Predictors of early postoperative hypocalcemia in patients with secondary hyperparathyroidism undergoing total parathyroidectomy

Objective To summarize the clinical features of secondary hyperparathyroidism (SHPT) in patients with chronic renal failure and to explore the predictive factors of postoperative hypocalcemia after total parathyroidectomy in these patients. Methods The clinical data of 87 patients admitted to Guangdong Electric Power Hospital from May 2013 to February 2020 were reviewed. All patients underwent total parathyroid resection and sternocleidomastoid microtransplantation. Age, sex, and the serum calcium, phosphorus, alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) concentrations were analyzed as predictive factors of postoperative hypocalcemia. Results Bone pain was the most common clinical manifestation in this study population, and all 87 patients experienced relief from their clinical symptoms after the surgical procedure. Age and the preoperative serum calcium, ALP, and iPTH concentrations were determined to be early predictive factors of postoperative hypocalcemia. Conclusions Age and the preoperative calcium, ALP, and iPTH concentrations are independent risk factors for postoperative hypocalcemia in patients with SHPT and renal disease who undergo total parathyroidectomy with sternocleidomastoid microtransplantation. These factors can help identify high-risk patients who can be managed by a multidisciplinary team to improve graft survival and quality of life.

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Risk Factors for Elevated Preoperative Alkaline Phosphatase in Patients with Refractory Secondary Hyperparathyroidism

The American Surgeon ◽

10.1177/000313481708301220 ◽

2017 ◽

Vol 83 (12) ◽

pp. 1368-1372 ◽

Cited By ~ 1

Author(s):

Meng Yang ◽

Ling Zhang ◽

Linping Huang ◽

Xiaoliang Sun ◽

Haoyang Ji ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Secondary Hyperparathyroidism ◽

Calcium Supplementation ◽

Univariate Analysis ◽

Total Parathyroidectomy ◽

Postoperative Hypocalcemia ◽

Preoperative Serum ◽

Significant Independent Risk Factor ◽

Risk Patients ◽

Optimal Cutoff Point

Elevated preoperative levels of alkaline phosphatase (ALP) in patients with refractory secondary hyperparathyroidism are correlated with postoperative hypocalcemia and mortality. The aim of this study was to identify the predictors of preoperative ALP in patients with secondary hyperparathyroidism. From April 2012 to December 2015, 220 patients with refractory secondary hyperparathyroidism undergoing total parathyroidectomy without autotransplantation were reviewed. A total of 164 patients presented with elevated preoperative ALP. Univariate analysis showed that patients with elevated ALP were significantly younger. The elevated ALP group had significantly higher levels of preoperative parathyroid hormone (PTH), lower preoperative serum calcium, higher preoperative phosphorus, lower postoperative hypocalcemia, and a longer hospital stay. Logistic regression analysis showed that elevated preoperative PTH was a significant independent risk factor for elevated preoperative ALP (P = 0.000), and its value of 1624 pg/mL was the optimal cutoff point. Factors predictive of elevated preoperative ALP in patients with secondary hyperparathyroidism include preoperative PTH. Earlier surgery, aggressive calcium supplementation, and more careful or aggressive postoperative care for high-risk patients are needed.

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Quality of Life after Total Parathyroidectomy in Patients with Secondary Hyperparathyroidism

10.21203/rs.3.rs-21522/v1 ◽

2020 ◽

Author(s):

Jia Xu ◽

ZiL Zhang ◽

DongS Zhou ◽

RongZ Fu ◽

YuL Wang

Keyword(s):

