Vitamin D Insufficiency Predicts Susceptibility of Parathyroid Hormone Reduction after Total Thyroidectomy in Thyroid Cancer Patients

Objective. Given its role in the regulation of calcium and PTH levels, vitamin D was presumed as a potential predictor of postoperative hypoparathyroidism. However, the reports about their association were controversial. This study aims to reveal the relationship between preoperative vitamin D and postoperative parathyroid hormone (PTH). Methods. A total of 242 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy (TT) during the period from June 2016 to December 2017 at our hospital were enrolled. Patients were divided into two groups, HypoP and Non-HypoP groups, based on postoperative PTH < 15.0 or ≥15.0 pg/mL, and ΔPTH50+ and ΔPTH50− groups, based on postoperative PTH reduction ratio ≥ 50% or <50%. Clinicopathological features and laboratory data were compared between two sets of groups. Results. Preoperative PTH level was lower in the HypoP group than in the Non-HypoP group (42.83 vs. 47.52 pg/mL, p = 0.018 ). No significant difference of vitamin D insufficiency was found between the HypoP and Non-HypoP groups (80.8% vs. 74.1%, p = 0.226 ). The rate of vitamin D insufficiency was higher in the ΔPTH50+ group than in the ΔPTH50− group (82.6% vs. 68.4%, p = 0.010 ). By multivariate logistic regression analysis, vitamin D insufficiency was an independent predictor of postoperative PTH reduction ratio ≥ 50% (OR = 2.2, p = 0.017 ). Conclusion. Vitamin D insufficiency is not associated with postoperative PTH in PTC patients undergoing TT. However, vitamin D insufficiency is an independent predictor of postoperative PTH reduction ratio.

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

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.

The role of magnesium in the correction of postoperative hypocalcemia

Background. The postoperative hypoparathyroidism remains a specific complication in the thyroid surgery. The incidence of iatrogenic hypoparathyroidism ranges from 3.0 % to 31.5 %. The decrease in the level of parathyroid hormone leads to the launch of a cascade of the electrolyte changes. The standard methods for controlling and correcting hypoparathyroidism do not guarantee the prevention of hypocalcemiacases. The role of calcium and magnesium in the conduction of the nerve impulses along muscle fibers is well known. The study of the role of magnesium will enable further correction of the manifestations of postoperative hypoparathyroidism.Aim — to study a relationship between postoperative hypoparathyroidism, changes in calcium-magnesium metabolism and their clinical manifestations; to analyze the effects of hypomagnesemia on the clinical manifestations of hypocalcemia; to study the possibility of correcting calcium-magnesium metabolism in the postoperative period.Materials and methods. The study involved 145 patients operated for the thyroid diseases. The patients were divided into two groups. The main group (n = 73) included the patients who took magnesium medications in the preoperative period for 10—14 days at a dose of 1500—2000 mg/day. In the observation group (n = 72), the patients did not take the magnesium medications. Parameters of the parathyroid hormone, ionized calcium, and magnesium were measured in all patients in the preoperative period and on the first day of the postoperative period. The parathyroid hormones’levels on the first day of postoperative period were ranged into the “ranges”: 1) parathyroid hormone — ≤ 1 pg/ml, 2) parathyroid hormone — 1—5 pg/ml, 3) parathyroid hormone — 5—10 pg/ml, 4) parathyroid hormone — > 10 pg/ml. The clinical manifestations of hypoparathyroidism were assessed on a scale: not pronounced, poorly pronounced, pronounced, sharply pronounced.Results. The correlations were found between the levels of the postoperative magnesium, ionized calcium and parathyroid hormone. In the main group, the number of the pronounced and sharply pronounced manifestations of hypocalcemia was observed in the parathyroid hormone range — ≤ 1 pg/ml. In the observation group, the largest number of the prono­unced and sharply pronounced clinical manifestations was recorded in the parathyroid hormone range — ≤ 1 pg/ml, parathyroid hormone — 1—5 pg/ml. In the main group, in comparison with the observation group, the total number of the clinical manifestations of hypocalcemia was lower.Conclusions. There were revealed the positive cor­rela­tions in the changes in the levels of the parathyroid hormone, ionized calcium and magnesium. It has been proven that uncorrected hypomagnesemia in the early postoperative period can be a predictor of the clinical manifestations of hypoparathyroidism. The correction of the serum magnesium levels in most patients reduces the clinical manifestations of hypocalcemia.

Analysis of complications of surgical treatment of patients with autoimmune thyroiditis

Aim — to study the frequency and structure of specific complications in surgeries for autoimmune thyroiditis AIT associated with benign nodules in comparison with operations for multinodular non-toxic goiter. Materials and methods. The analysis of complications of thyroidectomy was performed for 237 patients operated for AIT (main group) and 261 for multinodular non-toxic goiter (control group). The evaluation was done to assess thesurgeryduration, the frequency of laryngeal paresis, postoperative hypoparathyroidism, thoracic duct damage, intense neck hematomas, dysphagia and changes in voice tone. Results. More complications were found in patients of the main group — 33 against 20 in the control group. The structure and number of individual complications from their total number in both groups was the same, and the frequency of the number of operated patients was significantly higher in the group of patients with AIT. The duration of thyroidectomy in AIT was (174.3 ± 4.2) min and depended on the severity of inflammatory changes in the gland and tissues around it, and in cases of multinodular non-toxic goiter — (127.0 ± 4.7) min (p < 0.01). Conclusions. Thyroidectomy for AIT compared to multinodular non-toxic goiter is accompanied by a greater number of complications and duration of surgery. There is an increased risk of developing hypoparathyroidism, laryngeal paresis, thoracic duct injuries, severe neck hematomas, dysphagia and changes in voice tone.

Management and Outcome of Parathyroid Carcinoma-Induced Primary Hyperparathyroidism: A Single-Centre Experience

Background. Parathyroid carcinoma (PC) is the rarest endocrine cancer and an infrequent cause of primary hyperparathyroidism (PHPT), responsible for less than 1% of cases. Due to its rarity, treatment is challenging. Methods. A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. We identified and individually described the patients affected with PC. Then, we split all patients treated for PHPT into four groups based on the cause: PC, adenoma, atypical adenoma, and hyperplasia. Patients’ demographics, preoperative evaluation results, intraoperative findings, and outcomes for the PC group were compared with groups of PHPT due to benign causes. Results. Eight cases of PC were identified, five males and three females. Seven cases presented with symptoms of hypercalcemia and one with a neck mass. Five underwent en bloc resections and three local excisions. Histopathological features showed capsular invasion in four patients, capsular and soft tissue invasion in three patients, and vascular invasion in one case. No patients had distant metastasis. One patient was classed as high risk based on the Schulte classification system. All patients treated for PC were alive and disease-free at a mean follow-up of 38.4 months. When compared with other PHPT patients, PC patients were more frequently male and had higher preoperative blood calcium and PTH and lower phosphate levels, larger and heavier parathyroids excised, lower postoperative calcium, and a higher rate of postoperative hypoparathyroidism. Conclusion. Our study highlights some aspects valuable to suspect PC and differentiate PHPT-PC from benign causes of PHPT preoperatively. Preoperative suspicion of malignancy is essential to guarantee the best course of treatment for patients. Although limited for size and follow-up, the excellent outcome of our series seems to support the value of both surgery extension and risk class according to the Schulte classification as possible prognostic factors for recurrence.

Score twice before you cut once: a clinical case of reconstructive bariatric surgery after obesity surgery in a patient with postoperative hypothyroidism and hypoparathyroidism

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.