MANAGEMENT OF ENDOCRINE DISEASE: Postsurgical hypoparathyroidism: current treatments and future prospects for parathyroid allotransplantation

Abstract

Background. Permanent post-surgical hypoparathyroidism (POSH) is a major complication of anterior neck surgery in general and of thyroid surgery in particular. Depending of diagnostic criteria, up to 10% of patients undergoing bilateral thyroid surgery develop POSH. This leads to a multitude of symptoms that decrease the quality of life and burden the healthcare provision through complex needs for medication and treatment of specific complications, such as seizures and laryngospasm. Methods. Narrative review of current medical treatments for POSH and of the experience accumulated with parathyroid allotransplantation. Results. In most patients, POSH is controlled with regular use of calcium supplements and active vitamin D analogues but a significant proportion of patients continue to experience severe symptoms requiring repeated emergency admissions. Replacement therapy with synthetic PTH compounds (PTH1-34, Natpara® and PTH1-84, teriparatide, Forsteo®) has been assessed in multicentre trials, but the use of this medication is restricted by costs and concerns related to the risk of development of osteosarcoma. Based on recent case reports of successful allotransplantation of parathyroid tissue between siblings, there is renewed interest in this technique. Data on selection of donors, parathyroid cell preparation before allotransplantation, site and timing of transplantation, need for immunosuppression and long-term outcomes are reviewed. Conclusion. A prospective trial to assess the efficacy of parathyroid allotransplantation in patients with severely symptomatic protracted post-surgical hypoparathyroidism is warranted.

Living-donor parathyroid cells allotransplantation in a kidney transplant recipient – Two-year results

“…[ 2 ] Parathyroid cell allotransplantation has been described sporadically over the last 40 years as a potential therapy for permanent hypoparathyroidism, but the existing evidence from the primary studies is very limited, suggesting an urgent need to investigate the observed benefit further. [ 3 4 5 ] Our case adds to the literature regarding the benefits of parathyroid cell allotransplantation in hypoparathyroidism.…”

Parathyroid Allotransplantation: A Systematic Review

“…Although there is still much to be gained, Stevenson et al [ 2 ] found the perspective of hypocalcemic patients in carrying out a clinical trial exploring the effectiveness of PTx to be positive. Subsequently, the same research group proposed a randomized trial investigating the need and extent of immunosuppression in PTx with extensive data collection [ 53 ].…”

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

“…Therefore, it is directly related to the sensitivity and experience of the surgeon, even though he strictly adheres to the principles of good surgical practice, which, in addition to anatomical integrity and the number of glands identified, also recommend respect for vascular support [ 1 , 37 , 38 ]. Recent studies have in fact shown that accidental removal and tissue or vascular damage do not find a remedy in glands autotransplantation [ 9 ], and allografting is still not beyond the experimental stage or good hopes for the future [ 39 ]. There is evidence that systematic and meticulous research can lead to invisible parathyroids damage and that selective identification is preferable to routine identification.…”