Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients

Identificador:  imarina:9138945

Handle: https://hdl.handle.net/20.500.11797/imarina9138945

Autors:  Diez, Juan J; Anda, Emma; Sastre, Julia; Perez Corral, Begona; Alvarez-Escola, Cristina; Manjon, Laura; Paja, Miguel; Sambo, Marcel; Santiago Fernandez, Piedad; Blanco Carrera, Concepcion; Galofre, Juan C; Navarro, Elena; Zafon, Caries; Sanz, Eva; Oleaga, Amelia; Bandres, Orosia; Donnay, Sergio; Megia, Ana; Picallo, Maria; Sanchez Ragnarsson, Cecilia; Baena-Nieto, Gloria; Fernandez-Garcia, Jose Carlos; Lecumberri, Beatriz; Sahun de la Vega, Manel; Romero-Lluch, Ana R; Iglesias, Pedro

Resum:
© 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.