180-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/04/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Denosumab is a humanized IgG2 monoclonal antibody that was approved for the treatment of osteoporosis in Japan in 2013. This study aimed to investigate the long-term safety and effectiveness of denosumab in Japanese patients with osteoporosis in daily clinical practice. MATERIALS AND METHODS This 3-year, prospective, observational, post-marketing study included patients who initiated treatment with denosumab (60 mg/6 months) for osteoporosis. Data were assessed at baseline, 3, 6, 12, 24 and 36 months. Key endpoints were adverse events (AEs), adverse drug reactions (ADRs), occurrence of osteoporotic fractures, bone mineral density (BMD), and bone turnover markers. Multivariate analyses were conducted to identify predictors of hypocalcaemia and percent change in BMD. RESULTS Overall, 3534 patients were assessed (mean 75.7 years; 89.8% women). In total, 298 patients (8.4%) developed ADRs; the most common was hypocalcaemia (3.9%). Hypocalcaemia risk was significantly increased in patients with creatinine clearance < 30 mL/min, no prior use of bisphosphonates, prior use of calcium and vitamin D preparations, baseline serum calcium < 8.5 mg/dL, and no concomitant use of calcium or vitamin D preparations. Six patients had adjudicated osteonecrosis of the jaw. Lumbar spine BMD increased significantly from baseline (mean percent change: 11.4% at 36 months). All bone turnover markers decreased significantly from baseline. Over 3 years, 3.3% of patients developed a new osteoporotic fracture. CONCLUSIONS This study confirmed the long-term safety and effectiveness of denosumab in Japanese patients with osteoporosis in daily clinical practice. No new safety signals were identified.
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Affiliation(s)
- Sakae Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideki Mizutani
- Post Marketing Study Department, Daiichi Sankyo Co., Ltd., 3-5-1, Nihonbashi Honcho, Chuo-ku, Tokyo, 103-8426, Japan.
| | - Eri Tsuruya
- Post Marketing Study Department, Daiichi Sankyo Co., Ltd., 3-5-1, Nihonbashi Honcho, Chuo-ku, Tokyo, 103-8426, Japan
| | - Ryoko Fukuda
- Post Marketing Study Department, Daiichi Sankyo Co., Ltd., 3-5-1, Nihonbashi Honcho, Chuo-ku, Tokyo, 103-8426, Japan
| | - Kiyoka Kuge
- Post Marketing Study Department, Daiichi Sankyo Co., Ltd., 3-5-1, Nihonbashi Honcho, Chuo-ku, Tokyo, 103-8426, Japan
| | - Naoki Okubo
- Biostatistics and Data Management Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
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Van Slycke S, Van Den Heede K, Bruggeman N, Vermeersch H, Brusselaers N. Risk factors for postoperative morbidity after thyroid surgery in a PROSPECTIVE cohort of 1500 patients. Int J Surg 2021; 88:105922. [PMID: 33774174 DOI: 10.1016/j.ijsu.2021.105922] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/20/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding are the most frequent postoperative complications after thyroid surgery, and therefore often used as quality indicators of thyroid surgery. We aimed to assess postoperative morbidity in a high-volume endocrine surgery unit, and to detect which factors are associated with higher risks. METHODS Prospective surgical cohort in a high-volume tertiary referral centre for endocrine surgery in xxx. The first 1500 patients operated with hemi or total thyroidectomy during 2010-2019 were included. Postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and peri-operative characteristics using multivariable logistic regression analyses, expressed as odds ratios and 95% confidence intervals. RESULTS Overall, 1043 patients (69.5%) received a total thyroidectomy and 457 (30.5%) a hemithyroidectomy. Permanent hypocalcaemia occurred in 3.1%, permanent recurrent laryngeal nerve palsy in 1.8% and surgical reintervention for bleeding in 2.6%. Younger age, female sex and cancer were risk factors for permanent hypocalcaemia. No clear risk factors could be identified for permanent nerve palsy. Female sex, high body mass index and heavier thyroids were protective against postoperative bleeding after total thyroidectomy. CONCLUSIONS Surgical experience in endocrine surgery seems beneficial for clinical outcomes and contributes to organizational efficiency. A low complication risk can be obtained by trained high-volume endocrine surgeons, yet the risk is not negligible.
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Affiliation(s)
- Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium; Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium; Department of Endocrine Surgery, Hammersmith, 72 Du Cane Road, W12 0HS, London, UK
| | - Niels Bruggeman
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Plastic and Reconstructive Surgery, Department of Human Structure and Repair, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Brusselaers
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Karolinska Hospital, Solnavägen 9, 17165, Stockholm, Sweden.
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Triguero Cabrera J, Fernández Segovia E, González Martínez S, Muñoz Pérez NV, Arcelus Martínez JI, Expósito Ruiz M, Villar Del Moral JM. Development and validation of a new model for predicting hypocalcaemia after total thyroidectomy: the NuGra model. Langenbecks Arch Surg 2020; 406:1199-1209. [PMID: 33048225 DOI: 10.1007/s00423-020-02002-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hypocalcaemia is the most frequent complication after total thyroidectomy. Finding a method for its early detection has become a priority. A single-center prospective cohort study was conducted to identify risk factors for postoperative hypocalcaemia, develop an early detection model, and test its validity in a different group of patients. METHODS The sample was composed of patients who underwent a total thyroidectomy between May 2012 and September 2015. Demographic, clinical, laboratory, and surgical data were collected. The incidence of hypocalcaemia and permanent hypoparathyroidism was calculated. Bivariate and multivariate analysis identified several independent predictors of hypocalcaemia, which were used to design a predictive model. The validity of the model was subsequently tested in a different cohort. Area under the ROC curve (AUROC) was calculated to determine its predictive power. RESULTS The study and validation groups included 352 and 118 patients, respectively. Seventy-three patients developed laboratory-confirmed hypocalcaemia (20.7%), and symptomatic in 43 (12.2%). Multivariate analysis confirmed as independent predictors of hypocalcaemia the higher number of parathyroid glands identified [OR 1.41(0.98, 2.02); p = 0.063] and pre-to-postoperative gradient of parathormone decline [OR 1.06(1.04, 1.08); p < 0.001]. Based on these variables, the NuGra (Number of parathyroid glands identified-Gradient of decline) model was developed for predicting laboratory-confirmed hypocalcaemia. Its predictive power was high (AUROC 0.902, CI 0.857-0.947) for the study and the validation group (AUROC 0.956, CI 0.919-0.993). CONCLUSIONS A higher number of parathyroid glands identified and a higher gradient of parathormone decline are risk factors for post-thyroidectomy hypocalcaemia. The NuGra model is useful for early prediction of individual risk for hypocalcaemia.
