Effect of Prophylactic Calcitriol Administration on Serum Ionized Calcium Concentrations after Parathyroidectomy: 78 Cases (2005–2015)

Abstract

BackgroundProphylactic administration of calcitriol has been suggested to mitigate the risk of hypocalcemia after parathyroidectomy. The effect of calcitriol on postoperative serum ionized calcium concentrations has not been evaluated in dogs after parathyroidectomy.Hypothesis/ObjectivesTo determine the effect of prophylactic calcitriol administration on postoperative serum ionized calcium (iCa) concentrations in dogs with primary hyperthyroidism (PHPTH) treated by parathyroidectomy.AnimalsSeventy‐eight dogs with primary hyperparathyroidism treated surgically.MethodsMulti‐institutional retrospective case study. Medical records from 2005 to 2015 were evaluated. Dogs were included if they had a diagnosis of PHPTH and had surgery to remove parathyroid tissue. Serum iCa concentrations were monitored for a minimum of 2 days postoperatively. Two study groups were evaluated: calcitriol administration and no calcitriol administration.ResultsSerial postoperative iCa concentrations measured at 12‐hour time intervals for 2 days postoperatively were positively associated with preoperative iCa concentrations. This association was evident at each time interval, and the effect of preoperative iCa concentrations on postoperative iCa concentrations decreased as time elapsed (12 hours, P < 0.0001; 24 hours, P < 0.0001; 36 hours, P < 0.04; and 48 hours, P = 0.01). Prophylactic calcitriol administration was not found to be significantly associated with postoperative iCa concentrations or its rate of decrease after parathyroidectomy.Conclusion and Clinical ImportanceWe found no protective value in administering calcitriol prophylactically to prevent hypocalcemia in the immediate postoperative period (48 hours) after parathyroidectomy. Preoperative iCa concentrations had a significant positive association with postoperative iCa concentrations throughout the monitoring period.

Perioperative characteristics, histological diagnosis, and outcome in cats undergoing surgical treatment of primary hyperparathyroidism

“…Two studies found that dogs with higher preoperative serum tCa concentrations were not predisposed to hypocalcemia, which is consistent with our results . Authors of a recent article describing a study of dogs that were surgically treated for PHPT reported that prophylactic preoperative calcitriol administration was not associated with postoperative iCa or its rate of decrease after parathyroidectomy . The effect of prophylactic preoperative calcitriol administration on postoperative iCa in cats remains unknown.…”

“…Median surgical time was relatively short (37 minutes). Similarly to dogs with PHPT, most (62.5%) cats were diagnosed with a parathyroid adenoma . However, parathyroid carcinoma was diagnosed in 21.9% of cats, which is higher than that reported in dogs (0%–15%) .…”

“…Similarly to dogs with PHPT, most (62.5%) cats were diagnosed with a parathyroid adenoma . However, parathyroid carcinoma was diagnosed in 21.9% of cats, which is higher than that reported in dogs (0%–15%) . A recent article describing a study in dogs undergoing surgical treatment of PHPT that reported a 15% incidence of parathyroid carcinoma in surgically resected glands did not find an association between histologic diagnosis and alterations in postoperative iCa concentration.…”

Ambidirectional cohort study on the agreement of ultrasonography and surgery in the identification of parathyroid pathology, and predictors of postoperative hypocalcemia in 47 dogs undergoing parathyroidectomy due to primary hyperparathyroidism

“…Primary hyperparathyroidism (PHPT) is a well‐recognized cause of hypercalcemia in dogs 1 . Despite this, research surrounding PHPT remains contentious 1–15 . In PHPT, a hypercalcemic state is produced through the secretion of parathyroid hormone (PTH) by pathologic chief cells (adenoma, hyperplasia, or adenocarcinoma) resulting in stimulation of renal tubular and intestinal calcium resorption and osteoclast‐mediated bone resorption 16,17 .…”

The Use of Percutaneous Ultrasound-Guided Radiofrequency Heat Ablation for Treatment of Primary Hyperparathyroidism in Eight Dogs: Outcome and Complications

“…A recent study also supports this theory, confirming the presence of a moderate correlation between the pre-operative iCa 2+ value and post-operative hypocalcemia [12]. Conversely, other authors report that the prophylactic administration of vitamin D has no protective value [20] and it should be limited to patients presenting signs of hypocalcemia or a severe decrease in serum calcium concentration after the procedure [21,22]. In the present study, a pre-operative supplementation was performed in only two (2/8) dogs.…”