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Cohen O, Ronen O, Khafif A, Rodrigo JP, Simo R, Pace-Asciak P, Randolph G, Mikkelsen LH, Kowalski LP, Olsen KD, Sanabria A, Tufano RP, Babighian S, Shaha AR, Zafereo M, Ferlito A. Revisiting the role of surgery in the treatment of Graves' disease. Clin Endocrinol (Oxf) 2022; 96:747-757. [PMID: 34954838 DOI: 10.1111/cen.14653] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 01/06/2023]
Abstract
Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence-based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up-to-date data.
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Affiliation(s)
- Oded Cohen
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Avi Khafif
- A.R.M. Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv, Israel
| | - Juan P Rodrigo
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, Oviedo, Spain
| | - Ricard Simo
- Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck and Thyroid Oncology Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts, USA
| | - Lauge H Mikkelsen
- Department of Pathology, Eye Pathology Section, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, AC Camargo Cancer Center, Sao Paulo, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia-Ips Universitaria, Medellín, Colombia
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello-Clínica Las Vegas-Quirón, Medellín, Colombia
| | - Ralph P Tufano
- Multidisciplinary Thyroid and Parathyroid Center, Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Madison, USA
| | - Silvia Babighian
- Department of Ophthalmology, Ospedale Sant'Antonio, Azienda Ospedaliera, Padova, Italy
| | - Ashok R Shaha
- Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Mark Zafereo
- Department of Head & Neck Surgery, Anderson Cancer Center, Houston, Texas, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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2
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Abstract
Currently, thyroid surgery is the most common and safe operation worldwide. However, thyroidectomy is still not free from the risks of complications and death due to the anatomical structure and physiological function particularity of the thyroid gland. Postoperative complications affect the life quality and life safety of patients after surgery. The common complications include hypoparathyroidism (HP), recurrent laryngeal nerve (RLN) injury, injury to the external branch of the superior laryngeal nerve (EBSLN), postoperative bleeding (PB), thoracic duct injury, laryngeal edema, tracheospasm, tracheal injury, and esophageal injury. A severe complication, such as dyspnea, asphyxia, or thyroid crisis, might cause the death of the patient. Therefore, every thyroid surgeon's responsibility is to remain alert and aware of the occurrence of various intraoperative and postoperative complications and exercise effective prevention and treatment. This is closely related to the advancement in thyroid disease research, the increase in local anatomy knowledge, the standardization of surgical approaches, the improvement in operating skills, the application of new technologies, and the emphasis on specialty training. In addition, many complications that effect patients are much better tolerated if the patient has appropriate expectations of what the complications are and how to treat them. Open communication between surgeon and patient optimizes the potential negative effects that complications may have on patients' quality of life. This paper discusses the prevention, recognition and therapy of intraoperative and postoperative complications in thyroid surgery.
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Affiliation(s)
- Shan Jin
- Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.,Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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Wen P, Xu L, Zhao S, Gan W, Hou D, Zhang L, Cao J, Xiong M, Jiang L, Yang J. Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy. Int J Endocrinol 2021; 2021:6613659. [PMID: 33868402 PMCID: PMC8035008 DOI: 10.1155/2021/6613659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and thus the results may not be reliable. OBJECTIVES This study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism. METHODS We retrospectively investigated the records of 1,095 patients with SHPT treated with tPTX between January 2008 and December 2018. Based on the postoperative serum calcium concentration, the patients were grouped into SH and non-SH groups. The clinical characteristics and biochemical results were analyzed, and binary logistic regression analysis was used to identify the risk factors for SH. RESULTS After surgery, 25.9% of the patients developed SH. Age, diastolic blood pressure (DBP), heart rate, frequency of bone pain, weight of resected glands, preoperative serum calcium, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and hemoglobin levels differed between the two groups. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery. CONCLUSIONS The preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should thus be monitored closely in order to initiate prompt interventions to avoid SH.