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Affiliation(s)
- Jennifer Triguero Cabrera
- Unit of Endocrine Surgery, Department of General Surgery, Virgen de las Nieves University Hospital, 18012, Av. De las Fuerzas Armadas, Granada, Spain.
| | - Elena Fernández Segovia
- Unit of Endocrine Surgery, Department of General Surgery, Virgen de las Nieves University Hospital, 18012, Av. De las Fuerzas Armadas, Granada, Spain
| | - Selene González Martínez
- Unit of Endocrine Surgery, Department of General Surgery, Virgen de las Nieves University Hospital, 18012, Av. De las Fuerzas Armadas, Granada, Spain
| | - Nuria Victoria Muñoz Pérez
- Unit of Endocrine Surgery, Department of General Surgery, Virgen de las Nieves University Hospital, 18012, Av. De las Fuerzas Armadas, Granada, Spain
| | - Juan Ignacio Arcelus Martínez
- Unit of Endocrine Surgery, Department of General Surgery, Virgen de las Nieves University Hospital, 18012, Av. De las Fuerzas Armadas, Granada, Spain.,Department of Surgery, University of Granada, Granada, Spain
| | - Manuela Expósito Ruiz
- Unit of Management and Research Support (FIBAO), Virgen de las Nieves University Hospital, Granada, Spain
| | - Jesús María Villar Del Moral
- Unit of Endocrine Surgery, Department of General Surgery, Virgen de las Nieves University Hospital, 18012, Av. De las Fuerzas Armadas, Granada, Spain
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Smilie C, Shah D, Batra P, Ahmed RS, Gupta P. Prevalence and predictors of hypocalcaemia in severe acute malnutrition. Public Health Nutr 2020; 23:3181-6. [PMID: 32703321 DOI: 10.1017/S1368980020001895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the prevalence and predictors of hypocalcaemia in under-five children (1-59 months) hospitalised with severe acute malnutrition (SAM). DESIGN A cross-sectional study was designed to determine the prevalence of hypocalcaemia among children hospitalised with SAM. Serum Ca and 25-hydroxycholecalciferol (25-(OH)D) were estimated. Hypocalcaemia was defined as serum Ca (albumin-adjusted) <2·12 mmol/l. To identify the clinical predictors of hypocalcaemia, a logistic regression model was constructed taking hypocalcaemia as a dependent variable, and sociodemographic and clinical variables as independent variables. SETTING A tertiary care hospital in Delhi, between November 2017 and April 2019. PARTICIPANTS One-hundred and fifty children (1-59 months) hospitalised with SAM were enrolled. RESULTS Hypocalcaemia was documented in thirty-nine (26 %) children hospitalised with SAM, the prevalence being comparable between children aged <6 months (11/41, 26·8 %) and those between 6 and 59 months (28/109, 25·7 %) (P = 0·887). Vitamin D deficiency (serum 25-(OH)D <30 nmol/l) and clinical rickets were observed in ninety-eight (65·3 %) and sixty-three (42 %) children, respectively. Hypocalcaemia occurred more frequently in severely malnourished children with clinical rickets (OR 6·6, 95 % CI 2·54, 17·15, P < 0·001), abdominal distension (OR 4·5, 95 % CI 1·39, 14·54, P = 0·012) and sepsis (OR 2·6, 95 % CI 1·00, 6·57, P = 0·050). CONCLUSION Rickets and hypocalcaemia are common in children with SAM. Routine supplementation of vitamin D should be considered for severely malnourished children. Ca may be empirically prescribed to severely malnourished children with clinical rickets, abdominal distension and/or sepsis.
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Edafe O, Sandler LM, Beasley N, Balasubramanian SP. Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism. Eur Arch Otorhinolaryngol 2021; 278:1337-44. [PMID: 32700234 DOI: 10.1007/s00405-020-06213-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
Purpose Post-laryngectomy hypoparathyroidism is associated with significant short- and long-term morbidities. This systematic review aimed to determine incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism. Methods Medline, EMBASE and the Cochrane library were searched for relevant articles on hypocalcaemia and/or hypoparathyroidism after laryngectomy or pharyngectomy. Two authors independently screened titles and abstracts from the search. Data from individual studies were collated and presented (without meta-analysis). Quality assessment of included studies was undertaken. The review protocol was registered in the PROSPERO database (CRD42019133879). Results Twenty-three observational studies were included. The rates of transient and long-term hypoparathyroidism following laryngectomy with concomitant hemi- or total thyroidectomy ranged from 5.6 to 57.1% (n = 13 studies) and 0 to 12.8% (n = 5 studies), respectively. Higher transient (62.1–100%) and long-term (12.5–91.6%) rates were reported in patients who had concomitant oesophagectomy and total thyroidectomy (n = 4 studies). Other risk factors included bilateral selective lateral neck dissection, salvage laryngectomy and total pharyngectomy. There is a lack of data on prevention and management. Conclusion Hypoparathyroidism occurs in a significant number of patients after laryngectomy. Patients who underwent laryngectomy with concomitant hemithyroidectomy may still develop hypoparathyroidism. Research on prevention and treatment is lacking and needs to be encouraged.
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Gallo D, Rosetti S, Marcon I, Armiraglio E, Parafioriti A, Pinotti G, Perrucchini G, Patera B, Gentile L, Tanda ML, Bartalena L, Piantanida E. When primary hyperparathyroidism comes as good news. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200046. [PMID: 32554826 PMCID: PMC7354736 DOI: 10.1530/edm-20-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 12/14/2022] Open
Abstract
SUMMARY Brown tumors are osteoclastic, benign lesions characterized by fibrotic stroma, intense vascularization and multinucleated giant cells. They are the terminal expression of the bone remodelling process occurring in advanced hyperparathyroidism. Nowadays, due to earlier diagnosis, primary hyperparathyroidism keeps few of the classical manifestations and brown tumors are definitely unexpected. Thus, it may happen that they are misdiagnosed as primary or metastatic bone cancer. Besides bone imaging, endocrine evaluation including measurement of serum parathyroid hormone and calcium (Ca) levels supports the pathologist to address the diagnosis. Herein, a case of multiple large brown tumors misdiagnosed as a non-treatable osteosarcoma is described, with special regards to diagnostic work-up. After selective parathyroidectomy, treatment with denosumab was initiated and a regular follow-up was established. The central role of multidisciplinary approach involving pathologist, endocrinologist and oncologist in the diagnostic and therapeutic work-up is reported. In our opinion, the discussion of this case would be functional especially for clinicians and pathologists not used to the differential diagnosis in uncommon bone disorders. LEARNING POINTS Brown tumors develop during the remodelling process of bone in advanced and long-lasting primary or secondary hyperparathyroidism. Although rare, they should be considered during the challenging diagnostic work-up of giant cell lesions. Coexistence of high parathyroid hormone levels and hypercalcemia in primary hyperparathyroidism is crucial for the diagnosis. A detailed imaging study includes bone X-ray, bone scintiscan and total body CT; to rule out bone malignancy, evaluation of bone lesion biopsy should include immunostaining for neoplastic markers as H3G34W and Ki67 index. If primary hyperparathyroidism is confirmed, selective parathyroidectomy is the first-line treatment. In advanced bone disease, treatment with denosumab should be considered, ensuring a strict control of Ca levels.
