Mid‐Term and Long‐Term Impact of Permanent Hypoparathyroidism After Total Thyroidectomy

Abstract

Background Permanent hypoparathyroidism (PH) is the most frequent long-term complication after total thyroidectomy. PH is related to many short-term and long-term complications, including clinical manifestations of hypocalcemia, hypercalcemia due to overtreatment, hyperphosphatemia, gastrointestinal, neuropsychiatric symptoms, decrease in renal function and infectious complications. The aim of this study was to identify the most frequent effects of PH and its associated risk factors. Methods We performed a retrospective analysis of a single institutional series of patients who developed PH after total thyroidectomy between 2000 and 2016. PH was defined as hypoparathormonemia (B12 pg/mL) or the need for calcium/vitamin D supplementation to achieve normal calcium levels for more than 12 months. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Results Thirty-nine patients fulfilled the criteria for PH. Mean ± SD age was 46.26 ± 13.4 years; 6 (15.4%) were males and 33 (84.6%) females. Mean follow-up was 6.13 ± 3.25 years. Mean calcium carbonate supplementation doses per day were 18.95 ± 17.5 g and 21.4 ± 19.3 g at 1 year and last follow-up, respectively. Hypocalcemic crisis was the most common complication (66.7%), followed by neuropsychiatric (38.5%) and gastrointestinal symptoms (33.3%). Ten patients showed a decrease in renal function (eGFR drop C25%) and 4 developed chronic kidney disease. The amount of calcium supplementation was the most relevant related risk factor. Conclusions PH is associated with multiple complications, including renal function impairment, gastrointestinal, neuropsychiatric and infectious complications. Lower calcium supplementation doses are related to lower complications rates.

The risk of chronic kidney disease development in adult patients with chronic hypoparathyroidism treated with rhPTH(1‐84): A retrospective cohort study

“…Retrospective claims database studies reported that patients with hypoparathyroidism were at increased risk of developing CKD, nephrolithiasis, nephrocalcinosis and decline in eGFR compared with individuals without hypoparathyroidism 6,8,9 . Another retrospective analysis that specifically included patients with postsurgical chronic hypoparathyroidism and who were treated with conventional therapy demonstrated that 26% of patients had a decline in eGFR of ≥25% and 10% developed CKD within 1 year after surgery 18 …”

“…6,8,9 Another retrospective analysis that specifically included patients with postsurgical chronic hypoparathyroidism and who were treated with conventional therapy demonstrated that 26% of patients had a decline in eGFR of ≥25% and 10% developed CKD within 1 year after surgery. 18 We hypothesized that, based on the stabilization of serum calcium levels, reduction in calcium excretion by the kidneys and stable eGFR observed in long-term trials of rhPTH(1-84), rhPTH(1-84) replacement therapy may offer a renoprotective effect. 15,16 Indeed, the results of the current study demonstrated that the treatment of patients with chronic hypoparathyroidism with a regimen that included rhPTH America and five European countries of patients with chronic hypoparathyroidism receiving conventional therapy reported that patients whose disease was not adequately controlled had a higher proportion of renal complications and CKD, and had higher hypoparathyroidism-related healthcare resource utilization, compared with patients whose disease was adequately controlled.…”

The long-term need for calcium supplementation after incidental parathyroidectomy

“…Conflicting reports exist regarding the correlation between IP and HYP. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Many authors suggest that a surgeon must try to find and preserve at least three PGs by any means. Among them, Ponce de Leon-Ballesteros et al.…”

Clinical assessment of T2 papillary thyroid carcinoma: a retrospective study conducted at a single tertiary institution

“…After thyroidectomy, 19%–38% and 0%–3% of patients presented with transient and permanent hypoparathyroidism, respectively 27 . Permanent hypoparathyroidism is associated with multiple complications, including renal function impairment, gastrointestinal and neuropsychiatric problems, and infections 28 . Second, TT is also associated with a greater risk of recurrent laryngeal nerve injury.…”