scholarly journals Clinical study on the status of transient thyrotoxicosis after surgery for secondary hyperparathyroidism patients with end-stage renal disease

2019 ◽  
Author(s):  
Baoshan Zou ◽  
Jiashuo Liu ◽  
Hong Li ◽  
Zhou Xu ◽  
Hao Li ◽  
...  
Keyword(s):  
Renal Disease ◽  
Secondary Hyperparathyroidism ◽  
Thyroid Function ◽  
End Stage Renal Disease ◽  
Normal Range ◽  
Normal Thyroid ◽  
Normal Thyroid Function ◽  
The Status ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background: Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD)，and part of SHPT patients need receive parathyroidectomy (PTX). However, as an important postoperative complication of SHPT, thyrotoxicosis has received little attention. Therefore, in this article, we aimed to study the status of transient thyrotoxicosis after PTX for SHPT patients with ESRD and normal thyroid function. Methods: A total of 36 SHPT patients with preoperative normal thyroid function, normal thyroglobulin(Tg) and normal thyroid antibodies receiving PTX were enrolled from the Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, from January 2017 to January 2019. Tg, high sensitivity thyrotropin stimulating hormone(sTSH), triiodothyronine(T3), free triiodothyronine(fT3)，thyroxine(T4) and free thyroxine(fT4) were evaluated the day before PTX and on day 1, 3 and 5 after PTX. Besides, all enrolled patients were evaluated whether there are symptoms associated with thyrotoxicosis. Results: Among the 36 SHPT patients, 3 case (8.3%), 14 cases (38.9%) and 24 cases (66.7%) had suffered thyrotoxicosis at the first, third and fifth day after surgery, respectively. Serum FT4 level increased significantly (＞1.5 times higher than the normal maximum) from pre-operation (0.66±0.14 ng/dl, normal range: 0.59-1.25ng/dl) to the third day after operation (2.13±2.16 ng/dl, p＜0.001) and then gradually decline, but still higher than the normal maximum on day 5 after surgery (1.40±0.59 ng/dl, p＜0.001). The frequencies of serum sTSH lower than the normal level gradually increased from the first day（11.1%） to fifth day （66.7%） after surgery. Serum Tg level increased significantly (＞4 times higher than the normal maximum) from pre-operation (8.43±6.26, normal range: 0.00-50.03ng/ml)to the first day after operation 213.07±157.69, p＜0.001) and then gradually decline, but still relatively higher than the normal maximum on day 5 after surgery (67.70±97.43ng/ml, p＜0.001). Conclusion: Transient thyrotoxicosis is a common postoperative complication of parathyroidectomy for SHPT patients with ESRD and normal thyroid function, and it is necessary for clinicians to evaluate the perioperative thyroid function to make early diagnosis and appropriate prevention and treatment of thyrotoxicosis.

scholarly journals Real-world evidence and optimization of vocal dysfunction in end-stage renal disease patients with secondary hyperparathyroidism

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Geng-He Chang ◽  
Fong-Fu Chou ◽  
Ming-Shao Tsai ◽  
Yao-Te Tsai ◽  
Ming-Yu Yang ◽  
...  
Keyword(s):  
Renal Disease ◽  
Secondary Hyperparathyroidism ◽  
Real World ◽  
End Stage Renal Disease ◽  
Cox Regression ◽  
Electrolyte Imbalance ◽  
Research Database ◽  
Cox Regression Analysis ◽  
Stage Renal Disease ◽  
End Stage

