scholarly journals CLINICAL CASE OF TERIPARATIDE USE FOR THE TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM WITH UNCONTROLLED HYPOCALCEMIA COMBINED WITH SEVERE OSTEOPOROSIS

2016 ◽  
Vol 19 (3) ◽  
pp. 37-40 ◽  
Author(s):  
T A Grebennikova ◽  
I I Larina ◽  
Zh E Belaya ◽  
L Y Rozhinskaya
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Surgical Procedures ◽  
Clinical Case ◽  
Standard Treatment ◽  
Clinical Presentation ◽  
Severe Osteoporosis ◽  
Oral Calcium ◽  
Postoperative Hypoparathyroidism ◽  
Severe Clinical Presentation

The development of postsurgical hypoparathyroidism is the most frequent complication of thyroidectomy and radical surgical procedures on the neck. Hypoparathyroidism is a disorder characterized by hypocalcemia, parathyroid hormone (PTH) deficiency, and abnormal bone remodeling. Standard treatment of hypoparathyroidism consists of oral calcium and active forms of vitamin D. However, some patients fail to achieve the normalization of calcium levels with this therapy. We present a clinical case of postsurgical hypoparathyroidism with severe clinical presentation of hypocalcaemia treated with recombinant human PTH 1-34 - teriparatide.

scholarly journals Use of parathyroid hormone analog (Teriparatide) in patients with chronic hypoparathyroidism after total thyroidectomy: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 29-35
Author(s):  
Avinash Rai ◽  
P Karki ◽  
D Paudel ◽  
R Maskey
Keyword(s):  
Vitamin D ◽  
Thyroid Cancer ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Standard Treatment ◽  
Hormone Analog ◽  
Postoperative Hypoparathyroidism ◽  
Treatment Refractory ◽  
Chronic Hypoparathyroidism ◽  
Intravenous Calcium

Background: Hypoparathyroidism and hypocalcemia is a common postoperative complication, after total thyroidectomy due to thyroid cancer. Standard treatment with supplementation of calcium and vitamin D analogs, usually treat this condition. In some patients, hypoparathyroidism is refractory to standard treatment plus intermittent calcium infusions with persistent low serum calcium levels and associated clinical complications. Attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. To our knowledge, this is the first time that we encounter a patient suffering from treatment-refractory postsurgical hypoparathyroidism who was treated with teriparatide. Case presentation: Male (31 years) with postoperative hypoparathyroidism, after total thyroidectomy due to papillary thyroid cancer, several weeks after the surgery still required intermittent intravenous calcium infusions because of tetany symptoms. He had persistent hypocalcemia despite oral treatment with up to 1 ug calcitriol and 4 g calcium per day necessitating additional intravenous administration of calcium gluconate intermittently. This time, Teriparatide treatment was introduced at once daily 50 micrograms (mcg) subcutaneous injection, while doses of calcium and calcitriol were gradually decreased depending on the response of serum total and ionized calcium taken periodically, which resulted in total resolution of hypocalcemia symptoms and the achievement and maintenance of laboratory normocalcaemia in just 5 days. Conclusion: Treatment refractory chronic hypoparathyroidism may be seen in some cases after total thyroidectomy. Furthermore, the use of recombinant human parathyroid hormone analog (Teriparatide) allows for the control of recurrent hypocalcemia reducing the daily dosage of calcium and vitamin D. Finally, regular intravenous calcium administration was no more needed.

scholarly journals A Prospective Study of Vitamin D Supplement in Thyroidectomy Patients Based on Relative Decline of Parathyroid Hormone

2021 ◽  
Vol 12 ◽  
Author(s):  
Qing Hao ◽  
Yun Qin ◽  
Wanjun Zhao ◽  
Lingyun Zhang ◽  
Han Luo
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
High Risk ◽  
Prospective Study ◽  
Oral Calcium ◽  
Group A ◽  
Relative Decline ◽  
A Prospective Study ◽  
Vitamin D Supplement ◽  
Intravenous Calcium

