Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 351
Filter
1.
Article in Chinese | WPRIM | ID: wpr-1011090

ABSTRACT

Objective:To investigate the value of retrograde thyroidectomy from top to bottom in the operation of retrosternal thyroid surgery. Methods:Retrospective analysis was performed on the cases of retrosternal goiter excised by our surgeons from January 2017 to June 2022,the technical points, feasibility and advantages of the operation were summarized. Results:A total of 15 cases of retrosternal goiter treated by retrograde thyroidectomy were collected, including 5 cases of type Ⅰ retrosternal goiter and 10 cases of type Ⅱ retrosternal goiter.The postoperative pathology was benign. The surgical time is 40-60 minutes for unilateral retrosternal goiter and 70-90 minutes for bilateral goiter. All patients were discharged normally within 7 days after operation, and no operative complications were observed such as bleeding, hoarseness or hypoparathyroidism. Conclusion:This surgical excision method of thyroid is suitable for the type Ⅰ and type Ⅱ retrosternal goiter surgery, which can avoid the difficulties in exposing and separating the the inferior thyroid behind the sternum in conventional surgical method, speed up the operation and reduced the difficulty of operation, and has certain promotion value in clinic.


Subject(s)
Humans , Thyroidectomy/methods , Retrospective Studies , Goiter, Substernal/pathology , Hypoparathyroidism/surgery
2.
Article in Chinese | WPRIM | ID: wpr-982750

ABSTRACT

Objective:To investigate the relationship between parathyroid hormone(PTH) level and permanent hypoparathyroidism(PHPP) on the first day after radical papillary thyroidectomy, and its predictive value. Methods:A total of 80 patients with papillary thyroid cancer who underwent total thyroid resection and central lymph node dissection were collected and analyzed from January 2021 to January 2022. According to whether PHPP occurred after surgery, the patients were divided into hypoparathyroidism group and normal parathyroid function group, and univariate and binary logistics regression were used to analyze the correlation between PTH and serum calcium levels and PHPP on the first day after surgery in two groups. The dynamic changes of PTH at different time points after operation were analyzed. The area under the receiver operating characteristic was used to evaluate the predictive power of PTH on the development of PHPP after surgery. Results:Among the 80 patients with papillary thyroid cancer, 10 cases developed PHPP, with an incidence rate of 12.5%. Binary logistics regression analysis showed that PTH on the first postoperative day(OR=14.534, 95%CI: 2.377-88.858, P=0.004) was an independent predictive risk factor for postoperative PHPP. Taking PTH=8.75 ng/L on the first postoperative day as the cut-off value, the AUC of the area under the curve was 0.874(95%CI: 0.790-0.958, P<0.001), the sensitivity was 71.4%, the specificity was 100%, and the Yoden index was 0.714. Conclusion:PTH level on the first day after total thyroid papillary carcinoma surgery is closely related to PHPP, and is an independent predictor of PHPP.


Subject(s)
Humans , Calcium , Hypoparathyroidism/surgery , Parathyroid Glands , Parathyroid Hormone , Postoperative Complications/surgery , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/complications , Thyroidectomy
3.
Med. UIS ; 35(3)dic. 2022.
Article in Spanish | LILACS | ID: biblio-1534823

ABSTRACT

Introducción: La hipocalcemia por hipoparatiroidismo es la complicación más frecuente tras tiroidectomía total. Un factor predictor importante de hipocalcemia es la parathormona postoperatoria, pero el momento en el que otorga mejores resultados predictivos aún se discute. Objetivo: El objetivo es analizar el valor pronóstico de la parathormona postoperatoria a las 24 horas como indicador de hipocalcemia, en comparación con la seriación de los niveles de calcio. Metodología: Estudio observacional retrospectivo y descriptivo de 297 pacientes intervenidos de tiroidectomía total durante ocho años. Los pacientes fueron clasificados en tres grupos de riesgo según la parathormona postoperatoria (alto, medio y bajo riesgo). Para comparar la parathormona frente al calcio postoperatorio como predictor de hipocalcemia, se obtuvieron curvas ROC y áreas debajo de la curva. Resultados: El riesgo relativo de tener hipocalcemia con parathormona ≤15 pg/mL es de 353,4 (p = 0,00). La prueba de parathormona postoperatoria (≤15 pg/mL a las 24 h) obtuvo una sensibilidad del 96,25 % para la detección de hipocalcemia, especificidad del 94,06 % y precisión global del 95,03 %. El grupo de alto riesgo (parathormona ≤15 pg/mL) concentra la mayoría de los pacientes con hipocalcemia, y abarca la totalidad de los casos permanentes. Conclusiones: La parathormona postoperatoria a las 24 horas de la tiroidectomía total es un test con un valor pronóstico considerable, capaz de predecir el riesgo de hipocalcemia postquirúrgica. Se encontró que los pacientes con parathormona >15 pg/mL pueden ser dados de alta de manera segura.


Introduction: Hypocalcemia due to hypoparathyroidism is the most frequent complication after total thyroidectomy. An important predictive factor of hypocalcaemia is postoperative parathormone (PTH), but the optimal time for testing PTH levels is under discussion. Objectives: The objective is to analyze the prognostic value of postoperative PTH at 24 hours as an indicator of hypocalcaemia, compared to serum calcium levels. Methodology: Descriptive retrospective observational study of 297 patients who underwent total thyroidectomy over an 8-year period. The patients were classified into 3 risk groups according to postoperative parathormone (high, medium and low risk). To compare parathormone versus postoperative calcium as a predictor of hypocalcemia, ROC curves and areas under the curve (AUC) were obtained. Results: The relative risk of having hypocalcemia with parathormone ≤ 15 pg/mL is 353.4 (p = 0.00). The postoperative parathormone test (≤ 15 pg / mL at 24h) obtained a sensitivity of 96.25% for the detection of hypocalcemia, specificity of 94.06% and global precision of 95.03%. The high-risk group (parathormone ≤ 15 pg/mL) accounts for the vast majority of patients with hypocalcemia and covers all permanent cases. Conclusions: Postoperative levels 24 hours after total thyroidectomy is a test with considerable prognostic value, capable of predicting the risk of postsurgical hypocalcemia. Patients with levels over > 15 pg/mL can be safely discharged.