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Affiliation(s)
- Daniela Gallo
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Sara Rosetti
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Ilaria Marcon
- Department of Oncology, ASST dei Sette Laghi, Varese, Italy
| | - Elisabetta Armiraglio
- Pathology Unit, ASST Gaetano Pini, Centro Specialistico Ortopedico Traumatologico, Gaetano Pini-CTO, Milano, Italy
| | - Antonina Parafioriti
- Pathology Unit, ASST Gaetano Pini, Centro Specialistico Ortopedico Traumatologico, Gaetano Pini-CTO, Milano, Italy
| | | | | | - Bohdan Patera
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Linda Gentile
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Maria Laura Tanda
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Luigi Bartalena
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
| | - Eliana Piantanida
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, Varese, Italy
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Fuss CT, Burger-Stritt S, Horn S, Koschker AC, Frey K, Meyer A, Hahner S. Continuous rhPTH (1-34) treatment in chronic hypoparathyroidism. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200009. [PMID: 32478671 PMCID: PMC7274549 DOI: 10.1530/edm-20-0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/21/2020] [Indexed: 11/20/2022] Open
Abstract
SUMMARY Standard treatment of hypoparathyroidism consists of supplementation of calcium and vitamin D analogues, which does not fully restore calcium homeostasis. In some patients, hypoparathyroidism is refractory to standard treatment with persistent low serum calcium levels and associated clinical complications. Here, we report on three patients (58-year-old male, 52-year-old female, and 48-year-old female) suffering from severe treatment-refractory postsurgical hypoparathyroidism. Two patients had persistent hypocalcemia despite oral treatment with up to 4 µg calcitriol and up to 4 g calcium per day necessitating additional i.v. administration of calcium gluconate 2-3 times per week, whereas the third patient presented with high frequencies of hypocalcemic and treatment-associated hypercalcemic episodes. S.c. administration of rhPTH (1-34) twice daily (40 µg/day) or rhPTH (1-84) (100 µg/day) only temporarily increased serum calcium levels but did not lead to long-term stabilization. In all three cases, treatment with rhPTH (1-34) as continuous s.c. infusion via insulin pump was initiated. Normalization of serum calcium and serum phosphate levels was observed within 1 week at daily 1-34 parathyroid hormone doses of 15 µg to 29.4 µg. Oral vitamin D and calcium treatment could be stopped or reduced and regular i.v. calcium administration was no more necessary. Ongoing efficacy of this treatment has been documented for up to 7 years so far. Therefore, we conclude that hypoparathyroidism that is refractory to both conventional treatment and s.c. parathyroid hormone (single or twice daily) may be successfully treated with continuous parathyroid hormone administration via insulin pump. LEARNING POINTS Standard treatment of hypoparathyroidism still consists of administration of calcium and active vitamin D. Very few patients with hypoparathyroidism also do not respond sufficiently to standard treatment or administration of s.c. parathyroid hormone once or twice daily. In those cases, continuous s.c. administration of parathyroid hormone via insulin pump may represent a successful treatment alternative.
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Affiliation(s)
- Carmina Teresa Fuss
- Division of Endocrinology and Diabetology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stephanie Burger-Stritt
- Division of Endocrinology and Diabetology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Silke Horn
- Division of Endocrinology and Diabetology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Ann-Cathrin Koschker
- Division of Endocrinology and Diabetology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Kathrin Frey
- Division of Endocrinology and Diabetology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Almuth Meyer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Helios Klinikum Erfurt, Erfurt, Germany
| | - Stefanie Hahner
- Division of Endocrinology and Diabetology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
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Wang M, Cho C, Gray C, Chai TY, Daud R, Luttrell M. Milk-alkali syndrome: a 'quick ease' or a 'long-lasting problem'. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200028. [PMID: 32408269 PMCID: PMC7274561 DOI: 10.1530/edm-20-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
SUMMARY We report the case of a 65-year-old female who presented with symptomatic hypercalcaemia (corrected calcium of 4.57 mmol/L) with confusion, myalgias and abdominal discomfort. She had a concomitant metabolic alkalosis (pH 7.46, HCO3- 40 mmol/L, pCO2 54.6 mmHg). A history of significant Quick-Eze use (a calcium carbonate based antacid) for abdominal discomfort, for 2 weeks prior to presentation, suggested a diagnosis of milk-alkali syndrome (MAS). Further investigations did not demonstrate malignancy or primary hyperparathyroidism. Following management with i.v. fluid rehydration and a single dose of i.v. bisphosphonate, she developed symptomatic hypocalcaemia requiring oral and parenteral calcium replacement. She was discharged from the hospital with stable biochemistry on follow-up. This case demonstrates the importance of a detailed history in the diagnosis of severe hypercalcaemia, with MAS representing the third most common cause of hypercalcaemia. We discuss its pathophysiology and clinical importance, which can often present with severe hypercalcaemia that can respond precipitously to calcium-lowering therapy. LEARNING POINTS Milk-alkali syndrome is an often unrecognised cause for hypercalcaemia, but is the third most common cause of admission for hypercalcaemia. Calcium ingestion leading to MAS can occur at intakes as low as 1.0-1.5 g per day in those with risk factors. Early recognition of this syndrome can avoid the use of calcium-lowering therapy such as bisphosphonates which can precipitate hypocalcaemia.
