scholarly journals Senile parathyroid dysfunction: Characteristics of its diagnosis and treatment

2013 ◽  
Vol 1 (1) ◽  
pp. 32-35
Author(s):  
Shuang-Tong Yan ◽  
Hui Tian
Keyword(s):  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Early Identification ◽  
The Elderly ◽  
Blood Calcium ◽  
The Common ◽  
Parathyroid Dysfunction ◽  
End Stage ◽  
Pth Level

AbstractSenile parathyroid dysfunction is mainly seen in primary or secondary hyperparathyroidism (pHPT or sHPT). pHPT in the elderly usually occurs in women, with fatigue and osteoporosis as the common symptoms. Screening of blood calcium and further evaluation of parathyroid hormone (PTH) for subjects with serum calcium >2.6 mmol/L can be helpful for early identification of patients. For pHPT patients with no contraindications to surgery and whose lesions can be well-localized, surgical treatment can be more beneficial. sHPT is mainly found in patients with end-stage chronic renal dysfunction necessitating hemodialysis or peritoneal dialysis. For these patients, monitoring of PTH level, early supplement of calcium preparations and use of large-dose calcitriol will facilitate maintaining levels of blood calcium and PTH.

scholarly journals Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia

2016 ◽  
Vol 8 (3) ◽  
pp. 203-207 ◽  
Author(s):  
MJ Paul ◽  
Thomas V Paul ◽  
Deepak T Abraham ◽  
Anish Cherian
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Value ◽  
Calcium Supplementation ◽  
Early Discharge ◽  
Tertiary Hospital ◽  
Vitamin D Supplementation ◽  
Postoperative Hypocalcemia ◽  
Parathyroid Dysfunction ◽  
Pth Level

ABSTRACT Aims Total thyroidectomy is significantly complicated by parathyroid dysfunction and hypocalcemia. These aspects impact the decision regarding the timing of discharge and quantum of calcium supplementation required. Therefore, we aimed at evaluating the accuracy of next-day parathyroid hormone (PTH) level as a predictor of post-thyroidectomy hypocalcemia. Secondly, we aimed at establishing our institution's postoperative PTH level, which can accurately predict the development of post-thyroidectomy hypocalcemia to help us ensure the safe and early discharge of patients. Materials and methods A prospective observational study of 50 continuous patients undergoing thyroidectomy was conducted at a tertiary hospital in South India. Postoperative blood samples were collected for estimation of PTH, calcium, albumin, and phosphorous. The data were collated and results analyzed using Stata I/C 10.1. Results A total of 30% (15/50) of the patients had postoperative hypocalcemia (serum calcium <8 mg/dL). Postoperative PTH was low (<8 pg/mL) in 40% (20/50) of patients. There was a significant association between PTH < 8 pg/mL and the presence of postoperative hypocalcemia (p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.7, and a next-day PTH of <6 pg/mL showed the highest sensitivity and specificity (83 and 60% respectively) for the development of postoperative hypocalcemia, with a positive predictive value (PPV) and negative predictive value (NPV) of 83 and 60 respectively. Conclusion The PTH assessment performed the day after surgery is an acceptable test to predict post-thyroidectomy hypocalcemia; PTH <6 pg/mL can be used as our institution's cutoff value. Department protocols for calcium and vitamin D supplementation following total thyroidectomy may be formulated based on the appropriately timed local postoperative PTH value to assist safe and early discharge of patients. Clinical significance Discharge protocols for patients undergoing thyroidectomy may be formulated based on the postoperative PTH values, thus enabling safe and early discharge of patients. How to cite this article Cherian AJ, Ramakant P, Paul TV, Abraham DT, Paul MJ. Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia. World J Endoc Surg 2016;8(3):203-207.