Quality Of Life ◽

Secondary Hyperparathyroidism ◽

Serum Calcium ◽

Short Form ◽

Serum Phosphorus ◽

Definitive Treatment ◽

Total Parathyroidectomy ◽

Calcium Phosphorus ◽

Stage Renal Disease

Abstract Background. Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to secondary hyperparathyroidism (2HPT). Surgery is the definitive treatment of 2HPT. The aim of this study is to assess the effect of total parathyroidectomy with deltoid autotransplantation on the QoL. Methods: A total of 201 ESRD with 2HPT were enrolled . The operation efficacy was evaluated by analyzing preoperative and postoperative values, including levels of intact parathyroid hormone (iPTH), serum phosphorus, serum calcium, alkaline phosphatase (ALP) and calcium-phosphorus product. The QoL was evaluated by MOS 36-item short-form health survey (SF-36) scores preoperatively and at 6 months postoperation. Results: Compared with the preoperative values, levels of PTH(2033pg/ml vs 62.5 pg/ml), serum phosphorus(2.30mg/dl vs 1.60mg/dl), serum calcium(3.62mg/dl vs 1.84mg/dl), and calcium-phosphorus product were all decreased postoperative. Number variation and anatomic location variation of thyroid glands were found in the patients. Quality of life improved significantly in all 8 individual and 2 component summary scales, with a more significant decrease in the physical health scales. Conclusion: Parathyroidectomy significantly improves quality of life in patients with secondary hyperparathyroidism.

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Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

International Journal of Endocrinology ◽

10.1155/2021/6613659 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Ping Wen ◽

Lingling Xu ◽

Shasha Zhao ◽

Wei Gan ◽

Dawei Hou ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Secondary Hyperparathyroidism ◽

Serum Calcium ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Total Parathyroidectomy ◽

Preoperative Serum ◽

Postoperative Serum ◽

Rate Frequency

Background. Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and thus the results may not be reliable. Objectives. This study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism. Methods. We retrospectively investigated the records of 1,095 patients with SHPT treated with tPTX between January 2008 and December 2018. Based on the postoperative serum calcium concentration, the patients were grouped into SH and non-SH groups. The clinical characteristics and biochemical results were analyzed, and binary logistic regression analysis was used to identify the risk factors for SH. Results. After surgery, 25.9% of the patients developed SH. Age, diastolic blood pressure (DBP), heart rate, frequency of bone pain, weight of resected glands, preoperative serum calcium, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and hemoglobin levels differed between the two groups. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery. Conclusions. The preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should thus be monitored closely in order to initiate prompt interventions to avoid SH.

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Quality of Life after Total Parathyroidectomy in Patients with Secondary Hyperparathyroidism

10.21203/rs.3.rs-117455/v1 ◽

2020 ◽

Author(s):

JIA XU ◽

DongS Zhou ◽

RongZ Fu ◽

YuL Wang

Keyword(s):

Quality Of Life ◽

Secondary Hyperparathyroidism ◽

Serum Calcium ◽

Short Form ◽

Serum Phosphorus ◽

Definitive Treatment ◽

Total Parathyroidectomy ◽

Calcium Phosphorus ◽

Stage Renal Disease

Abstract Background. Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to secondary hyperparathyroidism (SHPT). Surgery is the definitive treatment for SHPT. The aim of this study is to assess the effect of total parathyroidectomy (PTX) with deltoid autotransplantation on QoL.Methods: A total of 201 ESRD patients with SHPT were enrolled. The operation efficacy was evaluated by analyzing preoperative and postoperative values, including the levels of intact parathyroid hormone (PTH), serum phosphorus, serum calcium, alkaline phosphatase (ALP) and calcium-phosphorus product. The QoL was evaluated by scores on the Medical Outcomes Study 36-item short-form (SF-36) health survey preoperatively and 6 months postoperatively.Results: Compared with preoperatively, postoperatively, the levels of iPTH (2033 pg/ml vs 62.5 pg/ml), serum phosphorus (2.30 mg/dl vs 1.60 mg/dl), serum calcium (3.62 mg/dl vs 1.84 mg/dl), and calcium-phosphorus product were all decreased. Variations in the number and anatomic location of thyroid glands were found in the patients. QoL improved significantly in all 8 individual and 2 component summary scales, with a more significant decrease in the physical health scales.Conclusion: PTX significantly improves QoL in patients with SHPT.

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Hypocalcaemia after Total Thyroidectomy

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v25i1.45191 ◽

2020 ◽

Vol 25 (1) ◽

pp. 19-27

Author(s):

Md Zahirul Islam ◽

AF Mohiuddin Khan ◽

Shaikh Nurul Fattah ◽

Dipankar Lodh ◽

Mohammad Nazrul Islam ◽

...

