Hypocalcaemia following thyroidectomy for thyrotoxicosis

See, A. C. H.; Soo, Khee‐Chee

doi:10.1002/bjs.1800840136

Cited by 60 publications

(22 citation statements)

References 9 publications

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“…It allowed removal of 13 nodes, all testing negative, thus confirming that VAT also can be an oncologically correct operation [10]. The fairly high rate of transient hypocalcemia (15%) should not discourage adoption of VAT because it is well known that in these patients, hypocalcemia is much more attributable to the ''hungry bone effect'' [12] than to anatomic damage of the parathyroid glands. The absence of permanent hypocalcemia and the short duration of this condition seem to confirm this interpretation of the biochemical data.…”

Section: Discussionmentioning

confidence: 84%

Video-assisted thyroidectomy for Graves? disease: report of a preliminary experience

et al. 2004

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Section: Discussionmentioning

confidence: 84%

Video-assisted thyroidectomy for Graves? disease: report of a preliminary experience

et al. 2004

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“…There are as yet no prospective studies or randomised control trials addressing the use of bisphosphonates in the prevention or limitation of duration of HBS. Data from case reports and small case series on the beneficial effect of preoperative treatment with bisphosphonates on the HBS in patients with hyperparathyroid bone disease (7,35,37,51) or with longstanding severe PHPT (49) are conflicting (23,27,35,36,37). Some cases thus report failure of preoperative bisphosphonates to prevent HBS, although this was believed to be due to short duration of treatment or low dosage used, as serum alkaline phosphatase levels had not normalised before surgery (23,38,42,43,44).…”

Section: Discussionmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature

Witteveen

Thiel

Romijn

et al. 2013

European Journal of Endocrinology

280

220

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Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcaemia associated with hypophosphataemia and hypomagnesaemia, and is exacerbated by suppressed parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. It is a relatively uncommon, but serious adverse effect of parathyroidectomy. We conducted a literature search of all available studies reporting a 'hungry bone syndrome' in patients who had a parathyroidectomy for PHPT, to identify patients at risk and address the pitfalls in their management. The severe hypocalcaemia is believed to be due to increased influx of calcium into bone, due to the sudden removal of the effect of high circulating levels of PTH on osteoclastic resorption, leading to a decrease in the activation frequency of new remodelling sites and to a decrease in remodelling space, although there is no good documentation for this. Various risk factors have been suggested for the development of HBS, including older age, weight/volume of the resected parathyroid glands, radiological evidence of bone disease and vitamin D deficiency. The syndrome is reported in 25-90% of patients with radiological evidence of hyperparathyroid bone disease vs only 0-6% of patients without skeletal involvement. There is insufficient data-based evidence on the best means to treat, minimise or prevent this severe complication of parathyroidectomy. Treatment is aimed at replenishing the severe calcium deficit by using high doses of calcium supplemented by high doses of active metabolites of vitamin D. Adequate correction of magnesium deficiency and normalisation of bone turnover are required for resolution of the hypocalcaemia which may last for a number of months after successful surgery. Preoperative treatment with bisphosphonates has been suggested to reduce post-operative hypocalcaemia, but there are to date no prospective studies addressing this issue. European Journal of Endocrinology 168 R45-R53

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“…The reported incidence of transient hypocalcemia after thyroid surgery varies between 0.6% and 83.0% and that of permanent hypocalcemia between 0% and 2.9% [1][2][3][4][5][6][7][8][9]. The wide range is almost certainly due to different definitions of hypocalcemia, but it may also reflect the fastidiousness with which it is sought.…”

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confidence: 96%

“…For example, by using phytate or ethylene diamine tetraacetic acid (EDTA) to induce a fall in calcium concentration, parathyroid insufficiency was found in 24% to 28% of the patients who had undergone thyroidectomy several years earlier [10,11]. However, several other studies have shown normal or even increased PTH concentrations during transient hypocalcemia after bilateral thyroid surgery [1,4,12,13]. Furthermore, transient hypocalcemia is seen following unilateral thyroid surgery [6, 8, 14 -17], a procedure during which the contralateral parathyroid glands are at no risk of inadvertent removal.…”

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Hemithyroidectomy: Long‐term effects on parathyroid function—preliminary report

2001

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Early hypocalcemia after thyroid surgery has frequently been reported, whereas data regarding long-term effects on calcium homeostasis are scarce. We have previously studied patients after hemithyroidectomy with an oral calcium load test and found normal parathyroid hormone (PTH) suppression. However, the 1,25-dihydroxyvitamin D concentration was decreased and the phosphate concentration increased, implying parathyroid insufficiency. We therefore proceeded to investigate PTH secretion and suppression in 10 euthyroid patients subjected to hemithyroidectomy due to benign thyroid disease before and at 1 year after surgery. In addition, biochemical variables known to influence calcium homeostasis were analyzed. Basal, maximal, and total PTH secretion were unaltered 1 year postoperatively. However, maximal PTH secretion was reached at a lower serum level of ionized calcium, and there was a tendency toward increased parathyroid sensitivity to ionized calcium. Furthermore, compared to preoperative, total serum calcium, 1,25-dihydroxyvitamin D, and free thyroxine (T4) concentrations were decreased at follow-up. Total serum calcium and 1,25-dihydoxyvitamin D concentrations were decreased 1 year after hemithyroidectomy. These changes were not due to parathyroid insufficiency. Instead, our results imply increased parathyroid sensitivity to calcium and possibly reduced peripheral sensitivity to PTH.

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Hypocalcaemia following thyroidectomy for thyrotoxicosis

Abstract: Hypoparathyroidism does not appear to be the main reason for hypocalcaemia after thyroidectomy, and other causes such as "hungry bone syndrome' may be important contributory factors.

Cited by 60 publications

References 9 publications

Video-assisted thyroidectomy for Graves? disease: report of a preliminary experience

Video-assisted thyroidectomy for Graves? disease: report of a preliminary experience

THERAPY OF ENDOCRINE DISEASE: Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature

Hemithyroidectomy: Long‐term effects on parathyroid function—preliminary report

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