Subject(s)
Humans , Male , Female , Thyroidectomy , Parathyroid Hormone , Postoperative Complications , Hypocalcemia , Hypoparathyroidism , Length of Stay
4.
Rev. fac. cienc. méd. (Impr.) ; 19(1): 15-22, ene.-jun. 2022. tab.
Article in Spanish | LILACS, BIMENA | ID: biblio-1519636

ABSTRACT

El hipoparatiroidismo postquirúrgico se caracteriza por hipocalcemia, hiperfosfatemia, e hipercalciuria, secundarios a concentraciones bajas de la hormona paratiroidea. La prevalencia en Estados Unidos es 23-37 casos/100.000 años-persona. Tras la cirugía de cuello ocurre como complicación en 78% de los casos; 75% resuelve espontáneamente en los primeros 6 meses y en el 25% restante es permanente. El tratamiento requiere administrar calcio oral y análogos de vitamina D (calcitriol y alfacalcidol) de forma crónica; en casos complicados se puede emplear calcio intravenoso en el postquirúrgico inmediato y mediato; algunos pacientes no responden a la terapia estándar. Objetivo: describir las características clínicas y la respuesta al tratamiento médico en pacientes con hipoparatiroidismo postquirúrgico permanente. Material y métodos: estudio descriptivo, transversal, con componente analítico mediante revisión de expedientes clínicos de pacientes que asistieron a la consulta externa del Servicio de Endocrinología del Centro Médico Nacional 20 de Noviembre; universo 88 expedientes, muestra por conveniencia 55 expedientes. Resultados: 35(63.6%) pacientes alcanzaron control óptimo de tratamiento a dosis de calcio elemental de 5.7-9.79g/24h (p= 0.0001 chi cuadrado), mostrando calcio sérico promedio 8.36 0.55 mg/dl y calcitriol con mediana de 0.5µg/24 h. 15(27.2%) pacientes presentaron efectos secundarios al uso de calcio oral, 3 de ellos requirieron manejo con Hormona Paratiroidea Recombinante Humana para alcanzar control óptimo. Conclusión: el calcio elemental por vía oral continúa siendo la piedra angular en el tratamiento del hipoparatiroidismo post quirúrgico permanente, con pocos efectos adversos. Se recomiendan más estudios aleatorizados para identificar las características de los pacientes candidatos al manejo con Hormona Paratiroidea Recombinante Humana...(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Endocrine Surgical Procedures , Hypoparathyroidism/drug therapy , Hypocalcemia , Neck/surgery
5.
Article in Chinese | WPRIM | ID: wpr-928394

ABSTRACT

OBJECTIVE@#To analyze the clinical phenotype and genetic basis for a male neonate featuring hypoparathyroidism, sensorineural hearing loss, and renal dysplasia (HDR) syndrome.@*METHODS@#The child was subjected to genome-wide copy number variation (CNVs) analysis and whole exome sequencing (WES). Clinical data of the patient was analyzed. A literature review was also carried out.@*RESULTS@#The patient, a male neonate, had presented with peculiar facial appearance, simian crease and sacrococcygeal mass. Blood test revealed hypocalcemia, hypoparathyroidism. Hearing test suggested bilateral sensorineural deafness. Doppler ultrasound showed absence of right kidney. Copy number variation sequencing revealed a 12.71 Mb deletion at 10p15.3-p13 (chr10: 105 001_12 815 001) region. WES confirmed haploinsufficiency of the GATA3 gene. With supplement of calcium and vitamin D, the condition of the child has improved.@*CONCLUSION@#The deletion of 10p15.3p13 probably underlay the HDR syndrome in this patient.


Subject(s)
Humans , Infant, Newborn , Male , DNA Copy Number Variations , Hearing Loss, Sensorineural/genetics , Hypoparathyroidism/genetics , Kidney/abnormalities , Syndrome , Urogenital Abnormalities/genetics
6.
Rev. chil. endocrinol. diabetes ; 15(3): 104-109, 2022. graf, tab
Article in Spanish | LILACS | ID: biblio-1392447

ABSTRACT

INTRODUCCIÓN: el hipoparatiroidismo es la alteración causada por hipofunción de las glándulas paratiroides y la causa más común es la posquirúrgica. OBJETIVO: conocer la incidencia de hipocalcemia dentro de las 72 horas del postoperatorio y de hipoparatiroidismo permanente de tiroidectomías en nueve años. SUJETOS Y MÉTODO: estudio observacional, descriptivo y retrospectivo de pacientes con tiroidectomías entre enero de 2011 y diciembre de 2019 en el Hospital de Clínicas. Se dividió la muestra por grupos etarios, se consideró hipocalcemia a valores ≤8,5 mg/dl e hipoparatiroidismo permanente cuando persistían por lo menos un año luego de cirugía. RESULTADOS: fueron 202 pacientes, 182 mujeres y 20 hombres, media de edad ± ES para mujeres 47.3±1.2 años y para hombres 55.1±3.4. El 61,5% presentó hipocalcemia en las primeras 72 horas del postoperatorio: 60,2% de mujeres y 71,4% de hombres (p=0.42). El 79% fueron hipocalcemias asintomáticas, 7,5% tuvo síntomas y 13,5% sin datos. El signo de Trousseau fue negativo 68% y positivo en 9%. Respecto a la patología hubo 107 resultados benignos, 94 malignos. CONCLUSIONES: el 90% fueron mujeres, 6 de cada 10 presentaron hipocalcemia en las primeras 72hs, en la gran mayoría fueron asintomáticas y tuvieron signo de Trousseau negativo. No hubo correlación entre hipocalcemia con edad, sexo, duración o tiempo de la cirugía, ni resultado de patología. La incidencia de hipoparatiroidismo transitorio fue 75,7% y permanente 7,3%. Cuando no hubo hipoparatiroidismo transitorio tampoco hubo hipoparatiroidismo permanente.


