Late Recovery of Parathyroid Function after Total Thyroidectomy in Children and Adults: Is There a Difference?

2021 ◽  
pp. 1-9
Author(s):  
Mechteld C. de Jong ◽  
Leyre Lorente-Poch ◽  
Joan Sancho-Insenser ◽  
Virginia Rozalén García ◽  
Caroline Brain ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Young Patients ◽  
Vitamin D Supplementation ◽  
Parathyroid Function ◽  
Centre Database ◽  
Extent Of Surgery ◽  
Late Recovery

Background: Parathyroid failure after total thyroidectomy is the commonest adverse event amongst both children and adults. The phenomenon of late recovery of parathyroid function, especially in young patients with persistent hypoparathyroidism, is not well understood. This study investigated differences in rates of parathyroid recovery in children and adults and factors influencing this. Methods: A joint dual-centre database of patients who underwent a total thyroidectomy between 1998 and 2018 was searched for patients with persistent hypoparathyroidism, defined as dependence on oral calcium and vitamin D supplementation at 6 months. Demographic, surgical, pathological, and biochemical data were collected and analysed. <F00_Regular>Parathyroid Glands Remaining</F00_Regular> in Situ (PGRIS) score was calculated. Results: Out of 960 patients who had total thyroidectomy, 94 (9.8%) had persistent hypoparathyroidism at 6 months, 23 (24.5%) children with a median [range] age 10 [0–17], and 71 (75.5%) adults aged 55 [25–82] years, respectively. Both groups were comparable regarding sex, indication, extent of surgery, and PGRIS score. After a median follow-up of 20 months, the parathyroid recovery rate was identical for children and adults (11 [47.8%] vs. 34 [47.9%]; p = 0.92). Sex, extent, and indication for surgery had no effect on recovery (all p > 0.05). PGRIS score = 4 (HR = 0.48) and serum calcium >2.25 mmol/L (HR = 0.24) at 1 month were associated with a decreased risk of persistent hypoparathyroidism on multivariate analysis (p < 0.05). Conclusion: Almost half of patients recovered from persistent hypoparathyroidism after 6 months; therefore, the term persistent instead of permanent hypoparathyroidism should be used. Recovery rates of parathyroid function in children and adults were similar. Regardless of age, predictive factors for recovery were PGRIS score = 4 and a serum calcium >2.25 mmol/L at 1 month.

scholarly journals Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy

2018 ◽  
Vol 178 (1) ◽  
pp. 103-111 ◽  
Author(s):  
Inés Villarroya-Marquina ◽  
Juan Sancho ◽  
Leyre Lorente-Poch ◽  
Lander Gallego-Otaegui ◽  
Antonio Sitges-Serra
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Common Adverse Effect ◽  
Parathyroid Glands ◽  
Permanent Hypoparathyroidism ◽  
Serum Calcium Concentration ◽  
Parathyroid Function

Objective Hypocalcaemia is the most common adverse effect after total thyroidectomy. It recovers in about two-thirds of the patients within the first postoperative month. Little is known, however, about recovery of the parathyroid function (RPF) after this time period. The aim of the present study was to investigate the time to RPF in patients with protracted (>1 month) hypoparathyroidism after total thyroidectomy. Design Cohort prospective observational study. Methods Adult patients undergoing total thyroidectomy for goitre or thyroid cancer. Cases with protracted hypoparathyroidism were studied for RPF during the following months. Time to RPF and variables associated with RPF or permanent hypoparathyroidism were recorded. Results Out of 854 patients undergoing total thyroidectomy, 142 developed protracted hypoparathyroidism. Of these, 36 (4.2% of the entire cohort) developed permanent hypoparathyroidism and 106 recovered: 73 before 6 months, 21 within 6–12 months and 12 after 1 year follow-up. Variables significantly associated with RPF were the number of parathyroid glands remaining in situ (not autografted nor inadvertently resected) and a serum calcium concentration >2.25 mmol/L at one postoperative month. Late RPF (>6 months) was associated with surgery for thyroid cancer. RPF was still possible after one year in patients with four parathyroid glands preserved in situ and serum calcium concentration at one month >2.25 mmol/L. Conclusions Permanent hypoparathyroidism should not be diagnosed in patients requiring replacement therapy for more than six months, especially if the four parathyroid glands were preserved.

