scholarly journals Vitamin D and Postoperative Hypoparathyroidism - a Random Relationship?

2020 ◽  
pp. 0
Author(s):  
Vítor Devezas ◽  
Luis Sá-Vinhas ◽  
Hugo Santos-Sousa ◽  
Luis Matos-Lima ◽  
Laura Barbosa
Keyword(s):  
Vitamin D ◽  
Postoperative Hypoparathyroidism

scholarly journals Postoperative Hypoparathyroidism: Presentation, Clinical Features and Long-term Follow-up from Tertiary Care Hospital

2021 ◽  
Author(s):  
Shrikrishna V Acharya
Keyword(s):  
Vitamin D ◽  
Tertiary Care ◽  
Renal Ultrasound ◽  
Care Hospital ◽  
Clinical Complications ◽  
Treatment Prevalence ◽  
Postoperative Hypoparathyroidism ◽  
Long Term Follow Up ◽  
Considerable Morbidity

Introduction: Hypoparathyroidism is commonly seen after total thyroidectomy. Though most of the time it is transient in nature but permanent decrease in function of the parathyroid function is also possible. Aim: A retrospective analysis of clinical presentation, treatment, prevalence of complications of hypoparathyroidism and its treatment with active vitamin D analogues was conducted. Materials and Methods: A retrospective cohort study followed by location and duration of study of all patients who developed Permanent Hypoparathyroidism (PH) and who were regular in follow-up for at least three years. Any patient with intact Parathyroid Hormone (iPTH) levels <13 pg/mL and was on replacement therapy with calcium and/or vitamin D for at least one year after surgery is labelled as PH. Data of their treatment, serum calcium, phosphorous, creatinine, urine calcium/creatinine ratio and renal ultrasound was recorded. Data was represented as percentage, mean and standard deviation. Statistical analysis was conducted using SPSS version 19. Results: Out of the 23 patients enrolled, three were male and 20 were female with a mean age of 41.2±15.2 years. The mean duration of follow-up was 48±28 months. Clinical complications in 12 patients were observed. Two patients developed renal colic due to renal stone on follow-up. None of the patients developed renal failure. Conclusion: PH causes considerable morbidity and economic burden to family due to its lifelong treatment and monitoring. It requires regular follow-up and monitoring to prevent complications of disease as well as its treatment with active calcium salts. Around 50% of the patients suffered few relevant clinical events requiring hospitalisation.

scholarly journals Recurrent acute kidney injury with outcome in chronic kidney disease due to hypercalcemia because of prolonged use of dihydrotachysterol

2019 ◽  
Vol 1 (2) ◽  
pp. 83-91
Author(s):  
Aleksey Borisov ◽  
Daniil Korabelnikov ◽  
Vadim Romanov
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Prolonged Treatment ◽  
Antiinflammatory Drugs ◽  
Postoperative Hypoparathyroidism ◽  
Intravenous Fluid Administration ◽  
Vitamin D Supplements ◽  
Chronic Interstitial Nephritis

Introduction. Hypoparathyroidism after hyroidectomy is treated with oral calcium and vitamin-D supplements. Everyday prolonged use of calcium and vitamin D medications can lead sometimes to hypercalcemia that can cause Akute Kidney Injury (AKI) and Arterial Hypertension. We report on a clinical case of a man patient with postoperative hypoparathyroidism who presented with hypercalcemia, AKI and Chronic Kidney Disease (CKD) as a result of prolonged treatment with Dihydrotachysterol and calcium medications. Сlinical case. A male patient, 59 y.o., 11 years ago underwent total thyroidectomy, since that time was daily medicated with l-thyroxine 125-150 mcg, dihydrotachysterol 15 drops (approx. 0,62 mg), calcium in different forms without monitoring the blood and urine levels. He had high arterial pressure up to 200/120 mm Hg, treated with amlodipine 10 mg daily. After 5 years he took onemonth treatment with non-steroidal antiinflammatory drugs for pain relief because of a rib fracture. That time he underwent first AKI with full recovery. After 5 years a few AKI recurred with hypercalcemia. Dihydrotachysterol and calcium were cancelled, but since that time patient kept on getting non-prescribed Dihydrotachysterol and calcium in the same doses. After 1 year more in relapse series a puncture biopsy of the kidney showed nephrocalcinosis, chronic interstitial nephritis and CKD (С4А3) was diagnosed. The patient was treated successfully by dis-continuation of the above drugs, intravenous fluid administration and enhancement of calcium renal excretion. The patient is currently free of complaints for about 3 months. Сonclusion. It is important for clinicians to monitor calcium and 25-OH-D levels in blood serum during the prolonged treatment with calcium and vitamin D medications to prevent a hypercalcemia that can lead to AKI, CKD and other sever complications.

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.

Endocrine Complications of Surgical Treatment of Thyroid Cancer: An Update

2017 ◽  
Vol 125 (08) ◽  
pp. 497-505 ◽  
Author(s):  
Pedro Iglesias ◽  
Juan Díez
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Thyroid Cancer ◽  
Surgical Treatment ◽  
Surgical Technique ◽  
Vitamin D Supplementation ◽  
Response To Therapy ◽  
Postoperative Hypoparathyroidism ◽  
Surgeon Experience ◽  
Endocrine Complications