Background: In postthyroidectomy patients, hypocalcemia is the most common complication to prolong hospital stay and decrease patients’ satisfaction. Based on current evidence, it is recommended to supply vitamin D to patients with high risk of developing hypocalcemia. However, how to stratify the risk of patients remains challenging.Aim: We conducted a prospective study to evaluate the effect of vitamin D supplement (calcitriol) on high-risk hypocalcemia patients based on relative decline of parathyroid hormone (RDP).Method: RDP was calculated by the difference between preoperative and postoperative first-day PTH divided by preoperative PTH and presented as percentage. Patients who underwent total thyroidectomy in addition to bilateral central compartment dissection were enrolled prospectively and were divided into two cohorts: Cohort I: patients with RDP ≤70% and Cohort II: patients with RDP >70%. Patients in Cohort I were then randomly assigned to Group A or B, and patients in Cohort II were randomly assigned to Group C or D. All groups received oral calcium, and patients in Groups B and D also received calcitriol. All patients were followed for one year. In the study, standard procedure dictates that only oral calcium is given to patients whose RDP ≤70% and that oral calcium and calcitriol are given to patients whose RDP >70%. Therefore, Cohort I Group A and Cohort II Group D are controls in this study.Results: The incidence of clinical hypocalcemia in Groups A and D (the controls) was 11.0% (10/91), and 17.6% (16/91) required additional intravenous calcium. Of note, no patients developed permanent hypocalcemia. Furthermore, calcitriol supplement did not have significant impact on clinical outcomes between Group A and B in Cohort I. By contrast, calcitriol supplement distinctly improved clinical outcome by comparing Groups C and D (Cohort II), as marked by clinical hypocalcemia, need of requiring intravenous calcium, and long-termed decreased levels of PTH.Conclusion: Supplying calcitriol based on RDP cutoff of 70% may be a wise practice in thyroidectomy patients, and RDP 70% may be a useful predictor to stratify high-risk patients.

scholarly journals Score twice before you cut once: a clinical case of reconstructive bariatric surgery after obesity surgery in a patient with postoperative hypothyroidism and hypoparathyroidism

2021 ◽  
Vol 12 (3) ◽  
pp. 92-97
Author(s):  
N. I. Volkova ◽  
Yu. S. Degtyareva ◽  
M. A. Burikov
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Vitamin D ◽  
Small Intestine ◽  
Clinical Case ◽  
Clinical Observation ◽  
Reverse Inclusion ◽  
Postoperative Hypoparathyroidism ◽  
History Of

Hundreds of thousands of bariatric surgeries are performed worldwide every year. Th ey have long been proven to be safe and eff ective in treating obesity and type 2 diabetes. Along with an unconditional positive eff ect, these interventions, especially shunting ones, are characterized by specifi c complications. In the absence of proper correction, they can become fatal for patients. One of these complications is malabsorption leading to a defi ciency of vitamins and microelements, which in most cases, is amenable to timely correction in the postoperative period. However, there are situations when it is not possible to carry out an eff ective correction and it becomes necessary to perform reconstructive interventions with the reverse inclusion of the small intestine in the digestion, which is associated with great diffi culties. Th e authors demonstrated this situation in the description of clinical observation of a patient with postoperative hypothyroidism and history of postoperative hypoparathyroidism, who underwent bariatric surgery. Impaired absorption of drugs (L-thyroxine, calcium, and vitamin D), and therefore, uncompensated hypothyroidism and hypocalcemia was an indication for reconstructive surgery.

scholarly journals Hypoparathyroidism and pseudohypoparathyroidism

2006 ◽  
Vol 50 (4) ◽  
pp. 664-673 ◽  
Author(s):  
Sergio S. Maeda ◽  
Erika M. Fortes ◽  
Ulisses M. Oliveira ◽  
Victoria C.Z. Borba ◽  
Marise Lazaretti-Castro
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Basal Ganglia ◽  
Calcium Supplementation ◽  
Free Calcium ◽  
Principal Function ◽  
Active Vitamin ◽  
Basal Ganglia Calcification ◽  
Oral Calcium ◽  
Glomerular Filtrate

The principal function of the parathyroid hormone (PTH) is maintenance of calcium plasmatic levels, withdrawing the calcium from bone tissue, reabsorbing it from the glomerular filtrate, and indirectly increasing its intestinal absorption by stimulating active vitamin D (calcitriol) production. Additionally, the PTH prompts an increase in urinary excretion of phosphorus and bicarbonate, seeking a larger quantity of free calcium available in circulation. Two mechanisms may alter its function, limiting its control on calcium: insufficient PTH production by the parathyroids (hypoparathyroidism), or a resistance against its action in target tissues (pseudohypoparathyroidism). In both cases, there are significantly reduced levels of plasmatic calcium associated with hyperphosphatemia. Clinical cases are characterized by nervous hyperexcitability, with paresthesia, cramps, tetany, hyperreflexia, convulsions, and tetanic crisis. Abnormalities such as cataracts and basal ganglia calcification are also typical of these diseases. Treatment consists of oral calcium supplementation associated with increased doses of vitamin D derivatives.

