Transient hyperthyroidism after total parathyroidectomy for tertiary hyperparathyroidism: A report of two cases

Lederer, Stephan R.; Schiffl, Helmut

doi:10.1007/s00508-008-0996-3

Cited by 9 publications

(11 citation statements)

References 8 publications

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“…Up to now, only a few case reports described transient hyperthyroidism following surgery for SHP [7,9-11]. This is the first prospective study evaluating the frequency and natural course of postoperative hyperthyroidism in patients with SHP.…”

Section: Discussionmentioning

confidence: 99%

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Transient hyperthyroidism after surgery for secondary hyperparathyroidism: a common problem

et al. 2011

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BackgroundPostoperative hyperthyroidism occurs in approximately one third of patients following parathyroidectomy due to primary hyperparathyroidism (PHP), but has only rarely been described in secondary hyperparathyroidism (SHP). The frequency, course, and laboratory markers of postoperative hyperthyroidism in SHP remain unknown. Our purpose was to evaluate the frequency and the clinical course of postoperative hypcrthyroidism following surgery of SHP and to determine the diagnostic value of thyroglobulin in this setting.Material and MethodsA total of 40 patients undergoing parathyroidectomy because of SHP were included in this study. Thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fl4), and thyroglobulin (Tg) were determined one day before and on day 1, 3, 5, 10, and 40 after surgery. At each of these visits patients were clinically evaluated for signs or symptoms of hyperthyroidism.ResultsBiochemical evidence of hyperthyroidism was evident in 77% of patients postoperatively despite of preoperatively normal serum levels. TSH dropped from 1.18 ± 0.06mU/L to 0.15 ± 0.07mU/L (p = 0.0015). Free triiodothyronine (fT3) and fT4 levels increased from 2.86 ± 0.02ng/L and 10.32 ± 0.13ng/L, respectively, to their maximum of 4.83 ± 0.17ng/L and 19.35 ± 0.58ng/L, respectively. Thyroglobulin levels rose from 3.8 ± 0.8ng/mL to 111.8 ± 45.3ng/mL (p < 0.001). At day 40 all thyroid related laboratory values were within normal range. Correlation analysis of postoperative values revealed significant correlations for lowest TSH (r = -0.32; p = 0.038), and highest fT3 (r = 0.55; p < 0.001) and fT4 levels (r = 0.67; p < 0.001) with Tg.ConclusionTransient hyperthyroidism is frequent after parathyroidectomy for SHP with Tg being a suitable marker. Awareness of this self-limiting disorder is important to avoid inappropriate and potentially harmful treatment.

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Section: Discussionmentioning

confidence: 99%

“…Only few case studies report the occurrence of postoperative hyperthyroidism in renal patients undergoing parathyroidectomy because of SHP [9-11]. Up to now the frequency and natural course of postoperative hyperthyroidism remains unknown in these patients.…”

Section: Introductionmentioning

confidence: 99%

Transient hyperthyroidism after surgery for secondary hyperparathyroidism: a common problem

et al. 2011

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“…This mechanism is likely to have been exacerbated by the extensive palpation and ultimate partial thyroidectomy in the case described here. Similarly, thyroid hormone levels were previously reported to rise following local trauma, fine-needle aspiration, thyroid surgery and strangulation [ 3 ]. This is consistent with our case in which there was extensive palpation and exploration to locate a single ectopic parathyroid gland.…”

Section: Discussionmentioning

confidence: 84%

Post-parathyroidectomy thyrotoxicosis and atrial flutter: a case for caution

Asmar

Ross

2010

Clinical Kidney Journal

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Despite transient hyperthyroidism reportedly occurring in ∼30% of post-parathyroidectomy (PTX) patients with primary hyperparathyroidism, it has rarely been described in the internal medicine literature. It occurs within days of surgery, is usually clinically mild or silent, and typically spontaneously resolves within weeks. Patients can, however, unusually present with symptoms and signs of thyrotoxicosis, including arrhythmias. We report a case of a hemodialysis patient who developed self-limited hyperthyroidism after intra-operative thyroid manipulation and excision during PTX surgery for secondary hyperparathyroidism that failed medical management. The patient was symptomatic with agitation, restlessness and new-onset atrial flutter, which required electrical cardioversion and temporary beta blockade. It is important that clinicians be aware of this potential surgical complication, so as to not attribute manifestations to post-PTX divalent cation disorders (i.e. hungry bone syndrome), thereby allowing prompt diagnosis and treatment. Post-operative monitoring of thyroid function is warranted for at least some subsets of patients: individuals who undergo thyroid exploration and palpation as part of their surgery to localize the parathyroid glands, as well as those with underlying cardiac disease or who are otherwise at high risk from even mild states of hyperthyroidism.

