Complications, Symptoms, Presurgical Predictors in Patients With Chronic Hypoparathyroidism: A Systematic Review

Abstract

The complications and symptoms of hypoparathyroidism remain incompletely defined. Measuring serum parathyroid hormone (PTH) and calcium levels early after total thyroidectomy may predict the development of chronic hypoparathyroidism. The study aimed (i) to identify symptoms and complications associated with chronic hypoparathyroidism and determine the prevalence of those symptoms and complications (Part I), and (ii) to examine the utility of early postoperative measurements of PTH and calcium in predicting chronic hypoparathyroidism (Part II). We searched Medline, Medline In‐Process, EMBASE, and Cochrane CENTRAL to identify complications and symptoms associated with chronic hypoparathyroidism. We used two predefined criteria (at least three studies reported the complication and symptom and had statistically significantly greater pooled relative estimates). To estimate prevalence, we used the median and interquartile range (IQR) of the studies reporting complications and symptoms. For testing the predictive values of early postoperative measurements of PTH and calcium, we used a bivariate model to perform diagnostic test meta‐analysis. In Part I, the 93 eligible studies enrolled a total of 18,973 patients and reported on 170 complications and symptoms. We identified nine most common complications or symptoms probably associated with chronic hypoparathyroidism. The complications or symptoms and the prevalence are as follows: nephrocalcinosis/nephrolithiasis (median prevalence among all studies 15%), renal insufficiency (12%), cataract (17%), seizures (11%), arrhythmia (7%), ischemic heart disease (7%), depression (9%), infection (11%), and all‐cause mortality (6%). In Part II, 18 studies with 4325 patients proved eligible. For PTH measurement, regarding the posttest probability, PTH values above 10 pg/mL 12–24 hours postsurgery virtually exclude chronic hypoparathyroidism irrespective of pretest probability (100%). When PTH values are below 10 pg/mL, posttest probabilities range from 3% to 64%. Nine complications and symptoms are probably associated with chronic hypoparathyroidism. A PTH value above a threshold of 10 pg/mL 12–24 hours after total thyroidectomy is a strong predictor that the patients will not develop chronic hypoparathyroidism. Patients with PTH values below the threshold need careful monitoring as some will develop chronic hypoparathyroidism. © 2022 American Society for Bone and Mineral Research (ASBMR).

Parathyroid Hormone Therapy for Managing Chronic Hypoparathyroidism: A Systematic Review and Meta-Analysis

“…The selection of patient‐important outcomes (defined as characteristics or variables that reflect how a patient feels, functions, or survives) referred to one systematic review that investigated the major complications related to chronic hypoparathyroidism, including nephrolithiasis, renal failure, seizures, arrhythmia, ischemic heart disease, depression, cataracts, infection, and all‐cause mortality. ( 18 ) In addition, the guideline panel added another four outcomes as patient‐important based on their experience managing patients (fracture, 50% or greater reduction in dose of active vitamin D and calcium, quality of life, and adverse events).…”

Hypoparathyroidism: update of guidelines from the 2022 International Task Force

“…Observational studies comparing patients with HypoPT to controls with normal parathyroid function have identified multiple complications associated with HypoPT (11)(12)(13)(14)(15)(16)(17). Percentages listed here represent the median among published studies.…”

The Second International Workshop on the Evaluation and Management of Hypoparathyroidism

“…(8) The systematic reviews and meta-analyses conducted are also being published as separate articles along with a paper dedicated to describing the methodology of the entire guideline process for both HypoPT as well as primary hyperparathyroidism (PHPT). (2)(3)(4) The PHPT summary statement and guidelines as well as the articles describing the advances in PHPT are being published in a consecutive issue of JBMR. (10) The summary statement and the guidelines for the evaluation and management of HypoPT provide an overview of the key advances in our knowledge and understanding of HypoPT, as well as the evaluation and management recommendations (both graded and ungraded) for HypoPT.…”

“…Four systematic reviews and meta-analyses were completed using the GRADE methodology, addressing the complications and management of chronic HypoPT. (2)(3)(4) In addition, narrative reviews were completed regarding the epidemiology, financial burden, and etiology of HypoPT. (5,6) The diagnosis and risk factors for the development of postsurgical HypoPT were reviewed.…”