Impairments in quality of life and predictors of symptom burden in patients with hypoparathyroidism: results from a population-based survey

Büttner, M; Krogh, Dieter; Siggelkow, Heide; Schnittger, Susanne

doi:10.1007/s12020-023-03443-2

Cited by 6 publications

(15 citation statements)

References 39 publications

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“…59.4% of patients with hypoPTH reported inadequate symptom control [4 ▪ ,9]. Manifestations of hypocalcemia can range from paraesthesia, muscle spasms, arrhythmia, heart failure, laryngospasm and seizures.…”

Section: Complications Of Hypoparathyroidismmentioning

confidence: 99%

“…Three studies reported lower SF-36 scores across all domains compared with age-matched and sex-matched clinical controls [18–20]. The newer, disease-specific Hypoparathyroid Patient Questionnaire (HPQ-28) found hypoPTH patients had the highest symptom burden in loss of vitality, pain and cramps, and numbness and tingling sensations [9]. Most studies did not find an association between calcium levels and QoL, likely because blood calcium cannot be captured in real-time with symptom onset [14 ▪▪ ].…”

Section: Complications Of Hypoparathyroidismmentioning

confidence: 99%

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Hypoparathyroidism update

Chiang

2024

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review Since the release of the 2022 Second International Workshop Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines, updates and advances are now available in the cause, complications, and treatment of adult chronic hypoparathyroidism (hypoPTH). This review aims to highlight these new findings and implications to patient care. Recent findings Postsurgical hypoparathyroidism remains the most common cause, immune-related hypoparathyroidism from checkpoint inhibitors is an emerging autoimmune cause. In a large retrospective cohort study of thyroidectomies, incident fracture was lower, particularly in the vertebra, in the hypoPTH cohort, compared with postthyroidectomy control group. Hypercalciuria increases risk for renal calculi in hypoPTH independent of disease duration and treatment dose. Quality of life is impaired in hypoPTH patients on conventional therapy, improvement was noted post-PTH replacement. TranCon PTH phase 3 RCT reported eucalcemia with reduced renal calcium excretion, normalization of bone turn-over markers, stable BMD and improved quality of life. Summary HypoPTH is a chronic disease associated with significant morbidity and poor Quality of Life. Awareness of treatment targets and follow-up investigations can alleviate patient anxiety regarding over-treatment and under-treatment. Progress in long-acting PTH replacement strategies might provide accessible, feasible alternatives to conventional therapy in brittle hypoPTH patients.

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Section: Complications Of Hypoparathyroidismmentioning

confidence: 99%

Section: Complications Of Hypoparathyroidismmentioning

confidence: 99%

Hypoparathyroidism update

Chiang

2024

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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“…If the condition persists and the PG function is not restored, the condition becomes permanent. It is well-described that permanent hypoPT is associated with reduced quality of life (5)(6)(7)(8)(9). In addition, novel studies have shown that permanent hypoPT following total thyroidectomy also might be associated with an increased risk of cardiovascular events, renal insufficiency, malignancy as well as an increased mortality (10,11).…”

Section: Introductionmentioning

confidence: 99%

Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution

Abood,

Ovesen,

Rolighed

et al. 2024

Front. Endocrinol.

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BackgroundHypoparathyroidism following total thyroidectomy is globally the most common complication to thyroid surgery. The reported complication rates vary widely and might be highly dependent on the surgical experience. In this study we aimed to evaluate the rate of hypoparathyroidism following primary total thyroidectomy at a low-volume institution that only performs thyroid surgery and does not have any experience with parathyroid surgery.MethodsRetrospective cohort study. All patients undergoing primary total thyroidectomy at the ENT-Department, Goedstrup Hospital, Denmark, over a 5-year period (2016-2020) were identified through the procedure codes for total thyroidectomy. Medical records, pathology reports, biochemical and medical histories were fully assessed for each patient. The primary endpoint was the rate of hypoparathyroidism- both immediate and permanent. Secondary outcomes were parathyroid gland identification rates, rates of parathyroid gland autotransplantation, and rates of inadvertent parathyroid gland excision.ResultsA total of 89 patients were included in the final analysis. A total of 33 patients (37.1%) experienced immediate hypoparathyroidism following surgery, while 30 patients (33.7%) still were on active vitamin D two months postoperatively. One year following surgery, 28 patients (31.5%) were still on active vitamin D and were considered as having permanent hypoparathyroidism. Sixty-one percent of the parathyroid glands were identified intraoperatively, and 19% of the patients experienced parathyroid autotransplantation. Inadvertent parathyroid gland excision occurred for 21% of the patients and was associated with a significantly increased risk of permanent hypoparathyroidism (RR = 2.99; 95% CI: 1.36 – 6.62, p = 0.005).ConclusionBoth transient and permanent hypoparathyroidism following total thyroidectomy at a low-volume, non-parathyroid institution occurred with much higher frequencies than previously reported. The elevated rates were most likely due to the low-volume, non-parathyroid nature of the surgeons which in part was mirrored in low parathyroid gland identifications rates, and high rates of autotransplantation and inadvertent parathyroid gland excision.