Keyword(s):

Total Thyroidectomy ◽

Serum Calcium ◽

Malignant Disease ◽

Cross Sectional Study ◽

Postoperative Hypocalcemia ◽

Eligibility Criteria ◽

Cross Sectional ◽

Thyroid Pathology ◽

Preoperative Serum ◽

Female Male Female

Objective: To determine whether postoperative hypocalcemia after total thyroidectomy is more frequent in malignant disease than benign disease. Methods: This is a Cross sectional study. The sample size is 126. All the patients were selected according to the eligibility criteria by purposive sampling. Patients were analyzed for age, gender, thyroid pathology, preoperative serum calcium, postoperative serum calcium. Results: Postoperative hypocalcemia was found in 37 (29.37%) patients. Most patients were female (Male: Female= 1: 4.2). Patients having low preoperative serum calcium had developed more postoperative hypocalcemia (p<0.03). Postoperative hypocalcemia was associated with thyroid pathology (p<0.009) and age (p<0.006), not associated with sex (p<0.907). In multivariate analysis very little association between malignant disease and postoperative hypocalcemia was found (p<0.07). Conclusion: The incidence of postoperative hypocalcemia following total thyroidectomy is 29.4% that is higher than the anticipated but is comparable to other published series. For total thyroidectomy surgeons should be aware of postoperative hypocalcemia but prophylactic calcium and vitamin D supplement is not mandatory in all cases. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 19-27

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Hypocalcemia-based prediction of hungry bone syndrome after parathyroidectomy in hemodialysis patients with refractory secondary hyperparathyroidism

Journal of International Medical Research ◽

10.1177/0300060518788744 ◽

2018 ◽

Vol 46 (12) ◽

pp. 4985-4994 ◽

Cited By ~ 1

Author(s):

Guang Yang ◽

Xiaoming Zha ◽

Huijuan Mao ◽

Xiangbao Yu ◽

Ningning Wang ◽

...

Keyword(s):

Secondary Hyperparathyroidism ◽

Calcium Supplementation ◽

Hemodialysis Patients ◽

Calcium Supplement ◽

Total Parathyroidectomy ◽

Prediction Equations ◽

Hungry Bone Syndrome ◽

Preoperative Serum ◽

Hungry Bone ◽

Intravenous Calcium

Objective This study was performed to explore the risk factors for hungry bone syndrome (HBS) and establish prediction equations for calcium supplementation after parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism. Methods We retrospectively analyzed data from 252 hemodialysis patients undergoing successful total parathyroidectomy with autotransplantation. HBS was defined according to a minimum postoperative serum corrected calcium (PcCa) concentration of <2.0 mmol/L. Independent predictors of HBS were analyzed, and prediction equations for HBS were derived accordingly. Results The incidence of HBS was 71.4%. The serum corrected calcium and preoperative serum alkaline phosphatase (ALP) concentrations were independent predictors of HBS. The preoperative serum ALP, intact parathyroid hormone (iPTH), and hemoglobin concentrations were independent factors influencing the average descending velocity of the PcCa concentration before calcium supplementation (PcCa-V), intravenous calcium supplement holding time (IVCa-T), and intravenous calcium supplement dosage (IVCa), while the serum ALP and iPTH concentrations were independent predictors of the oral calcium supplement dosage (OCa). Four prediction equations for PcCa-V, IVCa-T, IVCa, and OCa were established. Conclusions Establishment of prediction equations for HBS may contribute to a new individualized therapy for patients with HBS.

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The Efficiency of Parathyroidectomy and the Comparison of the Complications of Surgical Procedures in Dialysis Patients

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1069 ◽

2011 ◽

Vol 3 (3) ◽

pp. 103-106

Author(s):

Çağlayan Kasım ◽

Bülent Güngör ◽

Bülent Koca ◽

Hamza Çınar ◽

Zafer Malazgirt ◽

...