INTRODUCTION: hypoparathyroidism is the alteration caused by hypofunction of the parathyroid glands and the most common cause is post-surgery. OBJECTIVE: to know the incidence of hypocalcaemia within 72 hours of the postoperative period and of permanent hypoparathyroidism of thyroidectomies in nine years. SUBJECTS AND METHOD: observational, descriptive and retrospective study of patients with thyroidectomies between January 2011 and December 2019 at Clinical's Hospital. The sample was divided by age groups, hypocalcemia was considered at values ≤8.5 mg/dl and permanent hypoparathyroidism when they persisted for at least one year after surgery. RESULTS: there were 202 patients, 182 women and 20 men, mean age ± SE for women 47.3±1.2 years and for men 55.1±3.4. 61.5% presented hypocalcaemia in the first 72 hours after surgery: 60.2% of women and 71.4% of men (p=0.42). 79% were asymptomatic hypocalcemia, 7.5% had symptoms and 13.5% without data. Trousseau's sign was negative in 68% and positive in 9%. Regarding the pathology, there were 107 benign results, 94 malignant. CONCLUSIONS: 90% were women, 6 out of 10 presented hypocalcemia in the first 72 hours, the vast majority were asymptomatic and had a negative Trousseau sign. There was no correlation between hypocalcaemia with age, sex, duration or time of surgery, or pathology result. The incidence of transient hypoparathyroidism was 75.7% and permanent 7.3%. When there was no transient hypoparathyroidism, there was also no permanent hypoparathyroidism.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Thyroidectomy/adverse effects , Hypocalcemia/epidemiology , Hypoparathyroidism/epidemiology , Postoperative Complications , Incidence , Retrospective Studies , Age and Sex Distribution , Hypocalcemia/etiology , Hypoparathyroidism/etiology
8.
Arch. endocrinol. metab. (Online) ; 65(3): 259-264, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285152

ABSTRACT

ABSTRACT Background: The aim of this study was to address the first cases of TOETVA done in Brazil, by TOETVA-Bra study group, regarding safety and complications. Materials and Methods: Series of the first 93 TOETVAs cases in Brazil. All authors except LPK, AJG JOR and RPT received TOETVA training including cadaveric hands-on in Thailand or United States (Johns Hopkins Medicine) during 2017. After they came back to Brazil and started doing their first TOETVA cases in the cities of Rio de Janeiro, Sao Paulo and Chapecó they agreed to collaborate and gather data using an online spreadsheet. All patients were submitted to the technique described by Anuwong. Results: A total of 93 patients underwent TOETVA. Most patients (58.1%) were submitted to total thyroidectomy and 59.1% had benign disease. Two patients (2.2%) needed conversion to open surgery. Five patients (9.3%) developed transient hypoparathyroidism and there were 3 (2.0%) temporary recurrent laryngeal nerve palsy. There was one (0.7%) permanent unilateral palsy. Twenty patients had some sort of complication, 16.1% were minor and 5.4% were major. A total of 73 patients (78.5%) had an uneventful recovery. Conclusion: The technique is reproducible with a low complication rate. While further studies are needed to confirm equivalency, early efforts suggest that TOETVA is not inferior to traditional open thyroidectomy in appropriately selected patients.


Subject(s)
Humans , Thyroidectomy/adverse effects , Hypoparathyroidism , Brazil , Endoscopy , Learning Curve
9.
Braz. j. otorhinolaryngol. (Impr.) ; Braz. j. otorhinolaryngol. (Impr.);87(2): 205-209, mar.-abr. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1249362

ABSTRACT

Resumo Introdução: A cirurgia mais comum da região cervical é a tireoidectomia. Atualmente, várias tecnologias estão disponíveis para hemostasia intraoperatória. Objetivo: Comparar o desempenho de três tecnologias (elétrica monopolar e bipolar e ultrassônica) no tempo operatório e complicações pós-operatórias. Método: Pacientes submetidos à tireoidectomia total sem tratamento prévio foram incluídos. Desenho científico usado: estudo de série prospectiva. Resultados: Foram incluídos 834 pacientes, 661 mulheres (79,3%) e 173 homens (20,7%). O diagnóstico foi de neoplasia maligna em 528 pacientes (63,3%) e de doença benigna em 306 pacientes (36,7%). O bisturi elétrico monopolar foi usado em 280 pacientes (33,6%), energia bipolar em 210 (25,2%) e ultrassônica em 344 (41,3%). O tempo operatório foi significantemente menor com bisturi ultrassônico ou bipolar quando comparado com elétrico. Em um modelo de regressão linear, sexo, diagnóstico de malignidade e tipo de energia foram significantes para duração do procedimento. Os pacientes operados com bisturi ultrassônico ou bipolar apresentaram incidência significantemente menor de hipoparatireoidismo. Conclusão: O uso do bisturi ultrassônico ou bipolar reduz de forma significante o tempo operatório e a incidência de hipoparatireoidismo transitório.