scholarly journals Late Recovery of Parathyroid Function after Total Thyroidectomy: A Case-Control Study

2021 ◽  
Author(s):  
Juan José Díez ◽  
Emma Anda ◽  
Julia Sastre ◽  
Begoña Pérez Corral ◽  
Cristina Álvarez-Escolá ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Replacement Therapy ◽  
Clinical Characteristics ◽  
Case Control Study ◽  
Case Control ◽  
Parathyroid Function ◽  
Postoperative Hypoparathyroidism ◽  
Late Recovery ◽  
Control Study

AbstractThe clinical characteristics of patients with postoperative hypoparathyroidism who recover parathyroid function more than 12 months after surgery have not been studied. We aimed to evaluate whether the intensity of replacement therapy with calcium and calcitriol is related to the late recovery of parathyroid function. We compared the demographic, surgical, pathological, and analytical features of two groups of patients: cases, i. e., late recovery patients (those who recover parathyroid function>1 year after thyroidectomy, n=40), and controls, i. e., patients with permanent hypoparathyroidism (n=260). Replacement therapy with calcium and calcitriol was evaluated at discharge of surgery, 3–6 months, 12 months, and last visit. No significant differences were found in clinical, surgical, pathological, or analytical characteristics between cases and controls. The proportion of cases who required treatment with calcium plus calcitriol at 12 months was significantly lower than that found in controls (p<0.001). Furthermore, daily calcium and calcitriol doses in controls were significantly higher than those in cases at 3–6 months (p=0.014 and p=0.004, respectively) and at 12 months (p<0.001 and p=0.043, respectively). In several models of logistic regression analysis therapy with calcium and calcitriol at 12 months was negatively related to late recovery of parathyroid function. Although delayed recuperation of parathyroid function after total thyroidectomy is uncommon (13%), follow-up beyond 12 months is necessary in patients with postoperative hypoparathyroidism, especially in those whose needs of treatment with Ca and calcitriol are reducing over time.

Parathyroid Autotransplantation in Patients Undergoing a Total Thyroidectomy: A Review of 261 Patients

1994 ◽  
Vol 111 (3P1) ◽  
pp. 258-264 ◽  
Author(s):  
Regina P. Walker ◽  
Edward Paloyan ◽  
Timothy F. Kelley ◽  
Chellam Gopalsami ◽  
Harriet Jarosz
Keyword(s):  
Vitamin D ◽  
Total Thyroidectomy ◽  
Blood Supply ◽  
Frozen Section ◽  
Parathyroid Tissue ◽  
Vitamin D Supplementation ◽  
Parathyroid Glands ◽  
Parathyroid Autotransplantation ◽  
Parathyroid Function

Parathyroid autotransplantation was first described in 1907 by Halsted. However, this simple and effective method of preserving parathyroid function has been used with increasing frequency only during the past 25 years. Beginning in the late 1960s, our group has transplanted normal parathyroid tissue into the ipsilateral sternocleidomastoid muscle whenever these glands could not be preserved in situ with adequate blood supply. In addition, if the blood supply of all four parathyroid glands appeared compromised, cryopreservation of parathyroid tissue was performed in case the autotransplanted tissue did not function after surgery. Since 1970, 393 patients underwent a total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and then autotransplanted. Of the 393 patients who underwent a total thyroidectomy, 261 patients required transplantation of one or more glands. Among those 261 patients who underwent selective parathyroid autotransplantation, 33 (13%) required temporary calcium and vitamin D supplementation. Of these 33 patients, 2 (less than 1%) had permanent hypoparathyroidism and are receiving long-term vitamin D therapy.

ID: 86: SAFETY OF 50,000-100,000 UNITS OF VITAMIN D3 PER WEEK IN VITAMIN D DEFICIENT, HYPERCHOLESTEROLEMIC PATIENTS, WITH STATIN INTOLERANCE

2016 ◽  
Vol 64 (4) ◽  
pp. 929.2-930
Author(s):  
V Jetty ◽  
G Duhon ◽  
P Shah ◽  
M Prince ◽  
K Lee ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Vitamin D3 ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
High Serum ◽  
Statin Intolerance ◽  
Serum Vitamin D ◽  
Median Serum