Keyword(s):

Secondary Hyperparathyroidism ◽

Patient Characteristics ◽

Total Parathyroidectomy ◽

Test Results ◽

Subtotal Parathyroidectomy ◽

Laboratory Test Results ◽

Surgical Methods ◽

Before And After ◽

Calcium Phosphorus ◽

Type Of Surgery

ABSTRACT Secondary hyperparathyroidism is the hyperplasia and hyperfunctioning of the parathyroid gland in chronic renal failure. The aim of our study was to evaluate the efficiency and complications of surgical methods for secondary hyperparathyroidism in patients requiring dialysis. Forty-one patients operated for secondary hyperparathyroidism before renal transplantation were retrospectively analysed. The efficiency and complications of types of surgery in relation with age, gender, duration of dialysis, symptoms, laboratory test results before and after surgery were evaluated. Mean duration of dialysis was 6.2 ± 3.98 years. Patient's calcium, phosphorus and parathormone levels before surgery were 9.83 ± 1.25 mg/dl, 5.73 ± 2.15 mg/dl, 1847, 0.02 ± 666.602 pg/ml and, after surgery, were 7.85 ± 1.36 mg/dl, 4.5 ± 1.55 mg/dl, 288.05 ± 404.09 pg/ml. The differences betweeen preoperative and postoperative values were statistically significant (p < 0.05) recognizing the efficiency of surgery. The age of patients, the duration of dialysis and the type of surgery were not significantly effective on this difference (p > 0.05). Fifteen patients had subtotal parathyroidectomy, 25 patients had total parathyroidectomy with autotransplantation and one patient had total parathyroidectomy. The incidence of complications did not differ with age, gender, duration of dialysis and type of surgery (p > 0.05). The type of surgery did not possess difference in the improvement in levels of calcium, phosphorus and parathormone and also in the incidence of complications in secondary hyperparathyroidism. Surgeon's experience and individual patient characteristics seem to be more important in determining the type of surgery.

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Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy

International Journal of Endocrinology ◽

10.1155/2020/8875257 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

A. Bove ◽

C. Dei Rocini ◽

R. M. Di Renzo ◽

M. Farrukh ◽

G. Palone ◽

...

Keyword(s):

Vitamin D ◽

Total Thyroidectomy ◽

Vitamin D Deficiency ◽

Serum Calcium ◽

Predictive Factor ◽

Postoperative Hypocalcemia ◽

Independent Predictive Factor ◽

Preoperative Serum ◽

Group 2 ◽

Group 1

Background. Total thyroidectomy (TT) is recommended in the treatment of malignant and benignant thyroid diseases, and, to date, transient hypocalcemia is the most frequent complication after the procedure. We prospectively evaluated the role of vitamin D deficiency as a predictor of postoperative hypocalcemia. Methods. This is a prospective cohort study which was conducted between January 2016 and April 2019. A total of 177 consecutive patients (141 (79.7%) women and 36 (20.3%) men) who underwent TT were included in the current study. Hypocalcemia occurred when serum calcium levels were below 8.0 mg/dL or 1.10 mmol/L. Patients were divided into two groups (Group 1, normocalcemic; Group 2, hypocalcemic) and were assessed taking into consideration preoperative serum 25-hydroxy vitamin D (25-OHD) levels, preoperative serum calcium levels, thyroid hormone levels, sex, body mass index (BMI), and smoking habits. Vitamin D deficiency was defined as 25-OHD levels <25 ng/mL. Results. The incidence of postoperative asymptomatic and symptomatic hypocalcemia in the two groups was 19.8% and 15.8%, respectively. Preoperative 25-OHD level was significantly different between Group 1 and Group 2 (31.5 ± 15.0 ng/mL vs 18.7 ± 9.8 ng/mL,p=0.017). Logistic regression analysis revealed that preoperative vitamin D deficiency was a significant predictive factor of postoperative hypocalcemia (p=0.012), and, specifically, the risk of hypocalcemia increased 15-fold in patients with a preoperative vitamin D level <25 ng/mL (odds ratio [OR], 14.8). Conclusions. Postoperative hypocalcemia is significantly associated with low preoperative levels of serum 25-OHD. Our studies demonstrate that vitamin D deficiency (<25 ng/mL) is an independent predictive factor of postoperative hypocalcemia.

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