Concurrent Hypoparathyroidism Is Associated With Impaired Physical Function and Quality of Life in Hypothyroidism

Abstract

Total thyroidectomy causes postsurgical hypothyroidism (HypoT). Besides HypoT, as a complication patients may also develop hypoparathyroidism (HypoPT). The aim of this study was to assess quality of life (QoL), muscle function, and postural stability in patients with postsurgical hypothyroidism and hypoparathyroidism (HypoTþPT) as compared to patients with postsurgical HypoT and healthy controls. Age-and gender-matched patients on treatment for HypoTþPT and HypoT were recruited from our outpatient clinic. Matched healthy controls were recruited from the general background population. Compared with controls, HypoT was associated with a significantly lower mental summary score, whereas patients with HypoTþPT had a significantly lower physical summary score (Short Form 36 Health Survey questionnaire version 2). Moreover, the physical component score was significantly lower in patients with HypoTþPT compared with HypoT. WHO-5 well-being index was significantly lower in both groups of patients compared with controls, but did not differ between groups of patients. Compared with controls, muscle strength and maximal force production was significantly reduced in HypoTþPT, but not in HypoT. In HypoTþPT, the time spent on the Timed Up & Go test and the Repeated Chair Stands test were significantly longer than in the HypoT group and the control group. Postsurgical HypoTþPT is associated with a more severe impairment of QoL, in particular regarding physical functioning, than HypoT. HypoTþPT patients are also hampered by impaired muscle function. Studies on how to improve well-being and muscle function in HypoTþPT patients are warranted.

Quality of life in hypoparathyroidism

“…An impairment of physical function as determined by QoL measures is in good agreement with many patients complaining of muscular symptoms, as well as studies have shown a reduced muscle strength/function compared with healthy controls [2]. As correctly noted by Büttner et al [1], conventional therapy with active vitamin D and calcium supplements does restore the physiological calcium/phosphorus homeostasis.…”

“…It may therefore be questioned whether the impaired QoL is due to the co-existence of hypothyroidism. Although only limited data are available, patients with both hypoparathyroidism and hypothyroidism seem to have a larger impairment in QoL-scores than patients only suffering from hypothyroidism, suggesting that hypoparathyroidism independently of hypothyroidism contributes to an impaired QoL [2].…”

Design and Preclinical Development of TransCon PTH, an Investigational Sustained-Release PTH Replacement Therapy for Hypoparathyroidism

“…Without effective treatment, HP patients suffer from numerous comorbidities, including hypocalcemia, hypercalcemia, hypercalciuria, renal stones, nephrocalcinosis, renal insufficiency, reduced muscle strength, impaired quality of life, psychiatric disorders, depression, basal ganglia calcifications that can lead to Parkinson's disease, and lenticular and arterial calcifications . Conventional therapy for HP involves large doses of vitamin D and oral calcium supplementation but does not address the underlying PTH deficiency.…”

“…Without effective treatment, HP patients suffer from numerous comorbidities, including hypocalcemia, hypercalcemia, hypercalciuria, renal stones, nephrocalcinosis, renal insufficiency, reduced muscle strength, impaired quality of life, psychiatric disorders, depression, basal ganglia calcifications that can lead to Parkinson's disease, and lenticular and arterial calcifications. (1,2,14) Conventional therapy for HP involves large doses of vitamin D and oral calcium supplementation but does not address the underlying PTH deficiency. Although often effective in raising sCa levels, SOC also raises sP and is associated with marked fluctuations in sCa that may result in both hypercalcemia and hypocalcemia, excess uCa excretion, kidney stones, and nephrocalcinosis with potential loss of renal function.…”

Novel method to save the parathyroid gland during thyroidectomy: Subcapsular saline injection

“…Despite this, effective surgical methods have not been identified. To maintain patient quality of life transient and permanent hypoparathyroidism rates after complete thyroidectomy should be reduced to approximately 20% and 0%‐1%.…”