[Hypoparathyroidism after surgery on thyroid cancer: is there a delayed chance for recovery after a prolonged period of substitutive therapy?].
BACKGROUND
Transient and persistent hypoparathyroidism (HPT) belong to the well known complications of total thyroidectomy performed because of thyroid carcinoma. The true frequency of persistent hypoparathyroidism is often higher than estimated in the reports published by the specialized centers with low rate of complications.


OBJECTIVE
Investigation whether the repeated check-up, performed over 2 years post thyroidectomy, reveals some cases of recovery in patients diagnosed with persistent HPT post thyroid cancer surgery.


METHODS
In total, 115 patients were included into the study, all of them treated with vitamin D derivatives and calcium supplementation. In 17 of them a diagnosis of transient hypoparathyroidism was made on the basis of evaluation performed 6 months after surgery, the remaining 98 were diagnosed with persistent HPT. Parathyroid (PTH) function was reevaluated after withdrawal of active vitamin D derivatives for 10 days and of calcium carbonate for two days during the hospital stay in patients admitted for radioiodine scan, thus after thyroxine withdrawal. The control group consisted of 123 DTC (differentiated thyroid carcinoma) patients without parathyroid dysfunction. On the basis of intact PTH serum level and calcium and phosphorus estimations HPT was unequivocally confirmed in 49 patients (50%). The remaining 49 patients exhibited normal PTH level and in 43 (86%) of them Ca(2+) level was also within normal range, thus delayed, recovery from HPT was stated.


RESULTS
Our results indicate that reevaluation of hypoparathyroidism post total thyreoidectomy is necessary, as delayed recover of parathyroid dysfunction is a frequent phenomenon. We also propose criteria of reevaluation of HTP in patients on chronic substitutive therapy.
Jurecka-Lubieniecka
Beata
B
Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Gliwice Branch, Gliwice, Poland. drlub@mp.pl
Paliczka
Ewa
E
Czarniecka
Agnieszka
A
Jarzab
Michał
M
Handkiewicz
Daria
D
Hasse-Lazar
Kornelia
K
Kukulska
Aleksandra
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood / Q000627:therapeutic use; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D007011:Hypoparathyroidism / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy*; D020127:Recovery of Function; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
D014807:Vitamin D; D002118:Calcium