Hypocalcemia after ultrasound-guided microwave ablation and total parathyroidectomy for secondary hyperparathyroidism: a retrospective study

Abstract

Objective: To compare the postoperative hypocalcemia between ultrasound-guided microwave ablation (MWA) and total parathyroidectomy (TPTX) for secondary hyperparathyroidism (SHPT). Methods: The retrospective study reviewed 286 SHPT patients (171 received MWA and 115 underwent TPTX) between March 2018 and May 2019. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. A total of 184 SHPT patients (92 in each group) were finally enrolled, the occurrence and prognosis of postoperative hypocalcemia were compared. And the risk factors associated with severe hypocalcemia (SH) in each group were analyzed. Results: Hypocalcemia encountered in 95cases (49 in the MWA group and 46 in the TPTX group). SH occurred in 76 cases (40 in the MWA group and 36 in the TPTX group). There were no statistically significant differences in the detection time, incidence, minimum value of serum calcium and symptomatic hypocalcemia between MWA and TPTX group (all p values > 0.05). Of patients developing hypocalcemia, serum calcium did not recover to normal range in 5 cases (10.2%) in the MWA group, while 13 cases (28.3%) were still hypocalcemia at 6 months follow-up in TPTX group (p ¼ 0.035). The time to recovery from hypocalcemia in the TPTX group (mean 30 days, range 3-180 days) was longer than the WA group (mean 14 days, range 3-126 days) (p ¼ 0.000). High serum alkaline phosphatase (ALP) level and low serum calcium level were the main risk factors of postoperative SH. Conclusion: There was no difference in hypocalcemia between MWA and TPTX group. Hypocalcemia in the TPTX group might need a longer time to recover.

Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: a meta-analysis

“…Hypocalcemia or even hungry bone syndrome (HBS) after PTX is a well-known and severe complication [ 5 , 8–10 ] reported to affect most patients with chronic kidney disease (CKD). Hypocalcemia may trigger weakness, headache, paresthesia, muscle cramps, laryngeal stridor, seizures, cardiac arrhythmias, and tetany.…”

Evaluation of efficacy of ultrasound‐guided microwave ablation in primary hyperparathyroidism

“…35 One patient developed bone pain with no obvious cause, mainly Patients after MWA may have a temporary decrease in serum calcium. 36 Thus, timely reexamination should be conducted to avoid the occurrence of postoperative hypocalcemia. When hypocalcemia occurs, calcium gluconate may be taken orally for mild symptoms.…”

Use of 99mTc-sestamibi SPECT/CT imaging in predicting the degree of pathological hyperplasia of the parathyroid gland: semi-quantitative analysis

“…For SHPT patients, hypocalcemia is one of the most common complications after PTX (23). Although we have given priority to the postoperative monitoring and management of serum calcium levels, the incidence of hypocalcemia after PTX remains high (24,25). Hypocalcemia is the reduction of calcium from circulation (26).…”