Juan J Díez1,2, Emma Anda3, Julia Sastre4, Begoña Pérez Corral5, Cristina Álvarez-Escolá6, Laura Manjón7, Miguel Paja8, Marcel Sambo9, Piedad Santiago Fernández10,11, Concepción Blanco Carrera12, Juan C Galofré13, Elena Navarro14, Carles Zafón15, Eva Sanz15, Amelia Oleaga8, Orosia Bandrés16, Sergio Donnay17, Ana Megía18, María Picallo9, Cecilia Sánchez Ragnarsson7, Gloria Baena-Nieto19, José Carlos Fernández-García20, Beatriz Lecumberri6, Manel Sahún de la Vega21, Ana R Romero-Lluch14, Pedro Iglesias1,2. 1. Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 2. Present address: Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Madrid, Spain. 3. Department of Endocrinology, Complejo Hospitalario de Navarra, Pamplona, Spain. 4. Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain. 5. Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain. 6. Department of Endocrinology, Hospital Universitario La Paz, Madrid, Spain. 7. Department of Endocrinology, Hospital Universitario Central de Asturias, Oviedo, Spain. 8. Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain. 9. Department of Endocrinology, Hospital Universitario Gregorio Marañón, Madrid, Spain. 10. Department of Endocrinology, Complejo Hospitalario de Jaén, Jaén, Spain. 11. Department of Endocrinology, Hospital Universitario Virgen de las Nieves, Granada, Spain. 12. Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain. 13. Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain. 14. Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 15. Department of Endocrinology, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 16. Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain. 17. Department of Endocrinology, Fundación Hospital de Alcorcón, Alcorcón, Madrid, Spain. 18. Department of Endocrinology, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain. 19. Department of Endocrinology, Hospital de Jerez, Jerez de la Frontera, Cádiz, Spain. 20. Department of Endocrinology, Hospital Universitario Virgen de la Victoria, Málaga, Spain. 21. Department of Endocrinology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
Abstract
BACKGROUND: Recent guidelines for the treatment of hypoparathyroidism emphasize the need for long-term disease control, avoiding symptoms and hypocalcaemia. Our aim has been to analyze the prevalence of poor disease control in a national cohort of patients with hypoparathyroidism, as well as to evaluate predictive variables of inadequate disease control. METHODS: From a nation-wide observational study including a cohort of 1792 patients undergoing total thyroidectomy, we selected 260 subjects [207 women and 53 men, aged (mean ± SD) 47.2±14.8 years] diagnosed with permanent hypoparathyroidism. In every patient demographic data and details on surgical procedure, histopathology, calcium (Ca) metabolism, and therapy with Ca and calcitriol were retrospectively collected. A patient was considered not adequately controlled (NAC) if presented symptoms of hypocalcemia or biochemical data showing low serum Ca levels or high urinary Ca excretion. RESULTS: Two hundred and twenty-one (85.0%) patients were adequately controlled (AC) and 39 (15.0%) were NAC. Comparison between AC and NAC patients did not show any significant difference in demographic, surgical, and pathological features. Rate of hospitalization during follow-up was significantly higher among NAC patients in comparison with AC patients (35.9% vs. 10.9%, P<0.001). Dose of oral Ca and calcitriol were also significantly higher in NAC subjects. In a subgroup of 129 patients with serum parathyroid hormone (PTH) levels available, we found that NAC patients exhibited significantly lower postoperative PTH concentrations than AC patients [median (interquartile range) 3 (1.9-7.8) vs. 6.9 (3.0-11) pg/mL; P=0.009]. CONCLUSIONS: In a nation-wide cohort of 260 subjects with definitive hypoparathyroidism, 15% of them had poor disease control. These patients required higher doses of oral Ca and calcitriol, had higher rate of hospitalization during follow-up and showed lower PTH concentrations in the postoperative period. 2020 Gland Surgery. All rights reserved.
BACKGROUND: Recent guidelines for the treatment of hypoparathyroidism emphasize the need for long-term disease control, avoiding symptoms and hypocalcaemia. Our aim has been to analyze the prevalence of poor disease control in a national cohort of patients with hypoparathyroidism, as well as to evaluate predictive variables of inadequate disease control. METHODS: From a nation-wide observational study including a cohort of 1792 patients undergoing total thyroidectomy, we selected 260 subjects [207 women and 53 men, aged (mean ± SD) 47.2±14.8 years] diagnosed with permanent hypoparathyroidism. In every patient demographic data and details on surgical procedure, histopathology, calcium (Ca) metabolism, and therapy with Ca and calcitriol were retrospectively collected. A patient was considered not adequately controlled (NAC) if presented symptoms of hypocalcemia or biochemical data showing low serum Ca levels or high urinary Ca excretion. RESULTS: Two hundred and twenty-one (85.0%) patients were adequately controlled (AC) and 39 (15.0%) were NAC. Comparison between AC and NAC patients did not show any significant difference in demographic, surgical, and pathological features. Rate of hospitalization during follow-up was significantly higher among NAC patients in comparison with AC patients (35.9% vs. 10.9%, P<0.001). Dose of oral Ca and calcitriol were also significantly higher in NAC subjects. In a subgroup of 129 patients with serum parathyroid hormone (PTH) levels available, we found that NAC patients exhibited significantly lower postoperative PTH concentrations than AC patients [median (interquartile range) 3 (1.9-7.8) vs. 6.9 (3.0-11) pg/mL; P=0.009]. CONCLUSIONS: In a nation-wide cohort of 260 subjects with definitive hypoparathyroidism, 15% of them had poor disease control. These patients required higher doses of oral Ca and calcitriol, had higher rate of hospitalization during follow-up and showed lower PTH concentrations in the postoperative period. 2020 Gland Surgery. All rights reserved.
Entities:
Keywords:
Permanent hypoparathyroidism; adequacy of control; parathyroid hormone (PTH); thyroidectomy
Authors: Gian Luigi Canu; Fabio Medas; Alessandro Longheu; Francesco Boi; Giovanni Docimo; Enrico Erdas; Pietro Giorgio Calò Journal: Open Med (Wars) Date: 2019-06-07