Worldwide Experiences with Assisted Peritoneal Dialysis

2017 ◽  
Vol 37 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Anna Giuliani ◽  
Akash Nayak Karopadi ◽  
Mario Prieto-Velasco ◽  
Sabrina Milan Manani ◽  
Carlo Crepaldi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Elderly Population ◽  
Age Groups ◽  
The Elderly ◽  
Clinical Results ◽  
Social Barriers ◽  
Stage Renal Disease ◽  
End Stage ◽  
Assisted Peritoneal Dialysis

End-stage renal disease (ESRD) is common in the elderly population, and renal replacement therapy (RRT) is often required. However, in this particular subgroup of patients, the choice between hemodialysis (HD) and peritoneal dialysis (PD) is often not an easy decision to make. Published literature has adequately demonstrated that PD prevalence is significantly less than HD across all patient age groups despite several advantages. We also know that elderly patients are less likely to complete a PD assessment, due to both medical and social barriers. Additionally, elderly patients are often reluctant to go ahead with PD despite being eligible PD candidates, mainly due to the fear of performing self-therapy. Recently, many new assisted PD (asPD) programs have cropped up in several countries. The main aim of these programs is to overcome barriers to PD and to promote PD utilization among elderly and non-self-sufficient patients. Although asPD has proven to be associated with good clinical results, there still remain concerns about its greater use. In this review, we will first describe an ideal asPD model and then enumerate examples of strategies and outcomes associated with successful asPD programs worldwide.

The Influence of Dialysate Calcium Concentration on the Pth Level in Children Undergoing Capd

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 567-569 ◽  
Author(s):  
Maria Sieniawska ◽  
Maria Roszkowska-Blaim ◽  
Beata Wojciechowska
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Dwell Time ◽  
Calcium Concentration ◽  
Vitamin D Metabolites ◽  
Intact Parathyroid Hormone ◽  
Gland Function ◽  
Dialysate Calcium ◽  
Pth Level

In 12 children aged four-and-a-half to 18 years (mean 11 ±4.2) undergoing continuous ambulatory peritoneal dialysis (CAPO), serum intact parathyroid hormone (iPTH), ionized calcium (iCa) levels, and calcium mass transfer (CaMT) were measured on three consecutive days: day 1, after a four-hour interval between dialyses; on day 2, after four hours dwell time with peritoneal dialysis (PD) Ca 3.5 mEq/L; and on day 3, after four hours dwell time with PD Ca 2.5 mEq/L. A significantly more negative CaMT was found when PD Ca 2.5 mEq/L was used, as compared with values obtained using PD Ca 3.5 mEq/L. Significantly lower parathyroid hormone (PTH) values were found after the interval between exchanges. We conclude that in order to properly evaluate parathyroid gland function and to decide whether or not to give vitamin D metabolites, a protocol for determining PTH should be standardized.

scholarly journals Effectiveness of surgical treatment of primary hyperparathyroidism with urolithiasis: correction of symptoms, laboratory parameters and stone-forming risk

2018 ◽  
Vol 11 (4) ◽  
pp. 191-200
Author(s):  
Sergey V. Sergiyko ◽  
Dmitriy S. Rogozin
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Clinical Symptoms ◽  
Stone Formation ◽  
Urinary Calculi ◽  
Urine Excretion ◽  
Blood Calcium ◽  
Laboratory Parameters ◽  
Risk Of Stone Formation

Background. Parathyroidectomy is the only effective method to improve the clinical and laboratory manifestations of the primary hyperparathyroidism (PHPT) and reduce the risk of urinary calculi formation. However, there are controversies about the existence of renal form of PHPT and about the effectiveness of surgery with regard to the risk of stone formation. Aims. To evaluate the effectiveness of PHPT surgical treatment in relation to clinical, laboratory parameters, as well as the risk of stone formation. Materials and methods. In a prospective single-arm observation one-center nonrandomized study we included patients with PHPT in whom parathyroidectomy was performed in 2012–2015. We analyzed clinical and laboratory parameters before and after surgery in a period from 1 to 3 years. Results. The study included 105 patients, of whom 35 (33.3%) had urolithiasis. Blood calcium after the surgery decreased from 2.72 mmol/l [2,56; 2,97] to 2,3 mmol/l [2,2; 2,35], p < 0.001. Blood calcium concentration decreased to normal values in all patients. Parathyroid hormone level decreased from 206 pg/ml [123; 347] to 72,8 pg/ml [30; 113], p < 0.001. Clinical symptoms questionnaire estmation decreased from 4 points [3; 6] to 2 points [1; 4], p < 0.001. In patients with urolithiasis clinical symptoms before treatment were more pronounced – 5 points [3; 7] vs. 4 points [3; 5] (p = 0.015) and decreased more significantly – by 3 points [2; 4] vs 2 points [1; 3]. The daily calcium urine excretion decreased from 11.4 mmol/day [8.9; 13.9] to 5.4 mmol/day [4.1; 6.8], p < 0.001. In 2 cases (5.7%; CI, 0.7–19.2%) we observed the progression of urolithiasis after surgery. The age of patients correlated with daily calcium urine excretion after surgery (r = 0.69; p = 0.028). Conclusions. Parathyroidectomy normalizes blood calcium and parathyroid hormone, improves clinical symptoms and reduces the risk of stone formation.

