Hungry bone syndrome (HBS) in patients operated for primary hyperparathyroidism (PHPT): A six-year experience

OBJECTIVE: To review cases of adult patients who develop Hungry Bone Syndrome (HBS) after parathyroidectomy for Primary Hyperparathyroidism (PHPT) in a tertiary care center in the Philippines and describe the clinical features, pre-operative preventive measures done and risk factors for HBS.METHODS:Design: Retrospective Case Note ReviewSetting: Tertiary Private HospitalParticipants: Chart review of adult Filipino patients who underwent parathyroidectomy for PHPT at Makati Medical Center from January 2011 to December 2016 was conducted and evaluated according to the inclusion and exclusion criteria. Medical information obtained included clinical parameters, biochemical results, operation performed, pathology, length of hospital stay and complications if with any.RESULTS: From among 20 adult Filipino patients (mean age 55 years; 13, 65% female) who underwent parathyroidectomy for PHPT, HBS was found in 7 (35%). Most common pre-operative symptoms of hypercalcemia were musculoskeletal complaints. To prevent HBS, all were hydrated prior to surgery while some were given bisphosphonates and diuretics. The most common parathyroid gland imaging used for pre-procedure localization was Tc 99m Sestamibi scan with single photon emission computed tomography (SPECT) and 19 (95%) had parathyroid adenoma on post-operative histopathologic report. Among biochemical and clinical factors that may be risk factors for HBS, those with HBS had significantly lower pre-operative 25-hydroxyvitamin D, higher BUN, phosphate and alkaline phosphatase (ALP) than those without HBS. Of these, only ALP showed significant association with HBS (OR = 107.17, p = CONCLUSION: Knowledge on post-parathyroidectomy HBS for PHPT may aid clinicians on preoperative prevention and post-operative monitoring. Thirty-five percent (7) of our patients presented with HBS post-parathyroidectomy for PHPT from 2011 to 2016. An abnormal ALP level pre-operatively may be a risk factor in developing HBS post-parathyroidectomy for PHPT

Thyroid ultrasound findings associated with thyroid peroxidase autoantibody positivity in patients with diffuse goiter

BACKGROUND: To determine the thyroid ultrasound findings in association with anti-TPO positivity among patients with diffuse goiter.DESIGN AND METHODS: We performed a cross-sectional study on patients with diffuse goiter seen at Makati Medical Center out-patient Endocrine clinics from October 1, 2011 to October 1, 2012. Patients with anti-TPO (thyroid peroxidase) above 100 pmol/L were considered anti-TPO positive and below this level were considered negative. After excluding patients with other possible causes of thyroiditis, thyroid ultrasound of anti-TPO positive and anti-TPO negative patients were reviewed and compared based on size, echogenicity, echopattern and vascularity of the thyroid parenchyma.RESULTS: In 94 patients who qualified for the study, 43.6% were anti-TPO positive. A higher proportion of anti-TPO positive was seen among females compared to males by almost twofold (49.7% vs 25%, p0.05). Stratified according to age group for female patients, anti-TPO positivity is relatively higher among 31-50 years old (51.1%, p =0.753). Among male, anti-TPO positivity is present in all 18-2 years old which is significantly higher compared to other age group (p larger thyroid size in all measurement parameters (p= 0.0053). Among anti-TPO positive patients, frequent ultrasound findings were: hypoechoic (79% vs. 21%, p 0.001); heterogenous parenchyma (71% vs. 29%, p 0.001) and increased vascularity (93% vs. 7%, p 0.001). Of note is the absence of homogenous prenchyma fnding among anti-TPO positive. All 23 (100%) patients who showed combined findings of hypoechoic, heterogenous parenchyma and increased vascularity were anti-TPO positive.CONCLUSION: Thyroid ultrasound findings that are found frequently among anti-TPO positive are increased thyroid size, parenchyma that are hypoechoiec and heterogenous and increased vascularity. Homogenous echotexture was not seen among anti-TPO positive. The combined sonographic characteristics of hypoechoic, heterogenous pattern and increased vascularity are highly suggestive of presence of anti-TPO (100%).