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Affiliation(s)
- Ping Wen
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingling Xu
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shasha Zhao
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Gan
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dawei Hou
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Zhang
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinlong Cao
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingxia Xiong
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Jiang
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junwei Yang
- Center for Kidney Disease, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Abstract
The first adjunctive hormone therapy for chronic hypoparathyroidism, recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] was approved by the FDA in January 2015. Since the approval of rhPTH(1-84), growing interest has developed in other agents to treat this disorder in both the scientific community and among pharmaceutical companies. For several reasons, conventional therapy with calcium and activated vitamin D supplementation, magnesium supplementation as needed, and occasionally thiazide-type diuretic therapy remains the mainstay of treatment, while endocrinologists and patients are constantly challenged by limitations of conventional treatment. Serum calcium fluctuations, increased urinary calcium, hyperphosphatemia, and a constellation of symptoms that limit mental and physical functioning are frequently associated with conventional therapy. Understanding how conventional treatment and hormone therapy work in terms of pharmacokinetics and pharmacodynamics is key to effectively managing chronic hypoparathyroidism. Multiple questions remain regarding the effectiveness of PTH adjunctive therapy in preventing or slowing the onset and progression of the classical complications of hypoparathyroidism, such as chronic kidney disease, calcium-containing kidney stones, cataracts, or basal ganglia calcification. Several studies point toward an improvement in quality of life during replacement therapy. This review will discuss current clinical and research challenges posed by treatment of chronic hypoparathyroidism.
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Affiliation(s)
- Guido Zavatta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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5
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Jiang W, Lee E, Newfield RS. The utility of intact parathyroid hormone level in managing hypocalcemia after thyroidectomy in children. Int J Pediatr Otorhinolaryngol 2019; 125:153-158. [PMID: 31323353 DOI: 10.1016/j.ijporl.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hypocalcemia is a common complication after thyroidectomy. Intact parathyroid hormone (PTH) has been successfully used as a predictive indicator for hypocalcemia in adults during the postoperative period. We aim to demonstrate the utility of PTH in predicting and managing postoperative hypocalcemia following thyroidectomy in pediatrics. METHODS The study is a retrospective case series including 38 patients up to 18 years of age who underwent total or completion thyroidectomy from 1/1/2010 to 12/31/2016 at a tertiary pediatric academic center. Patient demographics, pathology, postoperative PTH, serum calcium, and length of stay were analyzed. RESULTS The median age was 14.3 years (range of 4.3-18.4 years) with 84.2% being female. Thyroid malignancy was noted in 25 patients, and 13 had benign pathology including 8 patients with multinodular goiter and 5 with Grave's disease. In this serie, 63.2% (24/38) developed hypocalcemia (serum calcium <8.5 mg/dL) postoperatively. The median PTH of 15.8 pg/mL in the hypocalcemic group was significantly lower than the median PTH of 41.6 pg/mL in the normocalcemic group (p < 0.001). Using a PTH threshold of 26 pg/mL, hypocalcemia was predicted with a sensitivity of 75%, and specificity of 100%. Six patients with calcium <7.5 mg/dL received teriparatide injections to avoid intravenous calcium replacement. The length of hospital stay for normocalcemic patients was 1.7 ± 0.8 days vs. 2.9 ± 1.4 days for hypocalcemic patients (p = 0.002). We found no correlation between the incidence of hypocalcemia and pathologic indication for surgery. Completion thyroidectomy was associated with a lower risk of hypocalcemia when compared to total thyroidectomy (p = 0.01) and neck dissections carried an increased risk of postoperative hypocalcemia (p = 0.04). CONCLUSION Postoperative PTH level has an excellent specificity in predicting hypocalcemia in this pediatric cohort using a threshold of PTH ≤ 26 pg/mL. Those with PTH >26 pg/mL may avoid hypocalcemia by oral calcium replacement with outpatient follow-up. We did not identify a reliable PTH cutoff value above which pediatric patients may be safely discharged immediately following surgery. Adult guideline or pathways that advocate for outpatient thyroidectomy surgery based on normal PTH ≥10 pg/mL in the recovery room may not apply to children.
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Affiliation(s)
- Wen Jiang
- Department of Surgery - Division of Otolaryngology, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA.
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, CA, USA.
| | - Ron S Newfield
- Department of Pediatrics - Division of Endocrinology, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA.
