title: Teriparatide Therapy and Reduced Postoperative Hospitalization for Postsurgical Hypoparathyroidism.
abstract: OBJECTIVE
  Up to 20% of patients undergoing thyroidectomy develop hypocalcemia after surgery. Although usually transient, severe symptomatic hypocalcemia may occur. Teriparatide acetate (recombinant human parathyroid hormone 1-34) therapy can rapidly raise calcium levels.
  
  
  OBJECTIVE
  To test the hypothesis that teriparatide therapy in patients with postthyroidectomy hypoparathyroidism would expedite relief of symptomatic hypocalcemia and reduce the duration of hospitalization compared with standard treatment.
  
  
  METHODS
  Case series of all hospitalized patients 18 years or older treated with teriparatide for symptomatic postthyroidectomy hypocalcemia occurring immediately after thyroidectomy at Mayo Clinic, Rochester, Minnesota, between January 1, 2008, and June 30, 2014. A secondary analysis was performed with matched control and cohort groups having postthyroidectomy hypocalcemia of similar degree who received standard treatment only. Participants included 8 hospitalized patients who received teriparatide therapy after 24 hours of standard treatment (cases) and eight control patients selected from a cohort of 1193 thyroidectomies were matched for age, sex, body mass index, and nadir calcium levels.
  
  
  METHODS
  Teriparatide acetate therapy (20 µg twice daily) subcutaneously for 1 week, with the option of continuing at 20 µg/d for up to 3 weeks.
  
  
  METHODS
  Safety, symptom resolution, calcium supplementation, and duration of hospitalization.
  
  
  RESULTS
  Among the 16 case and control patients the median nadir calcium level was 7.1 mg/dL in both groups. Most patients underwent thyroidectomy for thyroid cancer. Teriparatide therapy was safe, with no adverse events noted, and completely eliminated symptomatic hypocalcemia in all treated patients within 24 hours of initiation. Hospital discharge occurred at a median of 1.0 day (interquartile range, 1.0-1.0 day) after teriparatide therapy initiation among cases vs 2.5 days (interquartile range, 1.8-3.0 days) after the equivalent clinical point was reached in controls (P = .01). This value was 2.0 days in the source cohort (P = .02). On hospital discharge, patients had similar calcium levels. Six months after surgery, all patients treated with teriparatide showed partial or complete parathyroid recovery. Calcium supplementation and calcium levels were comparable between the groups.
  
  
  CONCLUSIONS
  In this pilot study, teriparatide therapy in patients with postthyroidectomy hypoparathyroidism was safe, rapidly eliminated hypocalcemic symptoms, and likely reduced the duration of hospitalization. Given the limitations of this small study, a large-scale randomized trial is needed to verify these results and to assess the long-term effect of teriparatide therapy on clinical outcomes.
authors: Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Meera
authors: M
authors: Shah
authors: Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Irina
authors: I
authors: Bancos
authors: Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Geoffrey B
authors: GB
authors: Thompson
authors: Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Melanie L
authors: ML
authors: Richards
authors: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota.
authors: Jan L
authors: JL
authors: Kasperbauer
authors: Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Bart L
authors: BL
authors: Clarke
authors: Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Matthew T
authors: MT
authors: Drake
authors: Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Marius N
authors: MN
authors: Stan
mesh_terms: D000328:Adult; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000517:prevention & control; D007011:Hypoparathyroidism / Q000097:blood / Q000517:prevention & control*; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D019379:Teriparatide / Q000627:therapeutic use*; D013964:Thyroid Neoplasms / Q000097:blood / Q000601:surgery*; D013965:Thyroidectomy
chemical_list: D019379:Teriparatide; D002118:Calcium