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“…Hypoparathyroidism (hypoPT) is a common and serious complication associated with total thyroidectomy . It is well established that hypoPT following total thyroidectomy decreases the quality of life . However, recent studies have also shown a hitherto unknown association between permanent hypoPT and cardiovascular disease, kidney disease, and malignant disease .…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 It is well established that hypoPT following total thyroidectomy decreases the quality of life. 4 , 5 , 6 , 7 , 8 , 9 However, recent studies have also shown a hitherto unknown association between permanent hypoPT and cardiovascular disease, kidney disease, and malignant disease. 10 , 11 Patients with permanent hypoPT even seem to have an increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions

Abood,

Rolighed,

Triponez

et al. 2024

JAMA Netw Open

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ImportanceHypoparathyroidism following thyroid surgery is a serious complication that occurs frequently when surgery is performed by low-volume thyroid surgeons without experience in parathyroid surgery.ObjectiveTo evaluate the occurrence of hypoparathyroidism following total thyroidectomy after the introduction of autofluorescence in low-volume, nonparathyroid institutions.Design, Setting, and ParticipantsThis prospective, multicenter cohort study, with a follow-up period of up to 1 year, was conducted in Denmark at 2 low-volume nonparathyroid institutions between January 2021 and November 2023. All adult patients referred for total thyroidectomy were assessed for eligibility (n = 90). Only patients with no history of thyroid surgery were considered (n = 89). Patients who only underwent lobectomy (n = 6) or declined to participate (n = 5) were excluded. All included patients completed follow-up. The prospective cohort was compared with a historical cohort of successive patients undergoing primary total thyroidectomy from 2016 to 2020 (before autofluorescence was available).InterventionIncluded patients underwent autofluorescence-guided total thyroidectomy.Main outcomes and MeasuresRate of hypoparathyroidism. Immediate hypoparathyroidism was defined as the need for active vitamin D postoperatively, whereas permanent hypoparathyroidism was considered when there still was a need for active vitamin D 1 year after surgery.ResultsSeventy-eight patients underwent autofluorescence-guided surgery (mean [SD] age, 55.6 [13.1] years; 67 [86%] female) and were compared with 89 patients in the historical cohort (mean [SD] age, 49.7 [12.8] years; 78 [88%] female). The rate of immediate hypoparathyroidism decreased from 37% (95% CI, 27%-48%) to 19% (95% CI, 11%-30%) after the introduction of autofluorescence (P = .02). Permanent hypoparathyroidism rates decreased from 32% (95% CI, 22%-42%) to 6% (95% CI, 2%-14%) (P &lt; .001), reaching 0% at the end of the study. More parathyroid glands were identified with autofluorescence (75% [95% CI, 70%-80%] vs 61% [95% CI, 56%-66%]) (P &lt; .001) and less parathyroid glands were inadvertently excised (4% [95% CI, 1%-11%] vs 21% [95% CI, 13%-31%]) (P = .001).Conclusions and RelevanceIn this cohort study of autofluorescence-guided thyroid surgery in low-volume, nonparathyroid institutions, the use of autofluorescence was associated with a significant decrease in both immediate and permanent hypoparathyroidism. When autofluorescence was used, hypoparathyroidism rates were comparable with those of high-volume surgeons who also perform parathyroid surgery.

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Impairments in quality of life and predictors of symptom burden in patients with hypoparathyroidism: results from a population-based survey

Cited by 6 publications

References 39 publications

Hypoparathyroidism update

Hypoparathyroidism update

Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution

Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions

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