title: Recovery of parathyroid hormone secretion and function in postoperative hypoparathyroidism: a case series.
abstract: BACKGROUND
  Transient and permanent postoperative hypoparathyroidism are recognized complications of neck surgery. Postoperative hypoparathyroidism is usually considered permanent when it persists for 6 months; in rare cases, recovery of hypoparathyroidism through 1 year has been described. Recovery of hypoparathyroidism years after diagnosis has not previously been reported.
  
  
  OBJECTIVE
  We report four patients being treated with PTH(1-84) in a research protocol who recovered from postoperative hypoparathyroidism many years after onset.
  
  
  METHODS
  Recovery from hypoparathyroidism was established by: 1) serum calcium and PTH levels within the normal range off PTH(1-84) treatment for at least 1 week; 2) requirement for daily calcium supplementation reduced to ≤1 g; and 3) no supplemental active vitamin D therapy.
  
  
  RESULTS
  Hypoparathyroidism developed in three subjects after repeated neck surgery for primary hyperparathyroidism and in one subject after total thyroidectomy for Graves' disease. Parathyroid tissue autotransplant was performed in two of the four subjects. Two had undetectable PTH levels at study entry, whereas the other two subjects had detectable, although low, PTH levels. Hypoparathyroidism had been present for at least 8 years, and in one case for 16 years. The recovery of parathyroid function followed treatment with PTH(1-84) for 36 to 63 months.
  
  
  CONCLUSIONS
  Although it remains relatively rare, this report documents recovery of long-term postoperative hypoparathyroidism many years after the initial diagnosis. A potential role for exogenous PTH is intriguing with several plausible mechanisms.
authors.affiliation: MD, Department of Medicine, PH 8W-864, Columbia University College of Physicians & Surgeons, 630 West 168th Street, PH8W, Room 864, New York, New York 10032. jpb2@columbia.edu.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Cusano
authors.forename: Laura
authors.initials: L
authors.lastname: Anderson
authors.forename: Mishaela R
authors.initials: MR
authors.lastname: Rubin
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Silva
authors.forename: Aline G
authors.initials: AG
authors.lastname: Costa
authors.forename: Dinaz
authors.initials: D
authors.lastname: Irani
authors.forename: James
authors.initials: J
authors.lastname: Sliney
authors.forename: John P
authors.initials: JP
authors.lastname: Bilezikian
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery*; D007011:Hypoparathyroidism / Q000378:metabolism*; D008875:Middle Aged; D010280:Parathyroid Glands / Q000378:metabolism / Q000637:transplantation; D010281:Parathyroid Hormone / Q000378:metabolism*; D016105:Parathyroidectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000378:metabolism*; D020127:Recovery of Function / Q000502:physiology*; D013965:Thyroidectomy / Q000009:adverse effects; D014182:Transplantation, Autologous
chemical_list: D010281:Parathyroid Hormone
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