AbstractPatients with end-stage renal disease (ESRD) may demonstrate secondary hyperparathyroidism (SHPT), characterized by parathyroid hormone oversecretion in response to electrolyte imbalance (e.g., hypocalcemia and hyperphosphatemia). Moreover, this electrolyte imbalance may affect vocal cord muscle contraction and lead to voice change. Here, we explored the effects of SHPT on the voices of patients with ESRD. We used data of 147,026 patients with ESRD from the registry for catastrophic illness patients, a sub-database of Taiwan National Health Insurance Research Database. We divided these patients into 2 groups based on whether they had hyperparathyroidism (HPT) and compared vocal dysfunction (VD) incidence among them. We also prospectively included 60 ESRD patients with SHPT; 45 of them underwent parathyroidectomy. Preoperatively and postoperatively, voice analysis was used to investigate changes in vocal parameters. In the real-world database analysis, the presence of HPT significantly increased VD incidence in patients with ESRD (p = 0.003): Cox regression analysis results indicated that patients with ESRD had an approximately 1.6-fold increased VD risk (p = 0.003). In the clinical analysis, the “jitter” and “shimmer” factors improved significantly after operation, whereas the aerodynamic factors remained unchanged. In conclusion, SHPT was an independent risk factor for VD in patients with ESRD, mainly affecting their acoustic factors.

scholarly journals INTRAVENOUS LEVOTHYROXINE DURING HEMODIALYSIS IN A PATIENT WITH HYPOTHYROIDISM AND NON-ADHERENCE TO ORAL MEDICATIONS

2020 ◽  
Vol 6 (5) ◽  
pp. e230-e233
Author(s):  
Dipa Avichal ◽  
Igor Kravets
Keyword(s):  
Renal Disease ◽  
Thyroid Function ◽  
End Stage Renal Disease ◽  
Hashimoto Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Psychiatric Medication ◽  
Medication Regimen ◽  
Free T4 ◽  
Stage Renal Disease ◽  
End Stage

Objective: We describe an unusual and challenging clinical scenario: a patient with end-stage renal disease on hemodialysis with severely uncontrolled hypothyroidism and worsening psychosis, who refused both oral and intramuscular levothyroxine, but was successfully treated with intravenous (IV) levothyroxine given on hemodialysis days. Methods: The patient was interviewed and examined on admission and during hospitalization. Thyroid function was assessed through thyroid-stimulating hormone (TSH), thyroxine (T4), free T4, and triiodothyronine (T3) by electrochemiluminescence immunoassay. Thyroid function was measured on admission, before and after each hemodialysis session for 1 week, and monthly thereafter. Results: The patient was a 71-year-old female with schizoaffective disorder, end-stage renal disease on hemodialysis, and uncontrolled Hashimoto thyroiditis due to non-adherence to oral levothyroxine therapy. On admission her TSH was 172.6 mIU/mL, free T4 was 0.59 ng/dL, and total T3 was 52 ng/dL. She presented to the hospital from her nursing home after repeated refusal to go to hemodialysis sessions secondary to worsening psychosis. At the hospital, she agreed to undergo hemodialysis and receive IV medications, but refused oral and intramuscular levothyroxine. After initiation of IV levothyroxine therapy 3 times weekly during hemodialysis, the patient’s thyroid function normalized within 19 weeks (TSH was 2.2 mIU/L, free T4 was 1.3 ng/dL, total T3 was 60 ng/dL). The achievement of the euthyroid status and adjustment of the patient’s psychiatric medication regimen were followed by a resolution of the patient’s psychosis. Conclusion: This case report demonstrates an unusual approach to the successful control of hypothyroidism, namely administration of IV levothyroxine 3 times weekly during hemodialysis sessions when conventional routes of levothyroxine administration could not be used due to the patient’s refusal.

Sagliker Syndrome in an End-Stage Renal Disease Patient With Secondary Hyperparathyroidism and Localized Mandible Enlargement: A Case Report

2015 ◽  
Vol 120 (2) ◽  
pp. e19
Author(s):  
Wagner Gomes da Silva ◽  
Oslei Paes de Almeida ◽  
Pablo Agustin Vargas ◽  
Karina Morais Faria ◽  
Márcio Ajudarte Lopes ◽  
...  
Keyword(s):  
Case Report ◽  
Renal Disease ◽  
Secondary Hyperparathyroidism ◽  
End Stage Renal Disease ◽  
Disease Patient ◽  
Stage Renal Disease ◽  
End Stage
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