Secretory Capacity of the Parathyroid Glands after Total Thyroidectomy in Normocalcemic Subjects

Abstract

In thyroidectomized patients, normal postoperative calcium and PTH values do not exclude a reduced secretory response of the parathyroids to hypocalcemic stimuli.

Volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in women with differentiated thyroid cancer under TSH suppression

“…Another explanation for the lower PTH levels and presumably higher cortical thickness might relate to distorted parathyroid function following thyroidectomy. Lower PTH levels in premenopausal patients with DTC have also been reported in other studies . Given that higher cortical thickness at the radius has been reported in patients with hypoparathyroidism, it is possible that higher cortical thickness is related to the ‘relative hypoparathyroidism’ observed in this group.…”

A nomogram to predict the likelihood of permanent hypoparathyroidism after total thyroidectomy based on delayed serum calcium and iPTH measurements

“…Thus, even though most patients recover from parathyroid failure after TT, the secretory capacity of the parathyroid glands is left impaired. This is in agreement with the seminal 1965 contribution of Wade et al (19) and other recent observations (16,20). This relationship between intraoperative surgical injury of the parathyroid glands and reduced iPTH reserve has been further confirmed in the study of Lang et al (21) who found that after TT for benign disease, PGRIS was the major determinant of protracted hypoparathyroidism and that aggressive parathyroid identification resulted in more patients developing postoperative hypocalcemia and protracted hypoparathyroidism.…”

Patterns in the Parathyroid Response to Sodium Bicarbonate Infusion Test in Healthy Volunteers

“…Moreover, it is not always evident which is the best way to monitor postoperative function of the gland [8]. The number of available provocative tests for the evaluation of the parathyroid function is limited to EDTA infusion test, sodium citrate infusion test, and, recently, sodium bicarbonate infusion test [3–7]. We have chosen to employ this last test for a number of reasons.…”

“…The sodium bicarbonate test was performed as previously described [6, 7]. The volunteers were in fasting state for at least 4 hours and 35 mL/m 2 of body surface of 8.4% sodium bicarbonate solution was infused in one arm over 2 minutes and blood samples for the determination of serum PTH were drawn before (PTH 0 ) and at 3 (PTH 3 min ), 5 (PTH 5 min ), 10 (PTH 10 min ), 30 (PTH 30 min ), and 60 minutes (PTH 60 min ) after the infusion of the other.…”

“…The volunteers were in fasting state for at least 4 hours and 35 mL/m 2 of body surface of 8.4% sodium bicarbonate solution was infused in one arm over 2 minutes and blood samples for the determination of serum PTH were drawn before (PTH 0 ) and at 3 (PTH 3 min ), 5 (PTH 5 min ), 10 (PTH 10 min ), 30 (PTH 30 min ), and 60 minutes (PTH 60 min ) after the infusion of the other. Infusion of sodium bicarbonate causes acute metabolic alkalosis and in turn increases the binding of calcium to albumin leading to a decrease of the ionized calcium in blood [7]. No side effects were observed during the sodium bicarbonate infusion test except for a transient lips or/and hands paresthesia, metallic taste, and slight pain in the arm.…”