scholarly journals Hereditary Vitamin-D Dependent Rickets Type II: A Case Report

2021 ◽  
Vol 59 (238) ◽  
Author(s):  
Neela Sunuwar ◽  
Swotantra Gautam ◽  
Anuradha Twayana ◽  
Saroj Adhikari Yadav ◽  
Firoz Anjum ◽  
...  
Keyword(s):  
Vitamin D ◽  
Case Report ◽  
Parathyroid Hormone ◽  
Biochemical Parameters ◽  
Genetic Disorder ◽  
High Dose ◽  
Type Ii ◽  
Radiological Findings ◽  
Oral Calcium ◽  
Subsequent Improvement

Hereditary vitamin D dependent rickets type II is a rare genetic disorder in children characterized by early onset of rickets and deranged biochemical parameters. Low serum calcium level, high alkaline phosphatase, high parathyroid hormone, and high values of 1,25-dihydroxy vitamin D are characteristic biochemical findings. We are reporting a rare case of Vitamin D Dependent Rickets and subsequent improvement after addition of cinacalcet. This is a case report of a 2.5-year-child with Hereditary Vitamin D Dependent Rickets type II receiving cinacalcet as adjunct to oral calcium and calcitriol. Oral cinacalcet (0.25mg/kg/day) was added to the regimen as an adjunct after treatment failure with high dose of oral calcium and calcitriol. A significant improvement in radiological findings and normal homeostasis of calcium, phosphate and parathyroid hormone was achieved after initiation of cinacalcet.

scholarly journals Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism

2020 ◽  
Vol 2020 ◽  
Author(s):  
Carmina Teresa Fuss ◽  
Stephanie Burger-Stritt ◽  
Silke Horn ◽  
Ann-Cathrin Koschker ◽  
Kathrin Frey ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Serum Calcium ◽  
Standard Treatment ◽  
Insulin Pump ◽  
Oral Treatment ◽  
List Type ◽  
High Frequencies ◽  
Clinical Complications

Summary Standard treatment of hypoparathyroidism consists of supplementation of calcium and vitamin D analogues, which does not fully restore calcium homeostasis. In some patients, hypoparathyroidism is refractory to standard treatment with persistent low serum calcium levels and associated clinical complications. Here, we report on three patients (58-year-old male, 52-year-old female, and 48-year-old female) suffering from severe treatment-refractory postsurgical hypoparathyroidism. Two patients had persistent hypocalcemia despite oral treatment with up to 4 µg calcitriol and up to 4 g calcium per day necessitating additional i.v. administration of calcium gluconate 2–3 times per week, whereas the third patient presented with high frequencies of hypocalcemic and treatment-associated hypercalcemic episodes. S.c. administration of rhPTH (1–34) twice daily (40 µg/day) or rhPTH (1–84) (100 µg/day) only temporarily increased serum calcium levels but did not lead to long-term stabilization. In all three cases, treatment with rhPTH (1–34) as continuous s.c. infusion via insulin pump was initiated. Normalization of serum calcium and serum phosphate levels was observed within 1 week at daily 1–34 parathyroid hormone doses of 15 µg to 29.4 µg. Oral vitamin D and calcium treatment could be stopped or reduced and regular i.v. calcium administration was no more necessary. Ongoing efficacy of this treatment has been documented for up to 7 years so far. Therefore, we conclude that hypoparathyroidism that is refractory to both conventional treatment and s.c. parathyroid hormone (single or twice daily) may be successfully treated with continuous parathyroid hormone administration via insulin pump. Learning points: Standard treatment of hypoparathyroidism still consists of administration of calcium and active vitamin D. Very few patients with hypoparathyroidism also do not respond sufficiently to standard treatment or administration of s.c. parathyroid hormone once or twice daily. In those cases, continuous s.c. administration of parathyroid hormone via insulin pump may represent a successful treatment alternative.

scholarly journals Parathyroid hormone replacement versus oral calcium and active vitamin D supplementation in hypoparathyroidism: A meta-analysis

