Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients
Juan J Díez 1 2 , Emma Anda 3 , Julia Sastre 4 , Begoña Pérez Corral 5 , Cristina Álvarez-Escolá 6 , Laura Manjón 7 , Miguel Paja 8 , Marcel Sambo 9 , Piedad Santiago Fernández 10 11 , Concepción Blanco Carrera 12 , Juan C Galofré 13 , Elena Navarro 14 , Carles Zafón 15 , Eva Sanz 15 , Amelia Oleaga 8 , Orosia Bandrés 16 , Sergio Donnay 17 , Ana Megía 18 , María Picallo 9 , Cecilia Sánchez Ragnarsson 7 , Gloria Baena-Nieto 19 , José Carlos Fernández-García 20 , Beatriz Lecumberri 6 , Manel Sahún de la Vega 21 , Ana R Romero-Lluch 14 , Pedro Iglesias 1 2
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.
CITA DEL ARTÍCULO Gland Surg. 2020 Oct;9(5):1380-1388. doi: 10.21037/gs-20-288