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Affiliation(s)
- Mawson Wang
- Nepean Blue Mountains Local Health District, Katoomba, New South Wales, Australia
| | - Catherine Cho
- Nepean Blue Mountains Local Health District, Katoomba, New South Wales, Australia
| | - Callum Gray
- Nepean Blue Mountains Local Health District, Katoomba, New South Wales, Australia
| | - Thora Y Chai
- Department of Endocrinology, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ruhaida Daud
- Nepean Blue Mountains Local Health District, Katoomba, New South Wales, Australia
| | - Matthew Luttrell
- Department of Endocrinology, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia
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Lomelino-Pinheiro S, Margarida B, Lages ADS. A novel TRPM6 variant (c.3179T>A) causing familial hypomagnesemia with secondary hypocalcemia. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200005. [PMID: 32369769 PMCID: PMC7219130 DOI: 10.1530/edm-20-0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/06/2020] [Indexed: 11/24/2022] Open
Abstract
SUMMARY Familial hypomagnesemia with secondary hypocalcemia (FHSH) is a rare autosomal recessive disorder (OMIM# 602014) characterized by profound hypomagnesemia associated with hypocalcemia. It is caused by mutations in the gene encoding transient receptor potential cation channel member 6 (TRPM6). It usually presents with neurological symptoms in the first months of life. We report a case of a neonate presenting with recurrent seizures and severe hypomagnesemia. The genetic testing revealed a novel variant in the TRPM6 gene. The patient has been treated with high-dose magnesium supplementation, remaining asymptomatic and without neurological sequelae until adulthood. Early diagnosis and treatment are important to prevent irreversible neurological damage. LEARNING POINTS Loss-of-function mutations of TRPM6 are associated with FHSH. FHSH should be considered in any child with refractory hypocalcemic seizures, especially in cases with serum magnesium levels as low as 0.2 mM. Normocalcemia and relief of clinical symptoms can be assured by administration of high doses of magnesium. Untreated, the disorder may be fatal or may result in irreversible neurological damage.
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Affiliation(s)
- Sara Lomelino-Pinheiro
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Bastos Margarida
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Adriana de Sousa Lages
- Endocrinology, Diabetes and Metabolism Department, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Válek M, Roblová L, Raška I, Schaffelhoferová D, Paleček T. Hypocalcaemic cardiomyopathy: a description of two cases and a literature review. ESC Heart Fail 2020; 7:1291-1301. [PMID: 32243105 PMCID: PMC7261529 DOI: 10.1002/ehf2.12693] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
Hypocalcaemic cardiomyopathy is a rare form of dilated cardiomyopathy. The authors here present two cases in which symptomatic dilated cardiomyopathy was the result of severe hypocalcaemia. First, we report about a 26‐year‐old woman with primary hypoparathyroidism and then about a 74‐year‐old man with secondary hypoparathyroidism following a thyroidectomy. In both cases, the left ventricular systolic function improved after calcium supplementation. In the first case, a lack of compliance led to a repeated decrease of both serum calcium level and left ventricular systolic function. The authors also present a comprehensive summary of all cases of hypocalcaemic dilated cardiomyopathy that have been described in literature to date. The mean age of the affected patients was 48.3 years, of which 62% were female patients. The most common causes of hypocalcaemic cardiomyopathy are primary hypoparathyroidism (50%) and post‐thyroidectomy hypoparathyroidism (26%). In the post‐thyroidectomy subgroup, the median time for the development of hypocalcaemic cardiomyopathy is 10 years (range: 1.5 months to 36 years). Hypocalcaemic cardiomyopathy leads to heart failure with reduced ejection fraction in 87% of patients. Generally, the most common complications of hypoparathyroidism and/or hypocalcaemia are cerebral calcifications, cognitive deficit, and cataracts. Once calcium supplementation is administered, the disease has a good prognosis and, in most individuals, a significant improvement (21%) or even normalization (74%) of the left ventricular systolic function occurs.
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Affiliation(s)
- Martin Válek
- Second Department of Medicine, Department of Cardiovascular Medicine, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Roblová
- Second Department of Medicine, Department of Cardiovascular Medicine, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivan Raška
- Third Department of Medicine, Department of Endocrinology and Metabolism, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dita Schaffelhoferová
- Department of Cardiology, Heart Center, České Budějovice Hospital, České Budějovice, Czech Republic
| | - Tomáš Paleček
- Second Department of Medicine, Department of Cardiovascular Medicine, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Priya SR, Dravid C. Central Compartment Nodal Bulk: A Predictor of Permanent Postoperative Hypocalcaemia. Indian J Surg Oncol 2020; 11:92-100. [PMID: 32205978 PMCID: PMC7064669 DOI: 10.1007/s13193-019-01010-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022] Open
Abstract
Central compartment clearance (CCC) for Papillary thyroid cancers (PTC) is one of the factors causing postoperative hypocalcaemia. We aimed to examine determinants of this major sequela. 41 patients treated for PTCs between 2014 and 2016 were studied. Surgical details, tumour and nodal characteristics, incidence of transient, temporary and permanent hypocalcaemia were noted. Central clearance was done bilaterally in 24 (58.5%) cases, ipsilaterally in 17 (41.6%). Central nodes were involved in 26 (63.4%) cases, unilaterally in 15 (36.6%), bilaterally in 11 (26.8%). Transient hypocalcaemia developed in 10 (24.4%) cases, temporary hypocalcaemia in 6 (14.6%) cases, and permanent hypocalcaemia in 2 (4.9%) cases. 17 (41%) patients were symptomatic. 9 (21.9%) patients received intravenous calcium. The only factor consistently associated with development of hypocalcaemia of all patterns, was the presence of matted central compartment nodes (p = 0.021). Matted nodes also related to a longer length of stay (p = 0.04) and requirement of intravenous calcium (p = 0.000). Extent of CCC, nodal yield, nodal positivity, perinodal extension, number of parathyroids identified, gender or pT size were not significantly associated. Symptomatic patients did not necessarily become permanently hypocalcaemic (p = 0.8). Patients requiring intravenous calcium were more likely to take oral calcium after discharge (p = 0.002). Postoperative hypocalcaemia is more likely in cases with bulky involved central nodes where extensive clearance is done. In routine CCC, even if done bilaterally, preservation of parathyroid function is possible. Permanent hypocalcaemia after CCC need not be taken as inevitable.