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6
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Abstract
BACKGROUND Post-surgical hypoparathyroidism is a common complication after thyroid surgery. The incidence is likely to increase given the rising trend in the annual number of thyroid operations being performed. Measures to prevent post-thyroidectomy hypoparathyroidism including different surgical techniques and prophylactic calcium and vitamin D supplements have been extensively studied. The management of post-thyroidectomy hypoparathyroidism however has not been extensively evaluated. Routine use of calcium and vitamin D supplements in the postoperative period may reduce the risk of symptoms, temporary hypocalcaemia and hospital stay. However, this may lead to overtreatment and has no effect on long-term hypoparathyroidism. Current recommendations on the management of post-thyroidectomy hypoparathyroidism is based on low-quality evidence. Existing guidelines do not often distinguish between surgical and non-surgical hypoparathyroidism, and transient and long-term disease.The aim of this systematic review was to summarise evidence on the use of calcium, vitamin D and recombinant parathyroid hormone in the management of post-thyroidectomy hypoparathyroidism. In addition, we aimed to highlight deficiencies in the current literature and stimulate further work in this field. OBJECTIVES The objective of this systematic review was to assess the effects of calcium, vitamin D and recombinant parathyroid hormone in managing post-thyroidectomy hypoparathyroidism. SEARCH METHODS We searched CENTRAL, MEDLINE, PubMed, Embase as well as ICTRP Search Portal and ClinicalTrials.gov. The date of the last search for all databases was 17 December 2018 (except Embase, which was last searched on 21 December 2017). No language restrictions were applied. SELECTION CRITERIA We planned to include randomised control trials (RCTs) or controlled clinical trials (CCTs) examining the effects of calcium, vitamin D or recombinant parathyroid hormone in people with temporary and long-term post-thyroidectomy hypoparathyroidism. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full texts for relevance. MAIN RESULTS Database searches yielded a total of 1751 records. We retrieved potentially relevant full texts and excluded articles on the following basis: not a RCT or CCT; intervention, comparator or both did not match prespecified criteria; non-surgical causes of hypoparathyroidism, and studies on prevention. None of the articles was eligible for inclusion in the systematic review. AUTHORS' CONCLUSIONS This systematic review highlights a gap in the current literature and the lack of high-quality evidence in the management of post-thyroidectomy temporary and long-term hypoparathyroidism. Further research focusing on clinically relevant outcomes is needed to examine the effects of current treatments in the management of temporary and long-term post-thyroidectomy hypocalcaemia.
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Affiliation(s)
- Ovie Edafe
- Sheffield Teaching Hospitals NHS Foundation TrustENT DepartmentGlossop RoadSheffieldUKS102JF
| | - Claudia E Mech
- Wrightington, Wigan and Leigh NHS Foundation TrustGeneral SurgeryWigan LaneWiganUKWN1 2NN
| | - Sabapathy P Balasubramanian
- Sheffield Teaching HospitalsEndocrine Surgery, Department of General SurgeryGlossop RoadSheffieldSouth YorkshireUKS10 2JF
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Lewiecki EM, Bilezikian JP, Carey JJ, Dell RM, Gordon CM, Harris ST, McClung MR, Miller PD, Rosenblatt M. Proceedings of the 2017 Santa Fe Bone Symposium: Insights and Emerging Concepts in the Management of Osteoporosis. J Clin Densitom 2018; 21:3-21. [PMID: 29229501 DOI: 10.1016/j.jocd.2017.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/31/2017] [Indexed: 11/28/2022]
Abstract
The 18th Annual Santa Fe Bone Symposium was held on August 4-5, 2017, in Santa Fe, New Mexico, USA. The symposium convenes health-care providers and clinical researchers to present and discuss clinical applications of recent advances in research of skeletal diseases. The program includes lectures, oral presentations by endocrinology fellows, case-based panel discussions, and breakout sessions on topics of interest, with emphasis on participation and interaction of all participants. Topics included the evaluation and treatment of adult survivors with pediatric bone diseases, risk assessment and management of atypical femur fractures, nonpharmacologic strategies in the care of osteoporosis, and skeletal effects of parathyroid hormone with opportunities for therapeutic intervention. Management of skeletal complications of rheumatic diseases was discussed. Insights into sequential and combined use of antiresorptive agents were presented. Individualization of patient treatment decisions when clinical practice guidelines may not be applicable was covered. Challenges and opportunities with osteoporosis drug development were discussed. There was an update on progress of Bone Health TeleECHO (Bone Health Extension for Community Healthcare Outcomes), a teleconferencing strategy for sharing knowledge and expanding capacity to deliver best-practice skeletal health care.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