Subject(s)
Humans , Male , Female , Thyroidectomy/adverse effects , Hypoparathyroidism , Postoperative Complications/epidemiology , Surgical Instruments , Prospective Studies , Operative Time
10.
Repert.Med.Cir ; 30(3): 219-255, 2021.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1362933

ABSTRACT

Introducción: revisión narrativa que explica el panorama actual de la hipocalcemia y el hipoparatiroidismo como complicaciones de la tiroidectomía, su diagnóstico y tratamiento; con una descripción de las nuevas estrategias de prevención y tratamiento. Métodos: los motores de búsqueda utilizados fueron PubMed, Clinical Key, Embase, Cochrane y Lilacs, se incluyeron referencias en español e inglés, publicadas entre 2016 y 2020. Los artículos seleccionados se revisaron utilizando CONSORT, STROBE o PRISMA, según el caso. Resultados: fueron seleccionados 35 artículos que tenían relación directa con el tema, entre ellos: metanálisis, revisiones sistemáticas, estudios prospectivos y observacionales, revisiones narrativas y consensos de expertos, procedentes de los cinco continentes. La hipocalcemia y el hipotiroidismo en sus dos formas se relacionan con la afectación de la vascularización de las glándulas paratiroides o su exérecis accidental, existiendo factores predisponentes propios del paciente, derivados de la técnica quirúrgica o la característica patológica de la lesión en el tiroides. Como estrategias de prevención disponemos de herramientas ópticas para definir en el perioperatorio la disposición de las paratiroides; además existe la posibilidad de autotrasplantarlas al identificarlas en la pieza anatómica. El mejor marcador del estado metabólico del calcio es la PTHi. Conclusiones: la preservación de las paratiroides y de su irrigación es la mejor estrategia para prevenir los trastornos posoperatorios del calcio


Introduction: narrative review explaining the current picture of hypocalcemia and hypoparathyroidism as complications of thyroidectomy, describing new strategies employed for their diagnosis and treatment. Methods: searches in the PubMed, Clinical Key, Embase, Cochrane and Lilacs databases; references in Spanish and English, published between 2016 and 2020 were included. The selected articles were reviewed using CONSORT, STROBE or PRISMA, as appropriate. Results: 35 articles directly related with the topic were selected, including meta-analyses, systematic reviews, prospective and observational studies, narrative reviews and expert consensus, on all five continents. The two forms of hypocalcemia and hypoparathyroidism can result from devascularization or accidental removal of the parathyroid glands, patient-specific factors, or from the surgical technique or the pathological characteristics of the thyroid lesion. Preventive strategies include the use of optical tools for preoperative determination of parathyroid glands location; as well as the possibility of autotransplantation after confirming parathyroid tissue in the biopsy specimen. The best marker of calcium metabolism is iPTH. Conclusions: preservation of the parathyroid glands and their irrigation is the best strategy to prevent postoperative calcium disorders.


Subject(s)
Calcium , Hypocalcemia , Hypoparathyroidism , Metabolism , Thyroidectomy , Thyroid Neoplasms , Neck/surgery
11.
Rev. Col. Bras. Cir ; 48: e20202557, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155373

ABSTRACT

ABSTRACT The thyroidectomy is the most frequently executed procedure in head and neck surgery. Since its first description by Kocher, the transverse cervical incision has been the main access to the thyroid site, as it provides broad exposure of the central neck compartment. Despite the meticulous suture of the incision, the development of a scar with variable dimensions is unavoidable and, hence, some patients might not agree to the approach, due to this consequence. The transoral endoscopic thyroidectomy vestibular access (TOETVA) gains importance as an alternative to the traditional surgery, since it avoids the formation of visible scars. The objective of this study is to develop a systematic review on the currently available literature to evaluate possible complications related to the TOETVA. The systematic review was based on the databases of Medline, Cochrane library, Embase and Scielo/Lilacs, resulting in the selection of six studies, which were compared in regard of the type of study duration of the study and identified complications. Our study showed that TOETVA is related to complications similar to the ones identified in the conventional approach, such as hematoma, seroma, recurrent laryngeal nerve injury, hypoparathyroidism, surgical site infection. The TOETVA was associated to a higher risk of thermic injury of the skin and mentual nerve paresthesia. Moreover, it was possible to conclude that TOETVA is a safe procedure for well selected patients, with favorable conditions and concerned about the aesthetic outcome. The risk of complications of the procedure should always be explained to those patients.


RESUMO A tireoidectomia é o procedimento cirúrgico mais frequentemente realizado na cirurgia de cabeça e pescoço. Desde sua descrição por Kocher, a incisão cervical transversa constitui o principal acesso à loja tireoideana e permite ampla exposição à região central do pescoço. Apesar do fechamento meticuloso da incisão, uma cicatriz de dimensões variáveis é inevitável, e certos pacientes podem discordar de tal abordagem. A tireoidectomia vestibular endoscópica transoral (TOETVA) ganha importância como alternativa à cirurgia tradicional, pois evita a formação de cicatrizes visíveis. O objetivo de estudo é realizar uma revisão sistemática da literatura das possíveis complicações da TOETVA. Foi realizada revisão sistemática da literatura nas bases de dados Medline, The Cochrane Library, Embase e SciElo/Lilacs, sendo selecionados seis artigos e tabulados os dados de tipo de estudo, período do estudo e complicações apresentadas. O estudo mostra que a TOETVA apresenta complicações semelhantes à técnica convencional, como hematoma, seroma, lesão de nervo laríngeo recorrente, hipoparatireoidismo, além de infecção de sítio cirúrgico, com maior risco de lesão térmica da pele e parestesia por lesão do nervo mentual. Em adição, foi possível concluir que a TOETVA é uma técnica segura para pacientes bem selecionados, com condições favoráveis e com especial preocupação com resultados estéticos, devendo sempre ser orientados sobre possíveis complicações.


