Calcium Requirements after Parathyroidectomy in Patients with Refractory Secondary Hyperparathyroidism

Abstract

Background/Aims: Calcium supplements are often required following successful parathyroidectomy (PTX) in order to prevent overt hypocalcemia. The current study aims to quantify these calcium needs and to identify predictors of a high calcium need present at the time of surgery. Methods: Charts of 42 patients with chronic kidney disease stage 5D, who underwent a successful subtotal PTX, were reviewed in detail. Biochemical indices of mineral metabolism available within a time frame of 4 weeks before and 6 weeks after the surgery were registered. Details concerning active vitamin D (1-α-calcidiol and calcitriol) and calcium supplementation were recorded as well. Results: Serum calcium, phosphorus and PTH levels declined whereas total alkaline phosphatase levels increased significantly in the early post-PTX period. Transient hypocalcemia was observed in 83% of the patients. The median daily postoperative elemental calcium requirements amounted to 3.2 g during week 1, and declined to 2.4 g during week 6. A high preoperative PTH level and a low serum calcium level were identified as independent predictors of a high postoperative calcium need. Conclusion: Substantial amounts of elemental calcium are required following successful subtotal PTX in order to avoid frank hypocalcemia, especially in patients with a high PTH level and a low calcium level before surgery.

Postoperative Hungry Bone Syndrome in Patients with Secondary Hyperparathyroidism of Renal Origin

“…Identification of preoperative indicators of HBS would allow for implementation of therapeutic measures to prevent the development of HBS. This study demonstrated younger age B45 years old as the single preoperative risk factor significantly associated with the development of HBS in patients undergoing SPTX or TPTX for 2HPT; this confirms findings from previous studies in the literature [13,15]. These results suggest that such patients should be placed on an aggressive perioperative calcium replacement protocol.…”

Parathyroidectomy in the treatment of secondary hyperparathyroidism. Clinical and laboratory outcomes/ Paratiroidectomia în tratamentul hiperparatiroidismului secundar. Aspecte clinice şi de laborator

“…After the surgery iPTH level decreased significantly and the average values remain low in both short and medium term period of follow-up. As we have previously mentioned we had 2 patients with persistent HPT, thus giving us a success rate of 93.1% after the first operation, somehow lower than the one reported in the literature (24)(25)(26).…”

“…Prolonged severe postoperative hypocalcemia (more than 4 days long) associated with hypophosphatemia define "hungry bones" syndrome, its severity being directly related with the degree of preoperative bone disease (24)(25)(26).…”

Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters

“…7 Patients are at high risk of hypocalcaemia with symptoms such as tetany, cardiac arrhythmia and even sudden death. 6,7 Transient postoperative hypocalcaemia, broadly referred to hungry bone syndrome, is often found following parathyroidectomy. 8 To avoid postoperative hypocalcaemia, intravenous calcium supplements are often required.…”

“…6,11 Numerous studies support the view that intravenous calcium supplementation works more quickly than oral administration and all patients after parathyroidectomy should be given intravenous calcium infusion therapy. 6,7,9,32,33 To avoid of these adverse consequences, calcium is commonly infused through femoral CVCs because of ease of operation for surgeons.…”