| | - John P Bilezikian
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Catherine M Gordon
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Steven T Harris
- University of California San Francisco, San Francisco, CA, USA
| | | | - Paul D Miller
- University of Colorado Health Sciences Center, Denver, CO, USA
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Palermo A, Santonati A, Tabacco G, Bosco D, Spada A, Pedone C, Raggiunti B, Doris T, Maggi D, Grimaldi F, Manfrini S, Vescini F. PTH(1-34) for Surgical Hypoparathyroidism: A 2-Year Prospective, Open-Label Investigation of Efficacy and Quality of Life. J Clin Endocrinol Metab 2018; 103:271-280. [PMID: 29099939 DOI: 10.1210/jc.2017-01555] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/27/2017] [Indexed: 12/27/2022]
Abstract
CONTEXT Daily parathyroid hormone (PTH) (1-34) administrations can reduce the required total daily dose of calcium and calcitriol and restore normocalcemia in refractory hypoparathyroidism. However, most PTH(1-34) trials have been conducted on small cohorts including subjects with hypoparathyroidism of various etiologies, and quality of life (QOL) was not investigated. OBJECTIVE To investigate the effects of 24-month PTH(1-34) treatment in a homogeneous cohort of adult subjects with postoperative hypoparathyroidism and to evaluate QOL changes. DESIGN Prospective open-label study. SETTING Italian multicenter study. PARTICIPANTS 42 subjects. INTERVENTION Twice-daily PTH(1-34) 20 μg subcutaneous injection. MAIN OUTCOME MEASURES Calcium and vitamin D supplementation requirements, serum calcium, phosphate, and urinary calcium excretion (3, 6, 12, 18, 24 months). At baseline and at 6 and 24 months, QOL was evaluated by the RAND 36-Item Short Form (SF-36) Health Survey, covering eight domains of physical and mental health. RESULTS Mean serum calcium concentration significantly increased from baseline to 3 months (7.6 ± 0.6 vs 8.9 ± 1.1 mg/dL, P < 0.001) and remained stable until the end of the study, despite reductions in calcium and vitamin D supplementation. Phosphate levels gradually decreased from baseline to 6 months (4.3 ± 1.1 vs 3.9 ± 0.6 mg/dL, P < 0.019), remaining stable until 24 months. Serum alkaline phosphatase and calcium excretion gradually increased from baseline to 24 months. Data from SF-36 showed a significant improvement in the mean scores of all eight domains (P < 0.001). CONCLUSION This study demonstrates the efficacy and safety of PTH(1-34) to treat adult patients with postsurgical hypoparathyroidism. PTH(1-34) may improve their mental and physical health.
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Affiliation(s)
- Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Assunta Santonati
- Department of Endocrinology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Daniela Bosco
- Department of Endocrinology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Antonio Spada
- Department of Endocrinology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Claudio Pedone
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Bruno Raggiunti
- Department of Endocrinology, Hospital San Liberatore Atri, Teramo, Italy
| | - Tina Doris
- Department of Endocrinology, Hospital San Liberatore Atri, Teramo, Italy
| | - Daria Maggi
- Unit of Endocrinology and Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Franco Grimaldi
- Department of Endocrinology and Diabetes, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Fabio Vescini
- Department of Endocrinology and Diabetes, Santa Maria della Misericordia Hospital, Udine, Italy
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Espiard S, Vantyghem MC, Desailloud R. [Not Available]. Ann Endocrinol (Paris) 2017; 78 Suppl 1:S1-S10. [PMID: 29157484 DOI: 10.1016/s0003-4266(17)30920-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Parathormone (PTH), produced by parathyroid glands, is the main regulator of calcium homeostasis. Hypoparathyroidism (hypoPT), due to decrease of PTH production, is a rare disease. Symptoms are multiple, altering function of several organs and leading to a decrease of quality of life. Acquired etiologies, including thyroïdectomy, the main cause of hypoPT, can be distinguished from congenital etiologies, including genetic defects. HypoPT, which is classically treated by supplementation by calcium and active vitamin D, can now be treated by recombinant injection in certain indications as a poor control under classical therapy. Here are summarized current knowledge on etiologies, epidemiology, clinical manifestations and management of hypoPT.
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Affiliation(s)
- S Espiard
- Service d'endocrinologie et métabolisme, hôpital C. Huriez, CHRU de Lille, rue Polonovski, 59037 Lille Cedex, France.
| | - M-C Vantyghem
- Service d'endocrinologie et métabolisme, hôpital C. Huriez, CHRU de Lille, rue Polonovski, 59037 Lille Cedex, France
| | - R Desailloud
- Service d'endocrinologie, diabétologie, nutrition, hôpital Nord, CHU-UPJV d'Amiens, Amiens, France
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