Subject(s)
Humans , Thyroid Gland/surgery , Thyroidectomy/methods , Natural Orifice Endoscopic Surgery/adverse effects , Hypoparathyroidism/surgery , Postoperative Complications , Thyroidectomy/adverse effects , Hematoma
12.
Arch. endocrinol. metab. (Online) ; 64(4): 374-382, July-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131115

ABSTRACT

ABSTRACT Objective The aim of the present study was to evaluate whether arterial stiffness is affected in the patients with hypoparathyroidism through pulse wave analysis (PWA). Subjects and methods Sixty-three patients diagnosed with hypoparathyroidism and sixty volunteers were evaluated for the study. When 21 patients were excluded in the hypoparathyroidism group due to exclusion criteria, the research continued with 42 patients and 60 volunteers who are similar to the patients in terms of age, gender and body mass index (BMI). Fasting plasma glucose after 10 hours of fasting, creatinine, thyroid stimulating hormone (TSH), free thyroxine (fT4), albumin, calcium, phosphorus, magnesium, 25-OH vitamin D, parathormone (PTH) and urine calcium results in 24-hour urine for the patients in the hypoparathyroidism group were recorded. Evaluation of arterial stiffness was performed by Mobil-O-Graph 24h PWA device. Results Systolic blood pressure (SBP) (p = 0.01), diastolic blood pressure (DBP) (p = 0.005), mean blood pressure (p = 0.009), central SBP (p = 0.004), central DBP (p = 0.01) and pulse wave velocity (PWV) (p = 0.02) were found higher in the hypoparathyroidism group. A positive correlation was detected between phosphorus level and SBP [(p = 0.03. r = 0.327)], central SBP [(p = 0.04, r = 0.324)] and PWV [(p = 0.003, r = 0.449)]. We detected that age and serum phosphorus levels were independent predictor variables for PWV (B = 0.014, p < 0.001 and B = 0.035, p < 0.001, respectively). Conclusion We detected that hypoparathyroidism causes an increase in blood pressure and arterial stiffness. The most significant determinant factors were detected as advanced age and hyperphosphatemia. The patients diagnosed with hypoparathyroidism should be closely monitored and treatment planning should include to prevent the patients from hyperphosphatemia.


Subject(s)
Humans , Vascular Stiffness , Hypoparathyroidism , Blood Pressure , Body Mass Index , Pulse Wave Analysis
13.
Arch. endocrinol. metab. (Online) ; 64(4): 427-435, July-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131116

ABSTRACT

ABSTRACT Objective The most vital complications of thyroidectomy are recurrent nerve damage and hypocalcaemia. We aimed to compare the tissue perfusion scores (PS) of IG fluorescence angiography (IGFA) and visual examination by the surgeon after total thyroidectomy. Subjects and methods Forty-three patients were accepted into the study. Localisation of the parathyroid gland (PG) was determined by the naked eye and scored in terms of tissue perfusion. The averages of fluorescent light intensities for each IGFA were calculated, the perfusions were scored and compared with the PS given by the surgeon. Biochemical parameters were noted. Results 37.2% of patients had autotransplanted PGs, according to their visual scores. The means of IGFA-PS for PGs scored as 0, 1 or 2 on visual inspection were 48.58 ± 4.49 [30-70], 89.65 ± 8.93 [36-144] and 158.76 ± 8.93 [70-253], respectively, which correlated with the visual PSs in a statistically significant manner (P < 0.0001). The predictive cut-off value for IGFA-PS was determined to be 70, given a visual PS of 0 (95% CI [0.72-0.85]), and this was interpreted to be a candidate cut-off point for the autotransplantation of PGs. Conclusion IGFA scoring may be considered as an operative predictor, providing objective criteria to evaluate the tissue and blood perfusion of PGs after thyroidectomy. IGFA scoring may be considered to have value in minimising postoperative permanent hypoparathyroidism in patients.


Subject(s)
Humans , Parathyroid Glands , Thyroid Gland/surgery , Postoperative Complications , Thyroidectomy , Fluorescein Angiography , Hypoparathyroidism , Indocyanine Green
14.
Medicina (B.Aires) ; Medicina (B.Aires);80(3): 289-291, jun. 2020. graf, tab
Article in Spanish | LILACS | ID: biblio-1125082

ABSTRACT

El hipoparatiroidismo (hipoPTH) es una enfermedad infrecuente caracterizada por hipocalcemia y niveles inapropiadamente bajos o ausentes de parathormona. Presentamos el caso de un hombre de 25 años, deportista de alto rendimiento, con antecedente de hipoPTH secundario a tiroidectomía total dos años antes por cáncer papilar multifocal bilateral tiroideo, estadificado como T3 N1b M0, derivado por hipocalcemia sintomática. Presentaba calcemias promedio de 7mg%, síntomas de hipocalcemia en reposo y múltiples internaciones. Inicialmente, se optimizó tratamiento convencional con aporte de calcio vía oral hasta 12g/día, vitamina D y calcitriol, sin mejoría clínica ni bioquímica. Se descartaron malabsorción y complicaciones crónicas de hipoPTH. Se evidenció a través de cuestionario de salud SF-36 disminución de la calidad de vida. Se indicó sustitución con parathormona recombinante humana [rhPTH(1-84)] 50μg/día subcutánea con posterior ascenso a 75μg y reducción progresiva de la medicación por vía oral. Actualmente se encuentra asintomático, sin requerimiento de calcio ni vitamina D, mantiene calcemias de 9mg%, realiza actividad deportiva y demuestra marcada mejoría en la calidad de vida según cuestionario SF-36 (36-Item Short Form Health Survey).


Hypoparathyroidism (HypoPT) is a rare disease characterized by low calcium and inappropriately low circulating parathormone levels. We present the case of a 25-year-old high-performance athlete male, with history of HypoPT after total thyroidectomy for papillary thyroid carcinoma (T3 N1b M0) two years before, who was referred to our clinic for symptomatic hypocalcemia. The patient reported serum calcium average levels of 7mg%, presented symptoms of hypocalcemia at rest and had multiple hospital admissions. First, standard treatment was optimized by calcium supplementation up to 12g/d and active vitamin D, not showing clinical or biochemical improvement. Malabsorption and complications of chronic HypoPT were ruled out. The 36-Item Short Form Health Survey (SF-36) demonstrated an impaired quality of life (QoL). Full-length recombinant human parathyroid hormone [rhPTH(1-84)] therapy was started with 50μg/d subcutaneous, and later adjusted to 75μg/d and the oral treatment gradually decreased. Currently, he is asymptomatic, with serum calcium levels above 9mg%, without receiving oral medication. He performs sports activity and shows marked improvement in quality of life according to SF-36 questionnaire.