BackgroundIn ∼85–90% of statin intolerant patients, vitamin D deficiency (serum 25 (OH) D <32 ng/ml) is a reversible cause of statin intolerance, usually requiring 50,000 to 100,000 units of vitamin D/week continuously to normalize serum vitamin D, and thus successfully allow reinstitution of statins which previously could not be tolerated because of myalgia-myositis.Specific AimIn 274 statin intolerant patients, all with low entry serum vitamin D (<32 ng/ml, median 21 ng/ml), we assessed safety and efficacy of vitamin D supplementation (50,000–100,000 units/week) over treatment periods of 3 months (n=274), 3 and 6 months (n=161), 3, 6, and 9 months (n=58), and 3, 6, 9, and 12 months (n=22).ResultsIn the 385 patients with 3 month follow-up, taking mean 61,000 and median 50,000 IU of vitamin D3/week, median serum vitamin D rose from 20 to 42 ng/ml (p<0.0001); vitamin D became high (>100 ng/ml) but not toxic-high (>150 ng/ml) in 4 patients (1.0%) (101, 102, 106, 138 ng/ml). Median serum calcium was unchanged from entry (9.6 mg/dl) to 9.6 at 3 months. On vitamin D supplementation, the trend of change in serum calcium from normal-to-high or from high-to-normal did not significantly differ (McNemar S=1.0, p=0.32), and there was no significant trend in change of the calculated glomerular filtration rate (eGFR) from entry to follow-up (McNemar S=2.6, p=0.11).In the 161 patients with 3 and 6 month follow-up, taking mean 67,000 and median 50,000 IU of vitamin D3/week, median entry serum vitamin D rose from 21 to 42 to 44 ng/ml (p<0.0001), serum vitamin D was high (>100 but <150 ng/ml) in 2 patients at 3 months (1.2%, 101, 102 mg/ml) and in 3 (1.9%) at 6 months (101, 140, 140 ng/ml). Median serum calcium was unchanged from entry (9.7 mg/dl), at 3 and 6 months (9.7, 9.6 mg/dl, p>0.05). On vitamin D supplementation, the change in serum calcium from normal-to-high or high-to-normal was no significant trend (McNemar S=0.7, p=0.41), and no trend in change of eGFR (McNemar S=1.3, p=0.26).In the 58 patients with 3, 6, and 9 month follow-up on mean and median 71,000 and 100,000 IU of D3/week, median entry vitamin D rose from 20 to 37, 41, and 44 ng/ml (p<0.0001), with 1 (1.7%, 102 ng/ml), 2 (3.5%, 140, 140 ng/ml), and 0 (0%) patients high. Median serum calcium was unchanged from entry, median 9.7, 9.8, 9.6, and 9.6 mg/dl. On vitamin D supplementation, the trend of change in serum calcium from normal-to-high or high-to-normal was not significant (McNemar S=1.8, p=0.18), and no trend in change of eGFR (McNemar S=2, p=0.16).In the 22 patients with follow-up at 3, 6, 9, and 12 months on mean and median 70,000 and 75,000 IU of D3/week, median serum vitamin D rose from 20 to 37, to 41, to 44, and to 43 ng/ml (p<0.0001), with 1 (5%, 102 ng/ml) high, 2 (9%, 140, 140) high, 0 (0%) high, and 1 (5%, 126 ng/ml) high. Serum calcium was unchanged, median at entry 9.6, and then at 3, 6, 9, and 12 months 9.7, 9.7, 9.5, and 9.7 mg/ml. At entry serum calcium was normal in 21, none high, and one became high at 12 month follow-up. The trend of change in eGFR was insignificant, McNemar S=1.0, p=0.32.When serum D rose above 100 ng/ml in the few cases, as above, it fell into the normal range within 2 weeks by reducing the vitamin D dose by 50%.ConclusionsWhen 50,000–100,000 units of vitamin D/week are given to reverse statin intolerance in statin intolerant patients with low entry vitamin D (<32 ng/ml), it appears to be safe over up to 1 year follow-up, without toxic high serum vitamin D levels >150 ng/ml, and levels rarely >100 ng/ml, and without changes in serum calcium or eGFR.

scholarly journals Case series on the on the onset of transient hypo-parathyroidism after thyroidectomy

2017 ◽  
Vol 4 (12) ◽  
pp. 3849
Author(s):  
Kannan Rajendran ◽  
S. Saravana Kumar ◽  
Robinson Smile
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Statistical Significance ◽  
Case Series ◽  
Medical College ◽  
Number Of Patients ◽  
Common Operation ◽  
Gandhi Medical College

