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Introduction Multiple endocrine neoplasia (MEN-1) usually presents following a diagnosis of primary hyperparathyroidism (PHPT). U.K. practice guidelines advise screening patients less than age 30 to identify MEN-1 mutations. It is our departmental policy to screen all patients under the age of 40. Methods A retrospective review of all patients having parathyroidectomy under the age of 40. A review of their mutational analysis and yield were the audit parameters. Results The records of 53 patients (17 F, 36 M) were available for audit (incomplete records were excluded); 45 patients had MEN-1 mutational analysis. 8 patients were not screened and 31% (14/45) were positive for MEN-1 mutations, 1 patient was positive for CDC73. Conclusion An 85% rate of compliance with the departmental screening protocol was found. This compares with a 25% yield in Uppsala and 11% in Utrecht.
Background Hypocalcaemia is a common complication after total thyroidectomy (TT). Treatment consists of calcium and active vitamin D supplementation. Low levels of vitamin D before surgery have been shown to be a risk factor for postoperative hypocalcaemia, yet studies examining routine preoperative vitamin D supplementation have shown conflicting results. This retrospective cohort study aims to investigate the potential benefit of preoperative active vitamin D supplementation on hypocalcaemia and its symptoms after TT. Methods This study included patients undergoing TT at Uppsala University Hospital from January 2013 to December 2020, resulting in a total of 401 patients after exclusion. Routine preoperative alfacalcidol treatment was initiated for all TT patients in January 2017 resulting in two groups for comparison: one group (pre-January 2017) that was prescribed preoperative alfacalcidol and one that was not. Propensity score matching was used to reduce bias. The primary outcome was early postoperative hypocalcaemia (serum calcium, S-Ca less than 2.10 mmol/l); secondary outcomes were symptoms of hypocalcaemia and length of stay. Results After propensity score matching, there were 108 patients in each group. There were 2 cases with postoperative day one S-Ca less than 2.10 in the treated group and 10 cases in the non-treated group (P < 0.001). No patients in the treated group had a S-Ca below 2.00 mmol/l. Preoperative alfacalcidol was associated with higher mean serum calcium level day one (2.33 versus 2.27, P = 0.022), and reduced duration of hospital stay (P < 0.001). There was also a trend toward fewer symptoms of hypocalcaemia (18.9 per cent versus 30.5 per cent, P = 0.099). Conclusions Prophylactic preoperative alfacalcidol was associated with reduced biochemical hypocalcaemia and duration of hospital stay following TT. Also, with this protocol, it is suggested that routine day 1 postoperative S-Ca measurement is not required.
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