Subject(s)
Humans , Male , Adult , Parathyroid Hormone/therapeutic use , Hypoparathyroidism/drug therapy , Thyroidectomy/adverse effects , Vitamin D/therapeutic use , Calcitriol/therapeutic use , Thyroid Neoplasms/surgery , Thyroid Neoplasms/complications , Hormone Replacement Therapy/methods , Calcium-Regulating Hormones and Agents/therapeutic use , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/complications , Hypoparathyroidism/etiology
15.
Arch. endocrinol. metab. (Online) ; 64(3): 282-289, May-June 2020. tab
Article in English | LILACS | ID: biblio-1131085

ABSTRACT

ABSTRACT Objective Hypoparathyroidism is a rare condition, whose most common etiology is complications of neck surgery. The aim of the study was to identify the clinical and biochemical profile of the patients with diagnosis of hypoparathyroidism, including the frequency of symptoms, clinical signs, long-term complications and disease control. Additionally, the study sought to know what the medication profile was, and the doses required by the patients. Subjects and method A retrospective cohort study was conducted wherein all patients with ICD-10 codes associated with hypoparathyroidism between 2011 and 2018 at the Hospital Universitario San Vicente Fundación were included. We investigated the etiology of the disease; biochemical profile including lowest serum calcium, highest serum phosphorus, 25OHD levels, calciuria and calcium/phosphorus product; medication doses, disease control, and presence of complications, especially renal and neurologic complications were also evaluated. Results The cohort included 108 patients (99 women/9 men) with a mean age of 51.6 ± 15.6 years. The main etiology was postoperative (93.5%), the dose of elemental calcium received was relatively low (mean 1,164 mg/day), and in only 9.2% of cases more than 2,500 mg/day of elemental calcium was necessary. We were able to evaluate the follow-up in 89 patients, and found that only 57.3% met the criteria for controlled disease. Conclusion The clinical profile of patients with hypoparathyroidism in our cohort is similar to that described in other international studies, with predominantly postoperative etiology. With standard therapy, only adequate control is achieved in a little more than half of patients. Arch Endocrinol Metab. 2020;64(3):282-9


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Parathyroid Hormone/blood , Hypoparathyroidism/complications , Biomarkers/blood , Retrospective Studies , Colombia , Hypoparathyroidism/blood , Middle Aged
16.
Actual. osteol ; 16(1): 77-82, Ene - abr. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1140152

ABSTRACT

Introducción. El hipoparatiroidismo es una enfermedad caracterizada por la ausencia o concentraciones inadecuadamente bajas de hormona paratiroidea (PTH), que conduce a hipocalcemia, hiperfosfatemia y excreción fraccional elevada de calcio en la orina. Las calcificaciones del sistema nervioso central son un hallazgo frecuente en estos pacientes. Caso clínico. Mujer de 56 años con antecedente de hipotiroidismo, que ingresó por un cuadro de 6 días de evolución caracterizado por astenia, parestesias periorales y movimientos anormales de manos y pies. Las pruebas de laboratorio demostraron hipocalcemia, hiperfosfatemia y niveles bajos de hormona paratiroidea. Se realizó una tomografía computarizada de cráneo que mostró áreas bilaterales y simétricas de calcificaciones en hemisferios cerebelosos, ganglios basales y corona radiata. No se evidenciaron trastornos en el metabolismo del cobre y hierro. Se estableció el diagnóstico del síndrome de Fahr secundario a hipoparatiroidismo y se inició tratamiento con suplementos de calcio y vitamina D con evolución satisfactoria. Discusión. El síndrome de Fahr es un trastorno neurológico caracterizado por el depósito anormal de calcio en áreas del cerebro que controlan la actividad motora. Se asocia a varias enfermedades, especialmente, hipoparatiroidismo. La suplementación con calcio y vitamina D con el objetivo de normalizar los niveles plasmáticos de estos cationes es el tratamiento convencional. (AU)


Introduction. Hypoparathyroidism is a disease characterized by absence or inappropriately low concentrations of circulating parathyroid hormone, leading to hypocalcaemia, hyperphosphataemia and elevated fractional excretion of calcium in the urine. Central nervous system calcifications are a common finding in these patients. Case report. 56-year-old woman with a history of hypothyroidism who was admitted for a 6-day course of illness characterized by asthenia, perioral paresthesias, and abnormal movements of the hands and feet. Laboratory tests showed hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels. A cranial computed tomography was performed. It showed bilateral and symmetrical areas of calcifications in the cerebellar hemispheres, basal ganglia, and radiata crown. No disorders of copper or iron metabolism were evident. The diagnosis of Fahr syndrome secondary to hypoparathyroidism was established and treatment with calcium and vitamin D supplements was started with satisfactory evolution. Discussion. Fahr's syndrome is a neurological disorder associated with abnormal calcium deposition in areas of the brain that control motor activity. It is associated with various diseases, especially hypoparathyroidism. The conventional treatment is supplementation with calcium and vitamin D, with the aim of normalizing their plasma levels. (AU)