Background: Surgery for thyroid disorders is the common operation in general surgery and total thyroidectomy is widely performed both for carcinoma as well as benign bilateral diseases of the thyroid and the most common complication is transient hypocalcaemia. A preliminary study was conducted to assess the risk factors for transient hypocalcaemia in our hospital.Methods: This was a prospective observational study conducted from February 2013 to April 2014 at the Mahatma Gandhi Medical College and Research Institute, Pondicherry and have included all patients undergone any type of thyroid surgery with a normal pre-operative serum calcium level. After initial clinical assessment, blood samples were drawn for estimation of thyroid function and serum calcium and albumin. Postoperative hypocalcemia was assessed by eliciting Chovstek’s and Troussea’s sign and biochemically estimating serum calcium and albumin at 6,24, and 24 hours intervals and 1st and 3rd months during follow-up. The risk factors involved are also studied like sex, age, type of thyroidectomy, identification of parathyroid, Identification of recurrent laryngeal nerve and their histology.Results: A total of 50 patients who underwent thyroidectomy were included in the study. The hypocalcemia occurred in 28% of patients studied showed that 66.7% of patients developed hypocalcemia at 48-72 hours. There was no statistical significance for the parameters of age or gender, benign and malignant conditions of thyroid. The analysis of type surgery performed showed a significant number of patients developing transient hypocalcaemia after near or total thyroidectomy (p-0.002).Conclusions: The present study, though consisted of a small group of patients has shown that transient hypocalcaemia after near or total thyroidectomy occurs in early post-operative days. Hence, on an average 2-5 days of hospital stay is mandatory. Near total or total thyroidectomy is a risk factor. Early diagnosis and replacement with calcium intra-venous reduce the morbidity and mortality of hypocalcaemia. 

scholarly journals A study of monitoring of early postoperative serum calcium levels in total thyroidectomy and its role in predicting temporary or permanent hypocalcemia: a prospective observational study

2020 ◽  
Vol 7 (3) ◽  
pp. 697
Author(s):  
Suryanarayana Reddy V. ◽  
Ashrith Reddy Cheruku ◽  
Rammohan Cheeti ◽  
Vivek Acha ◽  
Prashanth Gunde
Keyword(s):  
Observational Study ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Prospective Observational Study ◽  
Post Operative Period ◽  
Permanent Hypocalcemia ◽  
Postoperative Serum ◽  
The Mean ◽  
Postoperative Hypocalcaemia

Background: This aim of study was to evaluate the ability of consecutive measurements of serum calcium levels to predict clinically relevant post-thyroidectomy hypocalcaemia and to assess risk factors for post-thyroidectomy hypocalcaemia.Methods: The study design was a prospective observational study, total 65 patients who undergoing completion or total thyroidectomy. Serum calcium level was measured at the time of first follow up (nearly 20th postoperative day) and patient was examined for signs of hypocalcemia.Results: In this study, 65 patients of all age group included from 19 years to 78 years. The mean (±SD) age of the patients was 47.65±12.35 years with range from 19 to 78 years. The mean difference of calcium values after 6 hours, 12 hours, 24 hours and 48 hours post-operative period were statistically significant (p<0.001) between patients with hypocalcaemia and patient with normokalaemia in unpaired t-test.Conclusions: There was no significant increase in morbidity (including postoperative hypocalcaemia) in completion thyroidectomy compared to primary total thyroidectomy.

Evaluation of Hypoparathyroidism following Total Thyroidectomy

2020 ◽  
Vol 26 (2) ◽  
pp. 116-120
Author(s):  
Md Nazmul Haque ◽  
Saif Rahman Khan ◽  
Moshammat Fatima Akhter ◽  
Mohammad Ashequr Rahman Bhuiyan ◽  
Mohammad Zakaria Sarker ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Serum Calcium ◽  
Calcium Supplementation ◽  
Follicular Carcinoma ◽  
Sampling Technique ◽  
Multinodular Goitre ◽  
Period 2 ◽  
Parathyroid Function ◽  
Malignant Lesions

