Post-Parathyroidectomy Hypocalcemia: Incidence, Risk Factors, and Management

Mittendorf, Elizabeth A.; Merlino, James I.; Mchenry, Christopher R.
February 2004
American Surgeon;Feb2004, Vol. 70 Issue 2, p114
Academic Journal
The purpose of this study was to evaluate the incidence and severity of hypocalcemia after parathyroidectomy and delineate its risk factors. Data was retrieved from a prospective database. Patients with postoperative hypocalcemia were identified and risk factors were investigated including primary versus renal hyperparathyroidism (HPT), preoperative calcium, parathyroid hormone (PTH) and alkaline phosphatase levels, gland weight, pathology, extent of surgery, and reoperative surgery. Of the 162 patients who underwent parathyroidectomy, 84 (52%) were hypocalcemic postoperatively; 55 (42%) of 132 patients with primary and 29 (97%) of 30 patients with renal HPT (P = 0.0001). Patients with renal HPT had more profound hypocalcemia with a mean ± SD calcium of 7.34 mg/dL ± 1.07 versus 7.76 mg/dL ± 0.59 for patients with primary HPT (P < 0.05). Symptoms were present in 28 (51%) of 55 patients with primary and 13 (45%) of 29 patients with renal HPT. Only three (2%) patients with primary compared to 29 (97%) with renal HPT were treated with intravenous calcium. The average length of stay for hypocalcemic patients was 0.7 days for primary HPT versus 4.7 days for renal HPT (P < 0.0005). Patients with primary HPT who underwent subtotal parathyroidectomy had significantly lower postoperative calcium levels (7.95 mg/dL ± 0.64) than patients who had a single or double adenoma removed (8.49 mg/dL ± 0.79) (P = 0.036). No other factor was predictive of postoperative hypocalcemia. Patients with renal HPT develop profound postoperative hypocalcemia requiring intravenous calcium and vitamin D therapy. Hypocalcemia in patients with primary HPT develop less severe hypocalcemia that is amenable to outpatient oral calcium therapy and should be routinely initiated following subtotal parathyroidectomy.


Related Articles

  • Accuracy of intra-operative PTH measurement during subtotal parathyroidectomy for tertiary hyperparathyroidism after renal transplantation. Triponez, Frederic; Dosseh, David; Hazzan, Marc; Noel, Christian; Soudan, Benoit; Lokey, Jonathan; Mozzon, Martha; Proye, Charles A. G. // Langenbeck's Archives of Surgery;Nov2006, Vol. 391 Issue 6, p561 

    Intra-operative parathyroid hormone (IOPTH) results are not known in the setting of tertiary hyperparathyroidism (HPT) after renal transplantation. A retrospective analysis of 35 tertiary HPT patients who all underwent subtotal parathyroidectomy and IOPTH monitoring was conducted. The mean...

  • Role of 1,25-dihydroxyvitamin D on the skeletal resistance to parathyroid hormone. Galceran, Tilde; Martin, Kevin J.; Morrissey, Jeremiah J.; Slatopolsky, Eduardo // Kidney International;Dec1987, Vol. 32 Issue 6, p801 

    Hypocalcemia in chronic renal failure (CRF) has been attributed in part to a skeletal resistance (S.R.) to the calcemic action of parathyroid hormone (PTH) as a consequence of low levels of 1,25(OH)2D3. To further elucidate the role of 1,25(OH)2D3 in the genesis of S.R., the calcemic effect of...

  • The impact of vitamin D status and tumor size on the intraoperative parathyroid hormone dynamics in patients with symptomatic primary hyperparathyroidism. Agarwal, Gaurav; Sadacharan, Dhalapathy; Ramakant, Pooja; Shukla, Manoj; Mishra, Saroj // Surgery Today;Dec2012, Vol. 42 Issue 12, p1183 

    Purpose: The intraoperative parathyroid hormone (IOPTH) monitoring is a useful adjunct for predicting whether a cure has been obtained during parathyroidectomy. We studied the influence of vitamin D status and parathyroid tumor weight on the IOPTH dynamics for predicting a cure in patients with...

  • Primärer Hyperparathyreoidismus. Hermann, M. // Der Chirurg;May2010, Vol. 81 Issue 5, p447 

    Normocalcemic hyperparathyrinemia, i.e. elevated parathyroid hormone (PTH) levels after parathyroidectomy in patients with primary hyperparathyroidism (pHPT) may occur in the course of postoperative recovery without the development of persistence or relapse. Intraoperative and long-term (7 year)...

  • Predictive Factors for Postoperative Severe Hypocalcaemia after Parathyroidectomy for Primary Hyperparathyroidism. Crea, Nicola; Pata, Giacomo; Casella, Claudio; Cappelli, Carlo; Salerni, Bruno // American Surgeon;Mar2012, Vol. 78 Issue 3, p352 

    The article focuses on a study which analyzed patients who underwent parathyroidectomy for primary hyperparathyroidism (pHPT) in an effort to identify the factors that can predict severe postoperative hypocalcaemia. It found more than 85 percent reduction in intraoperative parathyroid hormone...

  • Total Parathyroidectomy Versus Subtotal Parathyroidectomy in the Treatment of Tertiary Hyperparathyroidism. Ting-Min Hsieh; Cheuk-Kwan Sun; Yen-Ta Chen; Fong-Fu Chou // American Surgeon;May2012, Vol. 78 Issue 5, p600 

    The purposes of this study are to evaluate the merits of surgical treatment, including subtotal parathyroidectomy (SP) and total parathyroidectomy (TP), in patients with tertiary hyperparathyroidism (THPT) and compare the outcome of the two surgical options. Medical records of patients...

  • Parathyroidectomy: is vitamin D a player for a good outcome? Carsote, M.; Paduraru, D. N.; Nica, A. E.; Valea, A. // Journal of Medicine & Life;Oct-Dec2016, Vol. 9 Issue 4, p348 

    Background The field of parathyroidectomy (PTx) is complex and brings together many specialists. Even if the surgical approaches changed from classical to minimally invasive PTx, a good outcome is correlated with an adeguate localization before and during PTx, while blood assays, such as...

  • test yourself. LINDELL, DAVE // American Surveyor;Jun2016, Vol. 13 Issue 5, p20 

    No abstract available.

  • CKD-MBD - B.  // Nephrology Dialysis Transplantation;May2013 Supplement, Vol. 28 Issue suppl_1, pi25 

    No abstract available.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics