Predictors of early postoperative hypocalcemia in patients with secondary hyperparathyroidism undergoing total parathyroidectomy

Abstract

Objective To summarize the clinical features of secondary hyperparathyroidism (SHPT) in patients with chronic renal failure and to explore the predictive factors of postoperative hypocalcemia after total parathyroidectomy in these patients. Methods The clinical data of 87 patients admitted to Guangdong Electric Power Hospital from May 2013 to February 2020 were reviewed. All patients underwent total parathyroid resection and sternocleidomastoid microtransplantation. Age, sex, and the serum calcium, phosphorus, alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) concentrations were analyzed as predictive factors of postoperative hypocalcemia. Results Bone pain was the most common clinical manifestation in this study population, and all 87 patients experienced relief from their clinical symptoms after the surgical procedure. Age and the preoperative serum calcium, ALP, and iPTH concentrations were determined to be early predictive factors of postoperative hypocalcemia. Conclusions Age and the preoperative calcium, ALP, and iPTH concentrations are independent risk factors for postoperative hypocalcemia in patients with SHPT and renal disease who undergo total parathyroidectomy with sternocleidomastoid microtransplantation. These factors can help identify high-risk patients who can be managed by a multidisciplinary team to improve graft survival and quality of life.

Construction and validation of a predictive model for hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism

“…Consistent with the present findings, it has previously been shown that patients with high preoperative ALP activities are at higher risk of postoperative hypocalcemia ( 31 , 32 ). A study by Yang et al.…”

“…Consistent with the present findings, it has previously been shown that patients with high preoperative ALP activities are at higher risk of postoperative hypocalcemia (31,32). A study by Yang et al (33) also showed that patients with preoperative serum ALP activities > 277 U/L are susceptible to postoperative hypocalcemia, but the clinical utility of ALP alone for the prediction of hypocalcemia was unsatisfactory in this study, whereas the combined index identified in the present study is a more accurate predictor.…”

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

“…In total, five studies mentioned the results of age [ 5 , 14 , 15 , 18 , 19 ]. The statistical heterogeneity was high (I 2 =82%, p = 0.0002), and a random-effects model was used to perform a meta-analysis was performed on the unadjusted data.…”

“…In total, six studies (including seven groups of data) reported the results of preoperative iPTH 2 [ 14 , 16 , 17 , 19 , 21 ],. Due to the high statistical heterogeneity (I 2 =94%) ( p < 0.00001), a random-effects model was utilized for the meta-analysis of the unadjusted data.…”

PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia

“…The major criticism is the lack of a clear PTH threshold for both calcium and vitamin D supplementation. Some authors suggest that PTH may not be the only determinant for the development of hypocalcemia and that other factors may play a major role such as vitamin D deficiency [40], dietary habits [41], and other metabolic disorders such as hypomagnesemia [42,43]. Hypomagnesemia is frequently associated with the use of drugs such as aminoglycosides, cyclosporine, cisplatin, amphotericin B, ACE inhibitors, proton pump inhibitors, and some diuretics (thiazides and loop) [44].…”