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Affiliation(s)
- S. R. Priya
- Head Neck Unit, Delhi State Cancer Institute, Delhi, India
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Gunawan F, George E, Kotowicz M. Denosumab-induced hypocalcaemia in metastatic castrate-resistant prostate cancer. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190063. [PMID: 31829971 PMCID: PMC6935716 DOI: 10.1530/edm-19-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/25/2019] [Indexed: 01/24/2023] Open
Abstract
SUMMARY Denosumab is a fully human MAB that acts as a potent anti-resorptive by inhibiting activation of osteoclasts by inhibiting the receptor activator of nuclear factor-kappa B (RANK) ligand. Hypocalcaemia has been reported as one of the serious adverse sequelae of use of denosumab. We present a case of refractory hypocalcaemia following administration of a single dose of denosumab in a patient with metastatic castrate-resistant prostate cancer. The patient's serum calcium and vitamin D concentrations and renal function were normal prior to denosumab administration. Serum alkaline phosphatase (ALP) level was however elevated pre-morbidly consistent with known bone metastases. The patient was treated with high-dose oral and IV calcium without any appreciable response in serum calcium. During his 30-day hospital admission, he demonstrated disease progression with development of new liver metastases and bone marrow involvement. Normocalcaemia was not achieved despite 1 month of aggressive therapy. Given the patient was asymptomatic and prognosis guarded, he was eventually discharged for ongoing supportive care under the palliative care team. LEARNING POINTS Denosumab is a potent anti-resorptive therapy and hypocalcaemia is one of the known adverse effects. Serum calcium and vitamin D concentrations must be replete prior to administration of denosumab to reduce the risk of hypocalcaemia. Denosumab has been proven to be more effective than zoledronic acid in preventing skeletal-related adverse effects in patients with metastatic castrate-resistant prostate cancer.
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Affiliation(s)
- Florence Gunawan
- Barwon Health, Geelong University Hospital, Geelong, Victoria, Australia
| | - Elizabeth George
- Barwon Health, Geelong University Hospital, Geelong, Victoria, Australia
| | - Mark Kotowicz
- Barwon Health, Geelong University Hospital, Geelong, Victoria, Australia
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Joseph ADD, Sirisena ND, Kumanan T, Sujanitha V, Strelow V, Yamamoto R, Wieczorek S, Dissanayake VHW. Hypoparathyroidism, Sensorineural deafness and renal disease (Barakat syndrome) caused by a reduced gene dosage in GATA3: a case report and review of literature. BMC Endocr Disord 2019; 19:111. [PMID: 31660939 PMCID: PMC6816161 DOI: 10.1186/s12902-019-0438-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/24/2019] [Accepted: 10/09/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Barakat syndrome is an autosomal dominant rare genetic disease caused by haploinsufficiency of the GATA binding protein 3 (GATA3) gene. It is also known as HDR syndrome, and is characterized by varying degrees of hypoparathyroidism, sensorineural deafness and renal disease. This is the first report of a heterozygous GATA3 whole gene deletion causing HDR syndrome in a Sri Lankan family. CASE PRESENTATION A 13-year-old boy with an acute febrile illness, hypocalcaemia and bilateral carpopedal spasm was referred for evaluation. A past medical history of treatment for persistent hypocalcaemic symptoms since the age of 7 months was obtained. Biochemical investigations showed persistent low serum corrected calcium levels with hyperphosphataemia, hypomagnesaemia, low parathyroid hormone levels, hypercalciuria, and low total 25-hydroxy vitamin D levels. His renal functions and renal sonography were normal. Audiometry showed bilateral moderate to severe sensorineural hearing loss. On screening, his mother was also found to have asymptomatic hypocalcaemia, hypomagnesaemia, hyperphosphataemia, hypercalciuria and low total 25-hydroxy vitamin D levels. She had impaired renal functions and chronic parenchymal changes in the renal scan. Audiometry showed bilateral profound sensorineural hearing loss. Genetic analysis using multiplex-ligation dependent probe amplification showed a reduced gene dosage for GATA3 that is consistent with a heterozygous whole gene deletion in both the child and mother. CONCLUSIONS This report demonstrates the wide intra-familial phenotypic variability observed in HDR syndrome and adds further to the existing scientific literature on the genotype-phenotype correlation of this syndrome. It highlights the need for HDR syndrome to be considered in the differential diagnosis of persistent hypocalcaemia with sensorineural deafness and/or renal involvement, and for appropriate genetic evaluation to be done to confirm the diagnosis.
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Affiliation(s)
- Anne D. D. Joseph
- University Medical Unit, Teaching Hospital Jaffna, Jaffna, Sri Lanka
| | - Nirmala D. Sirisena
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo 8, Sri Lanka
| | | | | | - Veronika Strelow
- MVZ Dr. Eberhard & Partner Dortmund GbR (ÜBAG), 44137 Dortmund, Germany
| | - Raina Yamamoto
- MVZ Dr. Eberhard & Partner Dortmund GbR (ÜBAG), 44137 Dortmund, Germany
| | - Stefan Wieczorek
- MVZ Dr. Eberhard & Partner Dortmund GbR (ÜBAG), 44137 Dortmund, Germany
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Xu SQ, Ma Y, Su HW, Cheng JF, Zhou YX. Comparison Of The Effects Of Focus Harmonic Scalpel And Conventional Haemostasis On Parathyroid Function In Thyroid Surgery. J Ayub Med Coll Abbottabad 2019; 31:481-484. [PMID: 31933295] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Protection of parathyroid is very important in thyroid surgery. Our aim was to compare the effect of Focus Harmonic Scalpel and Conventional Haemostasis on parathyroid function in thyroid surgery. METHODS To analyse the clinical data of patients in our hospital from November 2011-December 2015 retrospectively. Operations have been performed with Focus Harmonic Scalpel in thyroid surgery since May 2013. Seventy-four patients with nodular goitre constituted Harmonic Scalpel group and Conventional Haemostasis group, and so did 139 patients with thyroid papillary carcinoma. Clinical data were compared such as age, gender, thyroid volume, operation procedure, preoperative parathyroid hormone and serum calcium concentration between the two groups. The differences between the two groups were observed in serum calcium concentration, parathyroid hormone concentration, incidence of transient hypocalcaemia and hypoparathyroidism after operation. RESULTS The preoperative data showed no significant difference between Harmonic Scalpel group and Conventional Haemostasis group. No significant difference existed in postoperative clinic data at six a.m. the first day after operation between the two groups for patients with nodular goitre. The incidence of transient hypoparathyroidism and hypocalcaemia in Harmonic Scalpel group were less than that in Conventional Haemostasis group in thyroid surgery. Significant differences existed in the mean of serum calcium concentration and incidence of transient hypocalcaemia between the two groups for thyroid papillary carcinoma statistically. CONCLUSION Focus Harmonic Scalpel has certain advantages than conventional Haemostasis in protecting parathyroid glands, reducing the incidence of transient hypoparathyroidism and hypocalcaemia in thyroid surgery, especially for patients with thyroid cancer.