AbstractPostoperative hypoparathyroidism (HypoPT) and hypothyroidism (HypoT) are the main endocrine complications after the surgical treatment for thyroid cancer. Postsurgical HypoPT can be transient, protracted or permanent. Its frequency varies according to the underlying cervical pathology, surgical technique, and mainly the experience of the surgeon. Risk factors for HypoPT include aggressiveness of the tumor, extent of surgery, the presence of parathyroid gland in the pathologic specimen, and surgeon experience. Clinical manifestations of postsurgical HypoPT can be acute or chronic. An adequate surgical technique that minimizes trauma and preserve the vascularization of the parathyroid glands is the better procedure to reduce the risk of postoperative HypoPT. Acute hypocalcemia may be managed with intravenous or oral calcium supplements, according to the level of serum calcium and the presence of signs and symptoms. Patients with permanent HypoPT require lifelong calcium and vitamin D supplementation. Calcitriol is the vitamin D metabolite of preference because of its high activity and short half-life. Both PTH (1–34) and intact PTH (1–84) have demonstrated to be attractive options in hypoparathyroid patients who cannot maintain stable serum and urinary calcium levels with calcium and vitamin D supplementation. However, the long-term safety of these preparations has not been established. Postsurgical HypoT is an unavoidable consequence of total or near-total thyroidectomy for thyroid cancer. Replacement and suppressive therapy are necessary in these patients. Thyroid hormone suppression therapy has shown to be accompanied by a decreased risk of disease progression and recurrence; however, it may also be associated with increased risk of dysrhythmia and loss of bone mass. Therefore, the intensity of TSH suppression must be established in a personalized way after balancing risk and benefits, according to the severity of the thyroid cancer, the response to therapy, and the individual risk factors for adverse events.

scholarly journals Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation

2021 ◽  
Author(s):  
Fiona Riordan ◽  
Matthew S. Murphy ◽  
Linda Feeley ◽  
Patrick Sheahan
Keyword(s):  
Vitamin D ◽  
Multivariate Analysis ◽  
Total Thyroidectomy ◽  
Parathyroid Glands ◽  
Graves Disease ◽  
Permanent Hypoparathyroidism ◽  
Academic Teaching ◽  
Postoperative Hypoparathyroidism ◽  
Academic Teaching Hospital ◽  
Systematic Identification

Abstract Purpose Systematic identification of all 4 parathyroid glands has been recommended during total thyroidectomy (TT); however, it is unclear whether this strategy necessarily translates into optimized functional parathyroid preservation. We wished to investigate the association between number of parathyroids identified intraoperatively during TT, and incidence of incidental parathyroidectomy, and postoperative hypoparathyroidism. Methods Retrospective review of prospectively maintained database of 511 consecutive patients undergoing TT at an academic teaching hospital. The association between number of parathyroid glands identified intraoperatively and incidence of biochemical hypocalcaemia (defined as any calcium < 2 mmol/L n first 48 h after surgery), symptomatic hypocalcaemia; permanent hypoparathyroidism (defined as any hypocalcaemia or need for calcium or vitamin D > 6 months after surgery), and incidental parathyroidectomy, was investigated. The association between number of parathyroid glands visualized and postoperative parathyroid hormone (PTH) levels was investigated in a subset of 454 patients. Results Patients in whom a greater number of parathyroids had been identified had a significantly higher incidence of biochemical and symptomatic hypocalcaemia, and significantly lower postoperative PTH levels, than patients with fewer glands identified. There were no significant differences in incidence of permanent hypoparathyroidism or incidental parathyroidectomy. On multivariate analysis, malignancy, Graves disease, and identification of 3–4 parathyroids were independent predictors of biochemical hypocalcaemia. For symptomatic hypocalcaemia, identification of 2–4 parathyroids, and identification of 3–4 parathyroids, were significant. Conclusions Systematic identification of as many parathyroid glands as possible during TT is not necessary for functional parathyroid preservation.

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 Assessment of Calcium and Vitamin D Medications Adherence in Patients with Hypoparathyroidism After Thyroidectomy

2021 ◽  
Author(s):  
Muhammet Cuneyt Bilginer ◽  
Cevdet Aydin ◽  
Burcak Polat ◽  
Sevgul Faki ◽  
Oya Topaloglu ◽  
...  
Keyword(s):  
Vitamin D ◽  
Medication Adherence ◽  
Side Effects ◽  
Disease Duration ◽  
Drug Withdrawal ◽  
Medication Compliance ◽  
Active Vitamin ◽  
Postoperative Hypoparathyroidism ◽  
Preliminary Study ◽  
Motivation Score

Abstract Summary: In this study, we found that patients with hypoparathyroidism had a problem with calcium medication compliance, and this problem increased with the duration of the disease. We also showed that patients are concerned about the possible side effects of drugs.Introduction: In this study, we aimed to evaluate adherence to avtive vitamin D and calcium replacement in patients with post surgical hypoparathyroidism.Methods: To elucidate the medication adherence, we performed a questionnaire survey using the six item “Medication adherence questionnaire’’(MAQ). The first, second and sixth questions reflect the motivation status of the patients whereas the third, forth and sixth questions reflect the knowledge about the medication that is received. The responses are scored and patients are classified regarding their motivation to and knowledge about the particular drug.Results: Totally 64 patients (Male:12/Female:52; mean age 48.6±11.6 years) who had postoperative hypoparathyroidism were included in our study. Median disease durance was 60 months (min-max; 12-295 months). We found that motivation score of calcium usage was significantly lower compared to vitamin D usage (p<0.001). The calcium motivation score was reversely correlated with disease duration (r= -0.256 and p=0.046). The most common worry about calcium usage was nephrotoxicity, and the most common worries about calcitriol treatment were kidney damage and polyuria. One third of the patients were taking oral calcium and calcitriol less than the recommended dose.Conclusion: One third of patients lack motivation to use calcium whereas half of the patients’ experiences anxiety about drug related side effects. This is a preliminary study showing that vital calcium and active vitamin D intake may be interrupted due to side effect anxiety and motivation can be increased by frequent visits and acknowledging the patient about the deleterious effects of drug withdrawal.

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.

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