2020 ◽  
Vol 24 (2) ◽  
pp. 206
Author(s):  
Jayaprakash Sahoo ◽  
Rajan Palui ◽  
RashmiRanjan Das ◽  
Ayan Roy ◽  
Sadishkumar Kamalanathan ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Meta Analysis ◽  
Hormone Replacement ◽  
Vitamin D Supplementation ◽  
Active Vitamin ◽  
Oral Calcium ◽  
Active Vitamin D

scholarly journals Vitamin D Insufficiency Predicts Susceptibility of Parathyroid Hormone Reduction after Total Thyroidectomy in Thyroid Cancer Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yan Zhang ◽  
Weihui Zheng ◽  
Yuanyuan Huang ◽  
Chao Chen
Keyword(s):  
Vitamin D ◽  
Thyroid Cancer ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Independent Predictor ◽  
Laboratory Data ◽  
Vitamin D Insufficiency ◽  
Reduction Ratio ◽  
Postoperative Hypoparathyroidism ◽  
Significant Difference

Objective. Given its role in the regulation of calcium and PTH levels, vitamin D was presumed as a potential predictor of postoperative hypoparathyroidism. However, the reports about their association were controversial. This study aims to reveal the relationship between preoperative vitamin D and postoperative parathyroid hormone (PTH). Methods. A total of 242 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy (TT) during the period from June 2016 to December 2017 at our hospital were enrolled. Patients were divided into two groups, HypoP and Non-HypoP groups, based on postoperative PTH < 15.0 or ≥15.0 pg/mL, and ΔPTH50+ and ΔPTH50− groups, based on postoperative PTH reduction ratio ≥ 50% or <50%. Clinicopathological features and laboratory data were compared between two sets of groups. Results. Preoperative PTH level was lower in the HypoP group than in the Non-HypoP group (42.83 vs. 47.52 pg/mL, p = 0.018 ). No significant difference of vitamin D insufficiency was found between the HypoP and Non-HypoP groups (80.8% vs. 74.1%, p = 0.226 ). The rate of vitamin D insufficiency was higher in the ΔPTH50+ group than in the ΔPTH50− group (82.6% vs. 68.4%, p = 0.010 ). By multivariate logistic regression analysis, vitamin D insufficiency was an independent predictor of postoperative PTH reduction ratio ≥ 50% (OR = 2.2, p = 0.017 ). Conclusion. Vitamin D insufficiency is not associated with postoperative PTH in PTC patients undergoing TT. However, vitamin D insufficiency is an independent predictor of postoperative PTH reduction ratio.

scholarly journals Treatment of severe idiopathic hypoparathyroidism: a case report

2018 ◽  
Vol 21 (2) ◽  
pp. 36-40 ◽  
Author(s):  
Diliara Sh. Umiarova ◽  
Tatiana A. Grebennikova ◽  
Natalya V. Tarbaeva ◽  
Zhanna E. Belaya
Keyword(s):  
Vitamin D ◽  
Standard Treatment ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Reference Interval ◽  
Ectopic Calcification ◽  
Therapeutic Tool ◽  
Autoimmune Destruction ◽  
Calcium Phosphorus ◽  
Bone Tissue Remodeling

Hypoparathyroidism is a rare disorder characterized by parathyroid hormone (PTH) insufficiency, the development of hypocalcemia and alteration of bone tissue remodeling. The goal of treatment is to normalize the indicators of calcium-phosphorus metabolism and leveling of clinical manifestations. Standard treatment of hypoparathyroidism consists of oral calcium and active forms of vitamin D, in doses necessary to maintain calcium levels at the lower limit of the reference interval. Nevertheless, treatment of the disease exerts certain difficulties in clinical practice. At the same time, compensation of the hypoparathyroidism is necessary to prevent ectopic calcification. Daily subcutaneous delivery of PTH (1–84) and PTH (1–34) has emerged as a promising therapeutic tool. However, its use should be restricted to patients insufficiently controlled with the standard treatment with active vitamin D and calcium. We present a clinical case of idiopathic hypoparathyroidism with severe clinical presentation of hypocalcaemia and ectopic calcification. Idiopathic hypoparathyroidism is a consequence of autoimmune destruction of the parathyroid glands and is exhibited by excluding all known causes of hypoparathyroidism. PTH (1–34) treatment allowed reducing the dose of calcium and vitamin D and achieving compensation of the disease.

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