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Affiliation(s)
- Sheng-Qian Xu
- Department of General Surgery, Affiliated to Jiangyuan Hospital, Jiangsu Institute of Nuclear Medicine, China
| | - Yi Ma
- Department of General Surgery, Affiliated to Jiangyuan Hospital, Jiangsu Institute of Nuclear Medicine, China
| | - Hong-Wei Su
- Department of General Surgery, Affiliated to Jiangyuan Hospital, Jiangsu Institute of Nuclear Medicine, China
| | - Jian-Feng Cheng
- Department of General Surgery, Affiliated to Jiangyuan Hospital, Jiangsu Institute of Nuclear Medicine, China
| | - You-Xing Zhou
- Department of General Surgery, Affiliated to Jiangyuan Hospital, Jiangsu Institute of Nuclear Medicine, China
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Prokop J, Estorninho J, Marote S, Sabino T, Botelho de Sousa A, Silva E, Agapito A. POEMS syndrome: a rare cause of adrenal insufficiency in a young male. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190010. [PMID: 31967972 DOI: 10.1530/edm-19-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/16/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes) is a rare multisystemic disease. Clinical presentation is variable, the only mandatory criteria being polyneuropathy and monoclonal gammapathy in association with one major and one minor criterion. Primary adrenal insufficiency is rarely reported. We describe a case of a 33-year-old patient, in whom the presenting symptoms were mandibular mass, chronic sensory-motor peripheral polyneuropathy and adrenal insufficiency. The laboratory evaluation revealed thrombocytosis, severe hyperkalemia with normal renal function, normal protein electrophoresis and negative serum immunofixation for monoclonal protein. Endocrinologic laboratory work-up confirmed Addison's disease and revealed subclinical primary hypothyroidism. Thoracic abdominal CT showed hepatosplenomegaly, multiple sclerotic lesions in thoracic vertebra and ribs. The histopathologic examination of the mandibular mass was nondiagnostic. Bone marrow biopsy revealed plasma cell dyscrasia and confirmed POEMS syndrome. Axillary lymphadenopathy biopsy: Castleman's disease. Gluco-mineralocorticoid substitution and levothyroxine therapy were started with clinical improvement. Autologous hematopoietic cell transplantation (HCT) was planned, cyclophosphamide induction was started. Meanwhile the patient suffered two ischemic strokes which resulted in aphasia and hemiparesis. Cerebral angiography revealed vascular lesions compatible with vasculitis and stenosis of two cerebral arteries. The patient deceased 14 months after the diagnosis. The young age at presentation, multiplicity of manifestations and difficulties in investigation along with the absence of serum monoclonal protein made the diagnosis challenging. We report this case to highlight the need to consider POEMS syndrome in differential diagnosis of peripheral neuropathy in association with endocrine abnormalities even in young patients. LEARNING POINTS POEMS syndrome is considered a 'low tumor burden disease' and the monoclonal protein in 15% of cases is not found by immunofixation. Neuropathy is the dominant characteristic of POEMS syndrome and it is peripheral, ascending, symmetric and affecting both sensation and motor function. Endocrinopathies are a frequent feature of POEMS syndrome, but the cause is unknown. The most common endocrinopathies are hypogonadism, primary hypothyroidism and abnormalities in glucose metabolism. There is no standard therapy; however, patients with disseminated bone marrow involvement are treated with chemotherapy with or without HCT.
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Affiliation(s)
- Joanna Prokop
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - João Estorninho
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Sara Marote
- Departments of Internal Medicine, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Teresa Sabino
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Aida Botelho de Sousa
- Departments of Hemato-Oncology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Eduardo Silva
- Departments of Internal Medicine, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Ana Agapito
- Departments of Endocrinology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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Savva C, Adhikaree J, Madhusudan S, Chokkalingam K. Oncogenic osteomalacia and metastatic breast cancer: a case report and review of the literature. J Diabetes Metab Disord 2019; 18:267-72. [PMID: 31275898 DOI: 10.1007/s40200-019-00398-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/14/2019] [Indexed: 12/16/2022]
Abstract
Objectives Oncogenic osteomalacia is a rare paraneoplastic metabolic syndrome that is characterised by severe hypophosphataemia, hyperphosphaturia and osteomalacia secondary to renal loss of phosphate. It is commonly caused by overproduction of fibroblast growth factor-23 (FGF23) from benign tumours of mesenchymal origin. Currently, there is no clear evidence on the management of oncogenic osteomalacia in patients with metastatic solid tumours. Methods We report a case of breast cancer-induced oncogenic osteomalacia and discuss its diagnosis and management. Results A 71-year-old woman with advanced breast cancer developed symptomatic oncogenic osteomalacia with raised FGF23, severe hypophosphataemia and hypocalcaemia. The electrolytic disturbances were exacerbated after the administration of bisphosphonates in the context of her oncological treatment. Systemic chemotherapy and maintenance endocrine treatment along with phosphate and calcium supplementation reduced the activity of oncogenic osteomalacia and resolved the electrolytic imbalances. Conclusions To our knowledge, this is the first reported case of oncogenic osteomalacia in a patient with breast cancer. Oncogenic osteomalacia constitutes a diagnostic and therapeutic challenge. Pre-clinical and clinical evidence suggest that a possible underlying mechanism is the presence of molecular alterations in the FGF/FGFR signalling pathway leading to overexpression of FGF23. In metastatic setting, anticancer treatment can potentially lead to the normalisation of the electrolytic disturbances and reduction of the activity of oncogenic osteomalacia. The use of antiresorptive therapy in patients with bone metastases can potentially trigger FGF23 overexpression. Its use should be guided by the patients' risk of skeletal-related events and electrolytic disturbances as well as the degree of activity of oncogenic osteomalacia.
