Incidence, survival time, and surgical treatment of parathyroid carcinomas in dogs: 100 cases (2010–2019)

OBJECTIVE To evaluate outcomes of dogs with parathyroid carcinoma (PTC) treated by surgical excision and to describe the incidence of postoperative hypocalcemia, degree of hypocalcemia, duration of hospitalization, duration of calcium supplementation, and survival time ANIMALS 100 client-owned dogs with PTC admitted to academic, referral veterinary institutions. PROCEDURES In a retrospective multi-institutional study, medical records of dogs undergoing surgical excision of PTC between 2010 to 2019 were reviewed. Signalment, relevant medical history, clinical signs, clinicopathologic testing, imaging, surgical findings, intraoperative complications, histologic examination, and survival time were recorded. RESULTS 100 dogs with PTC were included, and 96 dogs had clinical or incidental hypercalcemia. Common clinical signs included polyuria (44%), polydipsia (43%), hind limb paresis (22%), lethargy (21%), and hyporexia (20%). Cervical ultrasonography detected a parathyroid nodule in 91 of 91 dogs, with a single nodule in 70.3% (64/91), 2 nodules in 25.3% (23/91), and ≥ 3 nodules in 4 (4/91)% of dogs. Hypercalcemia resolved in 89 of 96 dogs within 7 days after surgery. Thirty-four percent of dogs developed hypocalcemia, on the basis of individual analyzer ranges, within 1 week after surgery. One dog had metastatic PTC to the prescapular lymph node, and 3 dogs were euthanized for refractory postoperative hypocalcemia. Estimated 1-, 2-, and 3-year survival rates were 84%, 65%, and 51% respectively, with a median survival time of 2 years. CONCLUSIONS AND CLINICAL RELEVANCE Excision of PTC results in resolution of hypercalcemia and excellent long-term tumor control. Surgical excision of PTC is recommended because of resolution of hypercalcemia and a good long-term prognosis. Future prospective studies and long-term follow-up are needed to further assess primary tumor recurrence, metastasis, and incidence of postoperative hypocalcemia.

Sporadic primary hyperparathyroidism with multiple parathyroid adenomas

Multiple lesions of the parathyroid glands (PTG) in primary hyperparathyroidism (PHPT) can be sporadic or develop as part of hereditary syndromes, manifesting at young age. There the description of a severe sporadic PHPT with big parathyroid neoplasms in the young patient is presented. Clinical data made it possible to suspect MEN-1 syndrome or parathyroid carcinomas; however, mutations CDKN, CDC73, MEN1 were excluded. The patient underwent removal of three identified tumors: benign adenomas of the left PTG and hyperplasia of the right one. Postoperative hypocalcemia and severe hungry bone syndrome required the administration of vitamin D and calcium carbonate preparations. However, a year after the operation, a «mild» recurrent disease was confirmed. Taking into account the patient’s refusal to reoperation and a significant improvement of the target organs state, active observation was continued. The patient needs further careful dynamic monitoring by specialists in order to timely identify indications for repeated surgical treatment to improve the life quality and span.

Evaluation of High Dose Preoperative Activated Vitamin D to Prevent Post Total Thyroidectomy Hypocalcemia

Background With increase in the number of thyroidectomies, the incidence of postoperative hypocalcemia has seen a rise as well. Deficiency of vitamin D has long been debated as a risk factor for post thyroidectomy hypocalcemia. The advantage of using vitamin D as a predictor for postoperative hypocalcemia may be (i) easy to estimate (ii) any deficiency can be easily corrected. Objective To determine the effectiveness of preoperative high dose calcitriol supplementation in reducing hypocalcemia following total thyroidectomy. Patients and Methods to assess the effect of preoperative vitamin D3 deficiency on post thyroidectomy hypocalcemia. For that purpose, 40 Egyptian patients for whom total thyroidectomy was performed in general surgery department at El-demerdash and Ain Shams University Specialized Hospital form March 2020 to September 2020. Patients were divided into 2 Groups; Group 1 included patients receiving preoperative single oral dose of active vit D(300000 IU) and Group 2 included patients receiving placebo instead of vit D. The incidence of postoperative hypocalcemia was investigated in all patients. Results Preoperative vitamin D measurements revealed a deficiency prevalence of 66.7% and a mean Vitamin D level of 17.09 ± 6.01. The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours and 72 hours. With respect to relation between calcium and preoperative vitamin D, the results showed that there is no big difference between two groups (hypocalcemia occurred in 30% from patients in vit D group and 35% in placebo group) and no patients with normal preoperative vitamin D had a postoperative hypocalcemia 24, 48 or 72 hours after the operation. Conclusion Giving of single preoperative high dose vitamin D doesn’t reduce the overall rate of hypocalcemia after total thyroidectomy. Postoperative hypocalcemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to develop hypocalcemia.

