Patients’ views about parathyroid transplantation for post-thyroidectomy hypoparathyroidism

Abstract

BackgroundPermanent hypoparathyroidism (hypoPT) represents the most common postoperative complication associated with total thyroidectomy. Current treatment relies on high-dose calcium and/or vitamin D supplementation, but often this is insufficient and some patients remain symptomatic. Parathyroid allotransplantation is a new therapeutic option described recently in the literature. This study aims to investigate the patients’ acceptability of parathyroid transplantation as a potential new treatment for hypoPT.MethodOnline survey of members of HypoParaUK, a support group for individuals affected by hypoPT.ResultsResponses were received from 252 hypoPT patients. Majority declared to experience severe symptoms despite regular medical treatment. On a severity scale of 0–5, symptoms that were most troublesome were fatigue (3.8), low sense of well-being (3.5), and numbness/tingling (2.9). On a scale of 0–10, on average, their current quality of life (QoL) was 5 ± 3 and they expected this would improve to 7 ± 2 with correction of their hypoPT. Forty-four percent of patients were extremely interested in a potential technique involving intramuscular injection of parathyroid cell suspension compared to just 14% who were interested in the more invasive procedure of implantation of a parathyroid allograft into the forearm. The main concerns expressed were related to the possible need for immunosuppressive therapy.ConclusionPatients with severe symptomatic hypoPT seem interested to consider participation in a clinical trial exploring the feasibility and success rate of parathyroid transplantation.Electronic supplementary materialThe online version of this article (10.1007/s00423-018-1693-y) contains supplementary material, which is available to authorized users.

MANAGEMENT OF ENDOCRINE DISEASE: Postsurgical hypoparathyroidism: current treatments and future prospects for parathyroid allotransplantation

“…A recent population study of 374 adult patients with hypoPT showed that 75% of sufferers experienced symptoms despite treatment and 79% had required emergency department or hospital admissions ( 11 ). This mirrors the results of our survey of HypoPara UK patients, where 93% of responders reported that they required emergency admission to hospital within the last 6 months ( 9 ).…”

“…Only 4% of patients never experienced fatigue or numbness/tingling sensations, while 30–35% experienced these symptoms almost all the time. In addition, 149 patients listed a myriad of associated symptoms rarely described in literature ( 9 ).…”

“…Interestingly, the majority of patients are still experiencing symptomatic hypocalcaemia despite regular use of medication and this impacts even more on their quality of life ( 9 ). A recent population study of 374 adult patients with hypoPT showed that 75% of sufferers experienced symptoms despite treatment and 79% had required emergency department or hospital admissions ( 11 ).…”

“…Recruitment of patients into such a trial and the proposed design of such a trial are outlined in Figs 1 and 2 , respectively. In our recent paper investigating the views of members of HypoPara UK group, at least 40% of 252 respondents expressed an interest participating in a clinical trial that would explore the feasibility and benefits of PTalloT ( 9 ). In addition to analysing biochemical parameters, such a study should determine if the improvement in quality of life becomes apparent and is sustainable.…”

Effect of Parathyroid Function After Thyroidectomy and Radioactive-Iodine Therapy for Thyroid Disease

“…However, in the study by Chew C, they found incidental parathyroidectomy did not contribute to significant changes in postoperative serum calcium levels [31]. The injury of parathyroid gland may compromise their blood supply and lead to hypoparathyroidism [32,33].…”