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Abstract
Background & Objective Patients who undergo Total thyroidectomy are at higher risk for postoperative hypocalcaemia, which can lead to significant short and long term morbidity. The aim of this study was to determine the frequency of postoperative hypocalcaemia undergoing Total thyroidectomy. Methods A total of 854 patients who underwent Total thyroidectomy and completion thyroidectomy between January 2003 to December 2016 at Endocrine Surgical unit, Jinnah Postgraduate Medical Centre, Karachi, were included in this retrospective study. Data were obtained for demographics, preoperative diagnosis, postoperative calcium levels, extent of surgery and final surgical pathology. Results A total of 854 patients underwent Total thyroidectomy. Of these 87.58% (n=748) were malignant and 12.41% (n=106) were benign. Among the malignant and benign patients, 47.3% (n=404) underwent Total thyroidectomy and 52.69% (n=450) underwent completion thyroidectomy. Overall incidence of transient hypocalcaemia was 7% (n=60) and that of permanent hypocalcaemia was 0.11% (n= 1). Conclusion Hypocalcaemia is one of major concern following total- thyroidectomy. Meticulous surgical techniques, identification and preservation of vascularity of parathyroid glands are essential in preventing postoperative hypocalcaemia following total thyroidectomy.
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Affiliation(s)
- Naseem Baloch
- Dr. Naseem Baloch, FCPS. Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Saima Taj
- Dr. Saima Taj, FCPS, MRCS. Department of Surgery, Sindh Govt: Korangi Hospital, Karachi, Pakistan
| | - Mariyah Anwer
- Dr. Mariyah Anwer, FCPS. Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Masooma Naseem
- Dr. Masooma Naseem, MBBS Student, Ziauddin University, Karachi, Pakistan
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Sawant R, Hulse K, Sohrabi S, Yeo JCL, Pal K, Gibb FW, Adamson R, Nixon IJ. The impact of completion thyroidectomy. Eur J Surg Oncol 2019; 45:1171-1174. [PMID: 30910458 DOI: 10.1016/j.ejso.2019.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The oncological benefit of completion thyroidectomy (CT) following thyroid lobectomy (TL) is presumed to be similar to that of upfront total thyroidectomy(TT), from a patient's perspective the risk and inconvenience of further surgery adds significantly to the impact of the overall treatment. The aim of this study is to assess the impact of CT in terms of the duration of admission and associated complications. METHODS A study of consecutive patients with DTC identified from prospective MDT records of South-East Scotland from 2009 to 2015. Surgical data was extracted from electronic medical record. RESULTS Of 361 patients diagnosed with DTC, 161 (45%) had CT. The median postoperative stay was 1 day (range 1-5days). In total 22 patients (14%)suffered complications. Four patients (3%) developed postoperative haematoma. Two (1%) had an identified permanent nerve palsy on the completion side. 13 patients (8%) remained on calcium supplementation for more than 6 months postoperatively and three patients (2%) developed wound complications. CONCLUSIONS Our study confirms that CT is regularly performed (45%). Recent changes in international guidelines recognize increasing number of patients as eligible for a conservative approach but recommend CT based on whether upfront TT would have been recommended if the TL pathology were known from the outset. Such an approach fails to consider the additional risk and inconvenience of CT on the overall patient experience. Due to a relatively high rate of complications, only those patients who are most likely to benefit from further surgery to facilitate adjuvant radioactive iodine should be offered additional surgery.
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Affiliation(s)
- R Sawant
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
| | - K Hulse
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
| | - S Sohrabi
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
| | - J C L Yeo
- Department of Otolaryngology, Head and Neck Surgery, Kirkaldy, NHS Fife, UK.
| | - K Pal
- Department of General Surgery, Borders General Hospital, UK.
| | - F W Gibb
- Department of Endocrinology, NHS Lothian, Edinburgh, UK.
| | - R Adamson
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
| | - I J Nixon
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh, UK.
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Aguiar M, Andronis L, Pallan M, Högler W, Frew E. Micronutrient deficiencies and health-related quality of life: the case of children with vitamin D deficiency. Public Health Nutr 2020; 23:1165-72. [PMID: 30744725 DOI: 10.1017/S1368980018003841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore the extent to which micronutrient deficiencies (MND) affect children's health-related quality of life (HRQoL), using vitamin D deficiency (VDD) as a case study. DESIGN Proxy valuation study to estimate the impact of VDD on the HRQoL of younger (0-4 years) and older (>4 years) children. We used the Child Health Utility 9 Dimension (CHU9D) questionnaire to estimate HRQoL for children within six VDD-related health states: 'hypocalcaemic cardiomyopathy', 'hypocalcaemic seizures', 'active rickets', 'bone deformities', 'pain and muscle weakness' and 'subclinical VDD'. SETTING Sampling was not restricted to any particular setting and worldwide experts were recruited. PARTICIPANTS Respondents were paediatric bone experts recruited through network sampling. RESULTS Thirty-eight experts completed the survey. The health state with the largest detrimental impact (mean score (se)) on children's HRQoL was hypocalcaemic cardiomyopathy (0·47 (0·02)), followed by hypocalcaemic seizures (0·50 (0·02)) and active rickets (0·62 (0·02) in young children; 0·57 (0·02) in older children). Asymptomatic VDD had a modest but noticeable negative impact on HRQoL, attributed mostly to tiredness in both age groups and pain in the older paediatric population. CONCLUSIONS Elicitation of HRQoL from clinical experts suggests a negative impact of VDD on HRQoL, even if there is no recognizable clinical manifestation. HRQoL data from populations of patients with MND will inform public health policy decisions. In some settings, routine collection of HRQoL data alongside national nutrition surveys may help capture the full burden of MND and prioritize resources towards effective prevention.
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St-Jean M, MacKenzie-Feder J, Bourdeau I, Lacroix A. Exacerbation of Cushing's syndrome during pregnancy: stimulation of a cortisol-secreting adrenocortical adenoma by ACTH originating from the foeto-placental unit. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM180115. [PMID: 30738017 PMCID: PMC6373782 DOI: 10.1530/edm-18-0115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/16/2019] [Indexed: 02/02/2023] Open
Abstract
A 29-year-old G4A3 woman presented at 25 weeks of pregnancy with progressive signs of Cushing's syndrome (CS), gestational diabetes requiring insulin and hypertension. A 3.4 × 3.3 cm right adrenal adenoma was identified during abdominal ultrasound imaging for nephrolithiasis. Investigation revealed elevated levels of plasma cortisol, 24 h urinary free cortisol (UFC) and late-night salivary cortisol (LNSC). Serum ACTH levels were not fully suppressed (4 and 5 pmol/L (N: 2-11)). One month post-partum, CS regressed, 24-h UFC had normalised while ACTH levels were now less than 2 pmol/L; however, dexamethasone failed to suppress cortisol levels. Tests performed in vivo 6 weeks post-partum to identify aberrant hormone receptors showed no cortisol stimulation by various tests (including 300 IU hLH i.v.) except after administration of 250 µg i.v. Cosyntropin 1-24. Right adrenalectomy demonstrated an adrenocortical adenoma and atrophy of adjacent cortex. Quantitative RT-PCR analysis of the adenoma revealed the presence of ACTH (MC2) receptor mRNA, while LHCG receptor mRNA was almost undetectable. This case reveals that CS exacerbation in the context of pregnancy can result from the placental-derived ACTH stimulation of MC2 receptors on the adrenocortical adenoma. Possible contribution of other placental-derived factors such as oestrogens, CRH or CRH-like peptides cannot be ruled out. Learning points: Diagnosis of Cushing's syndrome during pregnancy is complicated by several physiological alterations in hypothalamic-pituitary-adrenal axis regulation occurring in normal pregnancy. Cushing's syndrome (CS) exacerbation during pregnancy can be associated with aberrant expression of LHCG receptor on primary adrenocortical tumour or hyperplasia in some cases, but not in this patient. Placental-derived ACTH, which is not subject to glucocorticoid negative feedback, stimulated cortisol secretion from this adrenal adenoma causing transient CS exacerbation during pregnancy. Following delivery and tumour removal, suppression of HPA axis can require several months to recover and requires glucocorticoid replacement therapy.
