Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

Abstract

Objective: Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and it may extend hospitalization durations. The purpose of this study is to determine the predictive factors related to the development of hypocalcemia and hungry bone syndrome (HBS) in patients who underwent parathyroidectomy for PHP. Materials and methods: Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD, albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1 st and 4 th days postoperatively, and in the 6 th postoperative month, and their neck ultrasound (US) and bone densitometry data were also recorded. Results: Hypocalcemia was seen in 63 patients (38.4%) on the 1 st day after parathyroidectomy. Ten patients (6.1%) had permanent hypocalcemia in the 6 th month after surgery. Out of the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP, and BUN values were higher in those patients who developed HBS. Furthermore, HBS was more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who underwent thyroidectomy simultaneously with parathyroidectomy. Conclusions: As a result, patients who have the risk factors for development of hypocalcemia and HBS should be monitored more attentively during the perioperative period. Arch Endocrinol Metab.2016;60(5):

Predictors of early postoperative hypocalcemia after total parathyroidectomy in renal hyperparathyroidism

“…This study has established that the proportion of postoperative hypocalcemia among the study subjects was 36.8%, and the results are comparable to other published studies [67]. The pathogenesis of postoperative hypocalcemia is multifactorial and its primary mechanism is possible due to abrupt removal of PTH stimulation after parathyroidectomy; hence, excess osteoclastic activity stops, but osteoblastic activity continues causing excess calcium and phosphate to pass into bones [12].…”

“…Many prior studies have evaluated the predictors of postoperative hypocalcemia in patients with primary hyperparathyroidism; however, the study of predictors of postoperative hypocalcemia in SHPT in renal failure patients is still limited [12131415]. Few studies have attempted to identify predictors for early postoperative hypocalcemia in SHPT with mixed results.…”

Protocolo de diagnóstico y manejo de hipocalcemia en postoperatorio de tiroides

“…This syndrome is classically described in hyperparathyroid patients with significant bone involvement, in which a sudden decrease in PTH levels occurs after parathyroid surgery, leading to sustained hypocalcemia with hypophosphoremia, which may further increase if the remaining parathyroid tissue functions normally. After being chronically hypercalcemic, he is temporarily stunned 4 . Although a classic hungry bone syndrome would not go unnoticed, mild forms of the syndrome are possibly underdiagnosed, so it must be kept in mind at all stages of the surgical process in hyperparathyroid patients, as well as in patients with hyperthyroidism that are going to undergo thyroidectomy and present hypermetabolic bone, either through bone mineral density (BMD) or through bone remodeling markers, such as alkaline phosphatase (AF).…”

A Practical Mathematic Method to Predict and Manage Hypocalcemia After Parathyroidectomy and Thyroidectomy

“…Some studies report a large drop in PTH after the removal of the offending parathyroid or a high preoperative PTH (>25) is associated with postoperative hypocalcemia, [11][12][13] while others do not note any correlation between PTH at any time point and postoperative hypocalcemia. [12][13][14][15][16] Others factors that have been correlated with postoperative hypocalcemia include: higher preoperative serum osteocalcin, phosphate levels, alkaline phosphatase, lower preoperative vitamin D, larger parathyroid mass, osteoporosis, older age, cardiovascular disease, and bilateral neck dissection. 10,14,[16][17][18] In contrast, several studies have noted that preoperative calcium and phosphate levels are not correlated with postoperative hypocalcemia.…”

“…[12][13][14][15][16] Others factors that have been correlated with postoperative hypocalcemia include: higher preoperative serum osteocalcin, phosphate levels, alkaline phosphatase, lower preoperative vitamin D, larger parathyroid mass, osteoporosis, older age, cardiovascular disease, and bilateral neck dissection. 10,14,[16][17][18] In contrast, several studies have noted that preoperative calcium and phosphate levels are not correlated with postoperative hypocalcemia. 19,20 Hypocalcemia can be a serious problem after a total thyroidectomy as well and is regarded as one of the most commonly seen complications related to a total thyroidectomy.…”