Subject(s)
Humans , Female , Middle Aged , Calcinosis/diagnostic imaging , Hypoparathyroidism/diagnosis , Nervous System Diseases/diagnostic imaging , Parathyroid Hormone/blood , Calcinosis/complications , Calcinosis/drug therapy , Calcitriol/administration & dosage , Calcium Carbonate/administration & dosage , Calcium Gluconate/administration & dosage , Calcium/administration & dosage , Hyperphosphatemia/blood , Hypocalcemia/blood , Hypoparathyroidism/etiology , Hypoparathyroidism/drug therapy , Nervous System Diseases/complications , Nervous System Diseases/drug therapy
17.
J. pediatr. (Rio J.) ; J. pediatr. (Rio J.);96(1): 60-65, Jan.-Feb. 2020. graf
Article in English | LILACS | ID: biblio-1090998

ABSTRACT

Abstract Objective Permanent hypoparathyroidism can be presented as part of genetic disorders such as Sanjad-Sakati syndrome (also known as hypoparathyroidism—intellectual disability-dysmorphism), which is a rare autosomal recessive disorder. Our aim was to confirm the diagnosis of a group of patients with dysmorphism, poor growth, and hypoparathyroidism clinically labeled as Sanjad-Sakati syndrome and to identify for the first time the genetic variations on Iranian patients with the same ethnic origin. Methods In this study, 29 cases from 23 unrelated Arab kindreds with permanent hypoparathyroidism and dysmorphism indicating Sanjad-Sakati syndrome were enrolled for 10 years in the southwest of Iran. The mutational analysis by direct sequencing of the tubulin folding cofactor E gene was performed for the patients and their families, as well as their fetuses using genomic DNA. Results Twenty-eight out of 29 cases had parental consanguinity. Twenty-seven cases presented with hypocalcemia seizure and two were referred because of poor weight gain and were found to have asymptomatic hypocalcemia. The dysmorphic features, hypocalcemia in the setting of low to normal parathyroid hormone levels and high phosphorus led to the diagnosis of these cases. Sequencing analysis of the tubulin folding cofactor E gene revealed a homozygous 12-bp deletion (c.155-166del) for all patients. Following that, prenatal diagnosis was performed for eight families, and two fetuses with a homozygous 12-bp deletion were identified. Conclusion These results make it much easier and faster to diagnose this syndrome from other similar dysmorphisms and also help to detect carriers, as well as prenatal diagnosis of Sanjad-Sakati syndrome in high-risk families in this population.


Resumo Objetivo O hipoparatireoidismo permanente pode estar presente como parte das doenças genéticas como na síndrome de Sanjad-Sakati (também chamada de síndrome de hipoparatireoidismo, retardo e dismorfismo), que é um distúrbio autossômico recessivo raro. Nosso objetivo foi confirmar o diagnóstico de um grupo de pacientes com dismorfismo, crescimento deficiente e hipoparatireoidismo clinicamente identificado como síndrome de Sanjad-Sakati e identificar as variações genéticas, pela primeira vez, em pacientes iranianos com a mesma origem étnica. Métodos Neste estudo, foram inscritos 29 casos de 23 famílias árabes sem parentesco com hipoparatireoidismo e dismorfismo indicando síndrome de Sanjad-Sakati, durante 10 anos no sudoeste do Irã. Foi feita a análise mutacional por sequenciamento direto do gene do cofator E de dobramento da tubulina dos pacientes e de suas famílias e também de seus fetos com o DNA genômico. Resultados Apresentaram consanguinidade parental 28 dos 29 casos. Desses, 27 casos apresentaram convulsão por hipocalcemia e dois foram encaminhados devido ao baixo ganho de peso, considerando diagnóstico de hipocalcemia assintomática. As características dismórficas, hipocalcemia na configuração de níveis de hormônio da paratireoide baixos a normais e alto nível de fósforo levaram ao diagnóstico dos casos. A análise de sequenciamento do gene do cofator E de dobramento da tubulina revelou deleção homozigótica de 12 pares de base (pb) (c.155-166del) em todos os pacientes. Após isso, foi feito o diagnóstico pré-natal em oito famílias e dois fetos foram identificados com deleção homozigótica de 12 pb. Conclusão Esses resultados tornam o diagnóstico dessa síndrome muito mais fácil e rápido do que outros dismorfismos semelhantes e também ajudam a detectar portadores, bem como o diagnóstico pré-natal da síndrome de Sanjad-Sakati em famílias de alto risco nessa população.


Subject(s)
Humans , Osteochondrodysplasias , Seizures , Abnormalities, Multiple , Growth Disorders , Hypoparathyroidism , Intellectual Disability , Tubulin , Molecular Chaperones , Iran
18.
Article in English | WPRIM | ID: wpr-961919

ABSTRACT

@#Repeated blood transfusions in transfusion dependent thalassemia (TDT) leads to iron overload-related endocrine complications. Hypoparathyroidism (HPT) with severe signs of hypocalcemia is a recognized complication among these patients. A 14-year-old thalassaemic boy, on regular transfusion and on anticonvulsant therapy with a presumptive diagnosis of epilepsy for the last 1 year, was admitted with high fever and severe muscle cramps with positive Trousseau’s sign. He was diagnosed as a case of primary HPT and magnesium deficiency on the basis of low serum calcium, high phosphate, normal alkaline phosphates, very low intact parathyroid hormone (iPTH), normal serum vitamin D and very low serum magnesium level. His calcium, magnesium and phosphate level normalised following treatment with intravenous magnesium and calcium. His iPTH improved but remained at low normal. He was discharged from hospital with oral calcium, calcitriol, and magnesium supplementation. The anticonvulsant (Phenobarbitone) was successfully withdrawn gradually over the next six months without any recurrence of seizure in the subsequent 3 years of follow up. Acquired HPT (apparently from hemosiderosis) is a common cause of hypocalcemia; and magnesium depletion further complicated the situation leading to severe hypocalcemia with recurrent episodes of convulsion. Magnesium replacement improved the parathyroid hormone (PTH) value proving its role in acquired HPT. Very high phosphate level on admission and poor PTH response with respect to the low serum calcium, indicates intrinsic parathyroid pathology. Metabolic abnormalities should always be evaluated in thalassaemic subject with seizure disorder and it appears that the initial convulsive episodes were due to hypocalcemia. Muscle pain, cramps or convulsion may occur from HPT and simultaneous magnesium deficiency in transfusion dependent thalassaemic subjects. Metabolic correction is more important than anticonvulsant medication. Calcium and magnesium should both be assessed routinely in transfusion dependent thalassemic patients.