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“…Further, biochemical signs of postoperative hyperthyroidism are negative serum levels of anti-thyroid antibodies, as well as reduced radio-iodine or Tc99m uptake rates (Table 1). Obviously, underlying disease for parathyroidectomy has no influence on the appearance of thyrotoxicosis, since this complication has been observed after parathyroidectomy for pHPT [4], as well as sHPT [5] and tHPT [6]. It is speculated that besides surgical trauma to thyroid gland, also humoral factors might trigger Fig.…”

Section: Sirsmentioning

confidence: 96%

“…Thus, in most cases thyrostatic therapy is unessential and only symptomatic treatment is required [9]. Risk for the development of postoperative thyrotoxicosis seems to be dependent on the extent of parathyroid surgery [6,10].…”

Section: Sirsmentioning

confidence: 99%

Thyrotoxicosis after parathyroidectomy mimicking myocardial infarction: a case report and review of the literature

et al. 2012

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Sirs:A 55-year-old female patient was presented to our surgical department for elective parathyroidectomy for sHPT following terminal kidney failure due to a minimal change glomerulonephritis with Ig-M sedimentation.An open operation through a Kocher's cut was performed, and two hypertrophic parathyroid glands were removed. Intraoperative parathyroid hormone (PTH) test revealed a significant decrease of serum PTH levels by *760 pg/ml after parathyroidectomy. The following stationary course was uneventful and patient was discharged 3 days after surgery.Three days after discharge, patient was admitted to the local Emergency Centre suffering from angina pectoris and dyspnoea. An instantly performed ECG showed tachycardia (120/min) and ST elevations (Fig. 1a) associated with elevated hs-cTnT concentrations (180.9 pg/ml; normal range \14.0 pg/ml; Fig. 1b). Assuming a STEMI, an urgent coronary angiography was performed, but no signs of arteriosclerotic coronary artery changes could be detected (Fig. 1c). Tako-Tsubo syndrome was ruled out via echocardiography revealing normal left ventricular function. Additional serum analyses finally revealed an extreme elevation of thyroid hormones fT3 (11.4 pg/ml; normal range 2.3-4.2 pg/ml) and fT4 (5.15 ng/dl; normal range 0.89-1.76 ng/dl), and a simultaneous reduction of TSH (0.04 lIU/ml; normal range 0.55-4.78 lIU/ml). Consequently, thyrotoxicosis following parathyroidectomy was diagnosed and a therapy with ivabradine was started. Genesis of the cardiac symptoms was thought to be induced most likely secondarily to the thyrotoxicosis. Thyroid hormone levels regressed to normal range during the next few days, ECG changes reversed and the patient was discharged 7 days after admission.Herein, we describe a case of thyrotoxicosis as a postoperative complication after an-from surgical viewpoint-uneventful parathyroidectomy. Thyrotoxicosis manifested with clinical signs of a myocardial infarction with corresponding changes in ECG. Symptomatic treatment with limitation of heart rate was followed by spontaneous normalization of thyroid hormone levels.Parathyroidectomy is a standard surgical procedure mainly for pHPT, but also in cases of failure of conservative treatment of secondary or tertiary hyperparathyroidism, parathyroidectomy might be a treatment option to overcome musculoskeletal pain, pathological fractures and pruritus.Parathyroidectomy is classically performed via Kocher's cut. Nowadays, technical advances have lead to novel concepts for minimally invasive parathyroid surgery, such as endoscopic parathyroidectomy, minimally invasive video-assisted parathyroidectomy (MIVAP) with median access, or a lateral approach (VAPLA), and open minimally invasive parathyroid surgery using a central or a lateral approach. Besides these cervical approaches, there are further surgical approaches to the parathyroid glands (e.g., transoral, transaxillary). Besides formation of visible cervical scars, which shall be reduced or be at least invisible using alternative than cervical approaches, ma...

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Transient hyperthyroidism after total parathyroidectomy for tertiary hyperparathyroidism: A report of two cases

Cited by 9 publications

References 8 publications

Transient hyperthyroidism after surgery for secondary hyperparathyroidism: a common problem

Transient hyperthyroidism after surgery for secondary hyperparathyroidism: a common problem

Post-parathyroidectomy thyrotoxicosis and atrial flutter: a case for caution

Thyrotoxicosis after parathyroidectomy mimicking myocardial infarction: a case report and review of the literature

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