Is serum phosphorous level an early indicator of post-operative hypocalcemia after total thyroidectomy? A prospective analysis

Background: Total thyroidectomy is a commonly performed surgery. Postoperative hypocalcemia is a worrisome complication which can be treated if recognized early. We analysed serum phosphorous as a potential marker of postoperative hypocalcemia.Methods: The study was a cross-sectional study done in our tertiary care hospital. We analysed the serum phosphorous levels of 50 patients who underwent total thyroidectomy at our institution. The incidence of hypocalcemia was documented and analysed with respect to serum phosphorous.Results: In the study, 18 (36%) had hypocalcaemia on third postoperative day and 32 (64%) had no hypocalcaemia. There was no relation between post thyroidectomy day one serum phosphorus value and post-thyroidectomy day three serum calcium value (p=0.709).Conclusions: The study did not find any statistically significant association between serum phosphorous and post-thyroidectomy serum calcium levels.

Can preoperative 25-hydroxyvitamin D levels predict transient hypocalcemia after total thyroidectomy?

Transient postoperative hypocalcemia is a common complication after total thyroidectomy. Evidence on contributing metabolic factors is contradictory. Our work aims to define the role of preoperative 25-hydroxyvitaminD levels in developing transient postoperative hypocalcemia. 183 consecutive patients who underwent total thyroidectomy at our institution (May 2017–December 2019) were included in the retrospective study. We reported gender, age, estimated glomerular filtration rate, creatinine, preoperative 25-hydroxyvitaminD, serum pre- and postoperative calcium, pre- and postoperative PTH levels and transient postoperative hypocalcemia occurrences. We compared variables both among patients with and without transient postoperative hypocalcemia and between patients with different 25-hydroxyvitaminD levels (< 10 ng/ml deficitary; 11–30 ng/ml insufficient; > 30 ng/ml, normal). A binomial logistic regression model evaluating the risk for transient postoperative hypocalcemia was elaborated. Patients with transient postoperative hypocalcemia had lower levels of postoperative PTH (p < 0.001) and more frequently normal or deficitary 25-hydroxyvitaminD levels (p = 0.05). When comparing patients according to their 25-hydroxyvitaminD levels, insufficiency was associated with a lower rate of transient postoperative hypocalcemia (p = 0.05); deficiency was associated with higher preoperative PTH (p = 0.021), postoperative PTH (p = 0.043) and estimated glomerular filtration rate (p = 0.031) and lower serum creatinine (p = 0.014). In the regression model higher preoperative PTH (OR = 1.011, p = 0.041) and 25-hydroxyvitaminD deficiency (OR = 0.343, p = 0.011) significantly predicted transient postoperative hypocalcemia. Data analysis revealed a correlation between transient postoperative hypocalcemia and 25-hydroxyvitaminD levels: our work points towards the possibility to stratify the risk of transient postoperative hypocalcemia according to patients’ preoperative 25-hydroxyvitaminD status.

Factors associated with postoperative hypocalcemia following surgery for thyroid cancer in childhood

Background: Postoperative hypocalcemia is a frequent complication after thyroid surgery. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. The present study analyzes rates and factors associated with the development of TtHP or PtHP following thyroid surgery in a pediatric population. Procedure: A retrospective multicenter study analyzing 363 patients was carried out. We recorded gender, age, tumor size, type of surgery, lymph node dissection, histology. Calcium levels were acquired daily for 72 hours after discharge. Subsequent sample collection was customized on the patient’s hypocalcemia severity. Results: We analyzed 363 patients aged ≤18 years (mean age 14.2 years) who underwent thyroid surgery clustered into age groups (≤15 or >15). Patients mean follow-up was 5.8 years (1-11yrs). At histology 310 (85%) were papillary carcinoma, 32 (9%) were follicular carcinoma, 6 (2%) presented diffuse sclerosing variant of papillary thyroid carcinoma whilst 15 (4%) had familial medullary carcinoma. TtHP developed in 36 (9,9%), PtHP in 20 (5.5%) cases. TtHP was more frequent in younger patients (p=0,009). Both PtHP and TtHP were increased in case of larger tumors (≥2 cm) (p=0,001). All TtHP and PtHP were in TT group. PtHP rate was increased if lymph node dissection was carried out (p<0.001). Conclusions: The risk of hypoparathyroidism is related to younger age, tumor size, TT and lymph node dissection therefore surgeons should tailor surgery as much as possible to avert such complication.