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Affiliation(s)
| | | | - Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine and Research Center, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
| | - André Lacroix
- Division of Endocrinology, Department of Medicine and Research Center, Centre Hospitalier Universitaire de Montréal, Montréal, Québec, Canada
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Lale A, Öz B, Akcan AC, Sözüer EM, Arıkan TB, Gök M. Determination of risk factors causing hypocalcaemia after thyroid surgery. Asian J Surg 2019; 42:883-9. [PMID: 30685145 DOI: 10.1016/j.asjsur.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/04/2018] [Accepted: 12/18/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The most common complication after thyroid surgery is hypocalcaemia and it sometimes leads to problems that are difficult to correct in patients. The present study was aimed to determine the risk factors causing the development of hypocalcaemia after thyroid surgery. METHODS 818 adult patients were included in the study. The data were recorded by examining the hospital automation system and patient files retrospectively. Patients' demographic characteristics, radiological imaging findings, serum biochemical parameters, extent of the performed surgery, histopathological diagnoses were recorded. RESULTS The rate of hypocalcaemia was 28.4% (1.7% permanent). In multivariate analysis: the female gender (p = 0.002), heavier thyroid gland (p = 0.084), substernal location (p = 0.004) and cervical lymph nodes dissection (CLND) (p < 0.001) were found to be significantly. Malignant thyroid pathology (p = 0.006) and total thyroidectomy (p = 0.025) increased the risk of hypocalcaemia significantly in univariate analysis. However, this increase in risk was not found to be statistically significant in regression analysis. Significant statistical result was not found on postoperative hypocalcaemia in terms of advanced age, hyperthyroidism and re-operation. The duration of hospitalization was higher in patients with postoperative hypocalcaemia (m = 2 days) (p < 0.001). CONCLUSION In our analyses CLND, female gender, substernal location and heavier thyroid gland was found to be the independent risk factors in the development of postoperative hypocalcaemia. The development of postoperative hypocalcaemia may be predicted and measures may be taken to prevent clinical findings.
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Abstract
INTRODUCTION The aim of this single centre retrospective observational record-based audit was to assess the incidence of post-thyroidectomy hypocalcaemia. The setting was a district general hospital in Hertfordshire covering a population of 500,000 people. A total of 196 patients who had had total or completion thyroidectomy during a five-year period were included in the study. MATERIALS AND METHODS The primary outcome measure was to determine the rate of biochemical and symptomatic hypocalcaemia in patients undergoing total or completion thyroidectomy. Secondary outcome measures assessed time taken for biochemical and clinical hypocalcaemia to resolve, whether malignancy affected the rate of hypocalcaemia and if removal of parathyroid glands during surgery were a predictor of hypocalcaemia. RESULTS The overall incidence of post-thyroidectomy hypocalcaemia (PTHC) within 24 hours was 21.4%. The incidence increased from 6 hours (13.8%) to 24 hours post-thyroidectomy (15.8%) and there was evidence of both transient and delayed PTHC within the first 24 hours. By 6 months post-surgery, 3.6% remained hypocalcaemic and required continual oral supplementation. Patients with benign thyroid disease had a higher risk of PTHC (P = 0.04) and patients younger than 50 years of age had a higher risk of symptomatic hypocalcaemia (P = 0.016). Other clinical factors including sex, type of surgery, neck dissection, oral calcium and/or vitamin D supplementation and inadvertent histological parathyroid gland excision were not associated with an increased incidence of PTHC or symptomatic hypocalcaemia. CONCLUSIONS Our audit shows that the rate of PTHC within our population was below the national average with higher risk in benign thyroid disease.
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Affiliation(s)
- S Arman
- East and North Hertfordshire NHS Trust, Stevenage , Hertfordshire , UK
| | - A Vijendren
- East and North Hertfordshire NHS Trust, Stevenage , Hertfordshire , UK
| | - G Mochloulis
- East and North Hertfordshire NHS Trust, Stevenage , Hertfordshire , UK
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Abstract
Severe acute malnutrition (SAM) is a major cause of child mortality and morbidity. Children treated for SAM are at risk of refeeding hypophosphataemia (HP). The study was done to find out the incidence and various predictors of moderate/severe HP in SAM among North Indian children. This prospective observational study was conducted from August 2014 to July 2015 in the inpatients' department of Department of Paediatrics at King George's Medical University, Lucknow, Uttar Pradesh, North India, a tertiary care teaching hospital. Before inclusion, ethical approval and written informed consent was obtained. Included in the study were sixty-five children aged 6-59 months of age, who were admitted to the hospital with SAM as per the WHO guidelines. SAM was defined as a mid-upper arm circumference <115 mm and/or weight-for-height/length <-3 z-scores of the WHO growth standards and/or have bilateral oedema. Serum P levels were measured on admission and for five consecutive days after starting feed. HP was defined as mild, moderate and severe with a cut-off of 1·19-0·65, 0·65-0·32 and <0·32 mmol/l, respectively. About 60 % children had HP, with 20 % having moderate/severe HP at admission. The proportion of HP increased to 83·1 %, with 38·5 % having moderate/severe HP on day 3 after feeding. It was concluded that HP is a common biochemical abnormality in SAM. Considering its impact on the health of the child, serum P levels should be monitored in patients with SAM who are treated with enteral feeding.
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