Hypercalcemia Induced by Excessive Intake of Calcium Supplement, Presenting Similar Findings of Primary Hyperparathyroidism

Kato, Yoshiyuki; Sato, Kanji; Sata, Akira; Omori, Kazue; Nakajima, Kiyotaka; Tokinaga, Kotaro; Obara, Takao; Takano, Kazue

doi:10.1507/endocrj.51.557

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…For all these patients, a PTH SC value above this threshold value allowed a prompt discharge at days 0 and 1 postoperatively, and avoidance of a unnecessary vitamin D and calcium supplementation. There is clinical benefit: no morbidity related to the calcium and vitamin treatment [9, 10], and improved patient quality of life. There is also economic benefit: no supplementary medication, reduced hospital stay, and absence of supplementary blood tests [11].…”

Section: Discussionmentioning

confidence: 99%

Parathyroid Hormone Assays following Total Thyroidectomy: Is There a Predictive Value?

Galy-Bernadoy¹,

Lallemant²,

Chambon³

et al. 2017

Eur Thyroid J

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Objectives: Parathyroid hormone (PTH) is a risk marker for hypoparathyroidism (hypoPTH). This study aimed to determine the predictive values of early PTH assays carried out at the moment of skin closure (PTH SC), to establish a treatment algorithm, identifying two threshold values. We assessed the reproducibility of this approach with two different immunoassay kits (hypoPTH) after total thyroidectomy, but its practical application is not consensual. Study Design: We conducted a prospective descriptive study, including all patients who underwent a total thyroidectomy between March 2012 and November 2013. Postoperative PTH SC levels, corrected calcium on postoperative days, and occurrence of hypoPTH symptoms were collected. Results: Of 257 patients, the rate of hypoPTH was 20%. Threshold values to obtain a 100% positive predictive value to identify patients for whom hypoPTH was absolutely certain were: PTH SC <7 ng/L for the Roche kit and PTH SC <4 ng/L for the Beckman-Coulter kit. Threshold values to obtain a 100% negative predictive value to identify patients for whom the absence of hypoPTH was absolutely certain were: PTH SC ≥19 ng/L for the Roche kit and PTH SC ≥9 ng/L the Beckman-Coulter kit. Conclusions: A single serum PTH sampled at skin closure is a reliable test to predict hypoPTH after a total thyroidectomy. The use of a threshold based on a 100% negative predictive value enables patients with no risk of hypoPTH to be safely discharged within the first 24 h postoperatively without unnecessary calcium and vitamin treatment. This medication can be given promptly to patients at risk of hypoPTH to limit the occurrence of hypocalcaemia.

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Section: Discussionmentioning

confidence: 99%

Parathyroid Hormone Assays following Total Thyroidectomy: Is There a Predictive Value?

Galy-Bernadoy¹,

Lallemant²,

Chambon³

et al. 2017

Eur Thyroid J

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“…The third possibility is drugs or supplements, such as calcium or vitamin D [14,[18][19][20], which inhibit PTH secretion, but our patient was not taking any drugs or supplements during either hypercalcemic crisis.…”

Section: Discussionmentioning

confidence: 96%

An Instructive Case Suggesting Cyclical Primary Hyperparathyroidism

et al. 2006

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Abstract. We report an instructive case of primary hyperparathyroidism in which cyclical secretion of PTH may have caused repeated hypercalcemic crises followed by temporary remission with a spontaneous drop in PTH. A 64-year-old man was admitted to our hospital twice with severe hypercalcemic crisis (corrected calcium (cCa) 15.0 mg/dl and 16.7 mg/dl) accompanied by an increase in intact PTH (220 pg/ml and 470 pg/ml). During both events, the serum PTH values spontaneously dropped followed by remission of the hypercalcemia. The tumor, detected at the left-upper side, showed neither vascularity on ultrasound examination nor washout delay on MIBI scintigraphy, suggesting that two parathyroid adenoma infarctions had occurred. Cervical exploration was undertaken. The histopathological examinations confirmed that the tumor was parathyroid adenoma. Contrary to our expectation, however, it did not reveal necrotic tissue that would indicate recent infarction. The findings in this case may be explained by cyclical secretion of PTH from a parathyroid adenoma. Although cyclical Cushing's syndrome is well known, to our knowledge this is the first documented case suggesting cyclical primary hyperparathyroidism.

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“…In addition, any patient with calcium supplements (especially if combined with VD administration) is at risk of developing symptomatic hypercalcemia and requires weekly monitoring until supplements are ceased [29,39]. For all these reasons, we as well as others [7,[31][32][33]40], believe that selective supplementation should be preferred over routine treatment.…”

Section: Discussionmentioning

confidence: 99%

Combining Early Postoperative Parathyroid Hormone and Serum Calcium Levels Allows for an Efficacious Selective Post‐thyroidectomy Supplementation Treatment

et al. 2012

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Background Optimal treatment protocol to prevent symptomatic hypocalcemia following total thyroidectomy is still matter of debate. We prospectively evaluated the efficacy of a selective supplementation protocol based on both early postoperative intact parathyroid hormone (iPTH) and serum calcium levels. Methods Two hundred thirty consecutive patients were divided in three different groups of treatment according to iPTH levels 4 h after total thyroidectomy (4 h‐iPTH) and serum calcium levels in the first postoperative day (1PO‐Ca): group A (4 h‐iPTH > 10 pg/ml, 1PO‐Ca ≥ 8.5 mg/dl), no treatment; group B (4 h‐iPTH > 10 pg/ml, 1PO‐Ca < 8.5 mg/dl), oral calcium (OC) 3 g per day; and group C (4 h‐iPTH ≤ 10 pg/ml), OC 3 g + calcitriol (VD) 1 μg per day. Development of biochemical and/or symptomatic hypocalcemia was evaluated. Results Fifty‐nine patients (25.6%) had subnormal 4 h‐iPTH levels (≤10 pg/ml) (group C). Among patients with normal 4 h‐iPTH levels, 25 (10.9%) had subnormal 1PO‐Ca (<8.5 mg/dl) (group B). The remaining 146 patients (63.5%) had normal 4 h‐iPTH and 1PO‐Ca levels (group A). One patient in group A, 2 in group B, and 18 in group C developed biochemical hypocalcemia. Only one patient in group C experienced major symptoms. Treatment was discontinued within 1 month in all the patients in group B. At a mean follow‐up of 303 days, five patients in group C were still under supplementation treatment. Conclusion The proposed supplementation protocol seems efficacious in preventing symptomatic hypocalcemia. It could allow a safe and early discharge of most patients, thus avoiding the constraints and the costs of routine supplementation.

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Hypercalcemia Induced by Excessive Intake of Calcium Supplement, Presenting Similar Findings of Primary Hyperparathyroidism

Cited by 13 publications

References 21 publications

Parathyroid Hormone Assays following Total Thyroidectomy: Is There a Predictive Value?

Parathyroid Hormone Assays following Total Thyroidectomy: Is There a Predictive Value?

An Instructive Case Suggesting Cyclical Primary Hyperparathyroidism

Combining Early Postoperative Parathyroid Hormone and Serum Calcium Levels Allows for an Efficacious Selective Post‐thyroidectomy Supplementation Treatment

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