The most common cause of hypoparathyroidism is damage to the glands during thyroid surgery. Parathyroid gland preservation during thyroidectomy is not only desirable, but essential for the effective management of surgical diseases of the thyroid gland Objective: To find out the incidence rate of hypoparathyroidism after total thyroidectomy. Methods: Study Period: 2 years from Jan 2017 to December 2018 Place of Study : National Institute of ENT, Tejgaon, Dhaka Study Design: Prospective Observational Study Sample size: 107 Sampling Technique: Convenient Sampling technique Results: Among the 107 cases 39 cases were malignant comprising 36.45% of the cases. toxic multinodular goitre were 6 cases among 107 cases (5.6%) and rest 62 cases were benign multinodular goitre with or without cystic change and follicular adenomas (57.94 %). 29 cases out of 39 malignant cases were papillary carcinoma of thyroid (74.36% of malignant lesions), 2 cases of medullary Ca thyroid (5.12 % of malignant lesions) rest 8 were follicular carcinoma (20.51% of malignant lesions). 26 out of 107 (24.30%) cases suffered from postoperative hypocalcaemic tetany within 1st-5th POD. Their parathyroid hormones were significantly reduced and serum calcium were also reduced and they required calcium supplementation. In 5 (4.67%) cases there was no sign and symptoms of tetany but their serum parathormone levels were little below normal level but serum calcium levels were normal and therefore no calcium supplementation were given. The rest 76 (71.03%) cases did not show any sign or symptoms of tetany and did not require calcium supplementation. Among the patients who suffered from tetany majority were cases of Carcinoma of thyroid (18 out of 26 patients of hypoparathyroidism) 69.23%, however lateral neck dissection did not seem to affect decline in parathyroid function as 10 out of 18 patients with thyroid malignancy who suffered from postoperative tetany undergone level II to level V neck dissection in addition to total thyroidectomy. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 116-120

scholarly journals Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

2012 ◽  
Vol 56 (3) ◽  
pp. 168-172 ◽  
Author(s):  
Felipe Augusto Brasileiro Vanderlei ◽  
Jose Gilberto Henriques Vieira ◽  
Flavio Carneiro Hojaij ◽  
Onivaldo Cervantes ◽  
Ilda Sizue Kunii ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Vitamin D Supplementation ◽  
Cutoff Value ◽  
Increased Risk ◽  
Symptomatic Hypocalcemia ◽  
Early Predictor ◽  
Selection Of

OBJECTIVE: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. SUBJECTS AND METHODS: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. RESULTS: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. CONCLUSION: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy.

Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases

2006 ◽  
Vol 121 (3) ◽  
pp. 237-241 ◽  
Author(s):  
C Page ◽  
V Strunski
Keyword(s):  
Total Thyroidectomy ◽  
Parathyroid Gland ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Normal Serum ◽  
Permanent Hypoparathyroidism ◽  
Multinodular Goitre ◽  
Serum Calcium Concentration ◽  
Normal Serum Calcium

Aims: To evaluate the risk of hypocalcaemia (transient or permanent) after total thyroidectomy for bilateral, benign, multinodular goitre, the frequency and impact of unintentional parathyroidectomy, and the value of parathyroid gland autotransplantation during thyroid surgery.Materials and methods: This was a retrospective study of 351 surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre over a seven-year period. The primary endpoint was serum calcium concentration immediately post-operatively and during follow up. Normal serum calcium concentration was defined as 2 mmol/l. Parathyroid data were collected during surgery and histological examination.Results: In 62 per cent of cases, no hypocalcaemia had been observed after surgery. In 35 per cent of cases, transient hypocalcaemia had been observed after surgery. In 3 per cent of cases, chronic hypocalcaemia had been present six months after surgery. Permanent hypoparathyroidism had been diagnosed two years after surgery in 1.4 per cent of cases. Unintentional parathyroidectomy had been detected in 5.2 per cent of cases. Parathyroid gland autotransplantation had been performed in 7 per cent of cases during surgery.Conclusion: Permanent hypoparathyroidism is rare, although transient hypoparathyroidism occurs relatively frequently. Unintentional parathyroidectomy and parathyroid gland autotransplantation do not affect serum calcium levels.

scholarly journals Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

2021 ◽  
Vol 10 (3) ◽  
pp. 543
Author(s):  
Antonio Sitges-Serra
Keyword(s):  
Adverse Effect ◽  
Total Thyroidectomy ◽  
Replacement Therapy ◽  
Thyroid Disorders ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism ◽  
Early Administration ◽  
Time Period ◽  
Parathyroid Function

Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy.

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