Álvarez-Escolá, C. (Cristina)

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    Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients
    (AME Publishing Company, 2020) Fernandez-Garcia, J.C. (José C.); Baena-Nieto, G. (Gloria); Bandrés, O. (Orosia); Zafón, C. (Carles); Anda, E. (Emma); Sánchez-Ragnarsson, C. (Cecilia); Megía, A. (Ana); Romero-Lluch, A.R. (Ana Reyes); Sambo, M. (Marcel); Picallo, M. (María); Donnay, S. (Sergio); Iglesias, P. (Pedro); Manjón, L. (Laura); Lecumberri, B. (Beatriz); Sahún-de-la-Vega, M. (Manel); Fernández, P.S. (Piedad Santiago); Pérez-Corral, B. (Begoña); Sanz, E. (Eva); Navarro, E. (Elena); Díez, J.J. (Juan J.); Paja, M. (Miguel); Blanco-Carrera, C. (Concepción); Galofre, J.C. (Juan Carlos); Sastre, J. (Julia); Álvarez-Escolá, C. (Cristina); Oleaga, A. (A.)
    Background: Recent guidelines for the treatment of hypoparathyroidism emphasize the need for long-term disease control, avoiding symptoms and hypocalcaemia. Our aim has been to analyze the prevalence of poor disease control in a national cohort of patients with hypoparathyroidism, as well as to evaluate predictive variables of inadequate disease control. Methods: From a nation-wide observational study including a cohort of 1792 patients undergoing total thyroidectomy, we selected 260 subjects [207 women and 53 men, aged (mean ± SD) 47.2±14.8 years] diagnosed with permanent hypoparathyroidism. In every patient demographic data and details on surgical procedure, histopathology, calcium (Ca) metabolism, and therapy with Ca and calcitriol were retrospectively collected. A patient was considered not adequately controlled (NAC) if presented symptoms of hypocalcemia or biochemical data showing low serum Ca levels or high urinary Ca excretion. Results: Two hundred and twenty-one (85.0%) patients were adequately controlled (AC) and 39 (15.0%) were NAC. Comparison between AC and NAC patients did not show any significant difference in demographic, surgical, and pathological features. Rate of hospitalization during follow-up was significantly higher among NAC patients in comparison with AC patients (35.9% vs. 10.9%, P<0.001). Dose of oral Ca and calcitriol were also significantly higher in NAC subjects. In a subgroup of 129 patients with serum parathyroid hormone (PTH) levels available, we found that NAC patients exhibited significantly lower postoperative PTH concentrations than AC patients [median (interquartile range) 3 (1.9-7.8) vs. 6.9 (3.0-11) pg/mL; P=0.009]. Conclusions: In a nation-wide cohort of 260 subjects with definitive hypoparathyroidism, 15% of them had poor disease control. These patients required higher doses of oral Ca and calcitriol, had higher rate of hospitalization during follow-up and showed lower PTH concentrations in the postoperative period.