Predicting Postthyroidectomy Hypocalcemia: Improving Predictive Ability of Parathyroid Hormone Level

2020 ◽  
Vol 86 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Veljko Strajina ◽  
Benzon M. Dy ◽  
Travis J. Mckenzie ◽  
Geoffrey B. Thompson ◽  
Melanie L. Lyden
Keyword(s):  
Parathyroid Hormone ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Calcium Level ◽  
Predictive Ability ◽  
Postoperative Hypocalcemia ◽  
Total Blood ◽  
Blood Calcium ◽  
Large Patient ◽  
Pth Level

We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9–10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy ( P < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6–24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.

scholarly journals Parathyroid Hormone Status in Patients with End Stage Renal Disease on Maintenance Haemodialysis

2014 ◽  
Vol 4 (1) ◽  
pp. 13-17
Author(s):  
SM Sajjad ◽  
YA Zaman ◽  
MA Rahim ◽  
A Mahmuda ◽  
WMM Haque ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Calcium Phosphate ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Maintenance Haemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Pth Level

Objective: To evaluate parathyroid hormone (PTH) status among end stage renal disease (ESRD) patients on maintenance haemodialysis (MHD). Methodology: This descriptive cross-sectional study was done in the Department of Nephrology, BIRDEM General Hospital, Dhaka, from April to September 2011. Results: A total of 50 patients were included in this study with a 3:2 male predominance. Mean age was 54.6 (range 34-76) years. Mean duration of ESRD was 3.73 years. All the patients were diabetic and other common co-morbidities were hypertension (76%), dyslipidaemia (56%), ischaemic heart disease (48%) and stroke (12%). They were receiving calcium (72%), vitamin D (40%), both calcium and vitamin D (38%) supplementation and 20% were not on any medication for treatment of chronic kidney disease mineral bone disorder (CKD-MBD). Mean pre-dialysis values of urea and creatinine were 30.28 mg/dl and 8.67 mg/dl respectively. Mean (± SD) serum level of calcium, phosphate and PTH were 8.32 (±1.26) mg/dl, 4.42 (±1.54) mg/dl and 125.45±117.71 pg/ml respectively. In 76% of the study subjects, PTH level was above normal. Significant difference (P=<0.05) in PTH levels was observed among patients with and without any medication for prevention of CKD-MBD but the levels were within the acceptable range. Serum calcium level in the study subjects had significant positive relationship with serum PTH level. It was also observed that PTH level had significant negative relationship with phosphate level. Conclusion: PTH level was higher in ESRD patients on MHD specially those who were not on any medication than those who took calcium, vitamin D or both but it was still within the acceptable reference range. In such patients, serum calcium, phosphate and PTH levels should be monitored periodically. DOI: http://dx.doi.org/10.3329/birdem.v4i1.18547 Birdem Med J 2014; 4(1): 13-17

Introduction of Renal Key Performance Indicators Associated with Increased Uptake of Peritoneal Dialysis in a Publicly Funded Health Service

2017 ◽  
Vol 37 (2) ◽  
pp. 198-204 ◽  
Author(s):  
Nigel D. Toussaint ◽  
Lawrence P. McMahon ◽  
Gregory Dowling ◽  
Stephen G. Holt ◽  
Gillian Smith ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Performance Indicator ◽  
The Elderly ◽  
Reduced Pressure ◽  
Home Dialysis ◽  
Technique Survival ◽  
Home Based ◽  
Australian State ◽  
Previous Decade ◽  
End Stage

BackgroundIncreased demand for treatment of end-stage kidney disease has largely been accommodated by a costly increase in satellite hemodialysis (SHD) in most jurisdictions. In the Australian State of Victoria, a marked regional variation in the uptake of home-based dialysis suggests that use of home therapies could be increased as an alternative to SHD. An earlier strategy based solely on increased remuneration had failed to increase uptake of home therapies. Therefore, the public dialysis funder adopted the incidence and prevalence of home-based dialysis therapies as a key performance indicator (KPI) for its health services to encourage greater uptake of home therapies.MethodsA KPI data collection and bench-marking program was established in 2012 by the Victorian Department of Health and Human Services, with data provided monthly by all renal units in Victoria using a purpose-designed website portal. A KPI Working Group was responsible for analyzing data each quarter and ensuring indicators remained accurate and relevant and each KPI had clear definitions and targets. We present a prospective, observational study of all dialysis patients in Victoria over a 4-year period following the introduction of the renal KPI program, with descriptive analyses to evaluate the proportion of patients using home therapies as well as home dialysis modality survival.ResultsFollowing the introduction of the KPI program, the net growth of dialysis patient numbers in Victoria remained stable over 4 years, at 75 – 80 per year (approximately 4%). However, unlike the previous decade, about 40% of this growth was through an increase in home dialysis, which was almost exclusively peritoneal dialysis (PD). The increase was identified particularly in the young (20 – 49) and the elderly (> 80). Disappointingly, however, 67% of these incident patients ceased PD within 2 years of commencement, 46% of whom transferred to SHD.ConclusionsIntroduction of a KPI program was associated with an increased uptake of PD but not home HD. This change in clinical practice restricted growth of SHD and reduced pressure on satellite services. The effect was offset by a modest PD technique survival. Many patients in whom PD was unsuccessful were subsequently transferred to SHD rather than home HD.

scholarly journals Vitamin D, Calcium, Parathyroid Hormone, and Sex Steroids in Bone Health and Effects of Aging

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Hitesh Kumar Bhattarai ◽  
Shreya Shrestha ◽  
Kabita Rokka ◽  
Rosy Shakya
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Bone Loss ◽  
Sex Hormones ◽  
Bone Health ◽  
The Elderly ◽  
Health Concern ◽  
Dietary Vitamin ◽  
Bone Modeling ◽  
Blood Calcium

Bone health of the elderly is a major global health concern, since about 1 in 3 women and 1 in 5 men suffer from bone loss and fractures, often called osteoporosis, in old age. Bone health is a complex issue affected by multiple hormones and minerals. Among all the hormones involved in bone health, calcitriol (also vitamin D), parathyroid, and sex hormones (especially estrogen) have been discussed in this review paper. We have discussed the metabolism of these hormones and their effects on bone health. Vitamin D can be obtained from diet or formed from 7-dehydrocholesterol found under the skin in the presence of sunlight. The active form, calcitriol, causes dimerization of vitamin D receptor and acts on the bones, intestine, and kidney to regulate the level of calcium in blood. Similarly, parathyroid hormone is secreted when the serum level of calcium is low. It helps regulate the level of blood calcium through calcitriol. Sex hormones regulate bone modeling at an early age and remodeling later in life. Loss of ovarian function and a decrement in the level of production of estrogen are marked by bone loss in elderly women. In the elderly, various changes in the calcium and vitamin D metabolism, such as decrease in the production of vitamin D, decrease in dietary vitamin D, decreased renal production, increased production of excretory products, decrease in the level of VDR, and decreased calcium absorption by the intestines, can lead to bone loss. When the elderly are diagnosed with osteoporosis, medications that directly target bone such as bisphosphonates, RANK ligand inhibitors, estrogen and estrogen analogues, estrogen receptor modulators, and parathyroid hormone receptor agonists are used. Additionally, calcium and vitamin D supplements are prescribed.

scholarly journals Paget´s disease of bone in a patient on peritoneal dialysis

2021 ◽  
pp. 196
Author(s):  
Keyword(s):  
Alkaline Phosphatase ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Renal Replacement Therapy ◽  
Hormone Level ◽  
Parathyroid Hormone Level ◽  
Imaging Findings ◽  
End Stage Kidney Disease ◽  
High Level ◽  
End Stage

Paget´s disease of bone is a disorder characterized by disorganized bone remodeling. It´s occurrence in patients with end-stage kidney disease on renal replacement therapy is rare. Here we report a case of Paget´s disease of bone in an 80-year-old male on peritoneal dialysis that presented a high level of alkaline-phosphatase with a mildly elevated parathyroid hormone level and typical imaging findings localized to the pelvis. This is the fourth reported case of Paget´s disease in a patient on peritoneal dialysis and the first treated with denosumab.

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