Subject(s)
Hemosiderosis , Hypoparathyroidism , Thalassemia
19.
Rev. méd. Urug ; 36(3): 293-300, 2020. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1127109

ABSTRACT

Resumen: Introducción: la hipocalcemia es la complicación más frecuente en tiroidectomías. Objetivo: conocer la incidencia de hipocalcemia en las primeras 72 horas del posoperatorio y de hipoparatiroidismo permanente como complicación de las tiroidectomías en seis años. Pacientes y método: estudio descriptivo y retrospectivo de pacientes tiroidectomizados entre enero de 2011 y diciembre de 2016. Hipocalcemia: valor de calcio total <8,5mg/dl. Las variables fueron: sexo, edad, tipo y duración de cirugía, manifestaciones clínicas de hipocalcemia aguda y anatomía patológica; se cruzaron con la medida de valor mínimo de calcemia. Se consideró hipoparatiroidismo permanente cuando persistían bajo tratamiento por lo menos un año luego de cirugía. Resultados: total 141 casos, 130 mujeres, media de edad 45,9 años. El 95% presentó hipocalcemia en las primeras 72 horas del posoperatorio; por edad y sexo: <29 años, 90% (p 0,38), 30-49, 96% (p 0,4), 50-69, 98% (p 0,52) y >70, 92% (p 0,16); 97% de mujeres tuvo hipocalcemia y 91% de hombres (p 0,26). Duración de cirugía: < 130 minutos, 130-185, >185, hipocalcemia en 4, 2 y 1 pacientes respectivamente. Lesiones malignas en 60 pacientes, 58 tuvieron hipocalcemia; de 81 benignos, 76 la presentó (p 0,537). En grupo de tiroidectomías, 95% tuvo hipocalcemia (p<0,05). El 71% fue hipocalcemias asintomáticas, 10% tuvo síntomas y 19% sin datos. Ocho con hipoparatiroidismo permanente, en 11 no hubo datos. Conclusiones: la mayoría presentó hipocalcemia. No hubo correlación entre hipocalcemia con edad, sexo, duración de la cirugía ni resultado de anatomía patológica. En tiroidectomías hubo correlación con hipocalcemia. Uno de cada diez presentó síntomas de hipocalcemia. La incidencia de hipoparatiroidismo permanente fue de 6%.


Summary: Introduction: hypocalcemia is the most frequent complication in patients undergoing thyroidectomy. Objective: to learn about the incidence of hypocalcemia during the first 72-hour period after surgery and permanent hypoparathyroidism, as a complication of thyroidectomy in 6 years. Methods: descriptive and retrospective study of patients undergoing thyroidectomy between January 2011 and December 2016. Hypocalcemia is defined as total serum calcium concentration < 8.8 mg/dL. Variables considered cwere gender, age, type and duration of surgery, clinical manifestations of acute hypocalcemia and pathological anatomy, and they were crossed with the minimum measurement of calcemia. Permanent hypoparathyroidism was defined when patients were still under therapy at least one year after the surgery. Results: 141 patients, 130 women, average age was 45.9 years old. 95% of them presented hypocalcemia within the first 72 hours of the postoperative period; as to age and gender: <29 years old, 90% (p 0.38), 30 - 49, 96% (p 0.4), 50 - 69, 98% (p 0.52) and =70 92% (p 0.16); 97% of women and 91% of men (p 0.26) suffered from hypocalcemia. Duration of surgery: < 130 minutes, 130 - 185, >185, hypocalcemia was seen in 4, 2 and 1 patients respectively. Malignant lesions were found in 60 patients, 58 had hypocalcemia; out of 81 benign cases, 76 had hypocalcemia (p 0,537). In a group of thyroidectomies, 95% had hypocalcemia (p<0.05). 71% were asymptomatic hypocalcemia, 10% presented symptoms and there was no data for 19%. Eight of them have permanent hypoparathyroidism and there was no data for 11 cases. Conclusions: most patients presented hypocalcemia. There was no correlation between hypocalcemia and age, gender, duration of surgery or pathology results. Correlation was found between thyroidectomies and hypocalcemia. One out of ten presented symptoms of hypocalcemia. Incidence of permanent hypoparathyroidism was 6%.


Resumo: Introdução: a hipocalcemia é a complicação mais frequente nas tireoidectomias. Objetivo: conhecer a incidência de hipocalcemia nas primeiras 72 horas do pós-operatório e de hipoparatireoidismo permanente como complicação das tireoidectomias em 6 anos. Pacientes e métodos: estudo descritivo e retrospectivo, de tiroidectomizados entre janeiro de 2011 e dezembro de 2016. Considerou-se hipocalcemia o valor de cálcio total ?8,5mg/dl. As variáveis estudadas foram: gênero, idade, tipo e duração da cirurgia, manifestações clínicas de hipocalcemia aguda e anatomia patológica; estas variáveis foram cruzadas com o valor mínimo de calcemia. Considerou-se hipoparatireoidismo permanente quando persistiam sob tratamento pelo menos durante um ano pós-cirurgia. Resultados: foram estudados 141 pacientes sendo 130 mulheres, com idade média de 45,9 anos. 95% apresentou hipocalcemia nas primeiras 72 horas do pós-operatório; por idade e gênero: ?29 anos, 90% (p 0,38), 30 - 49, 96%(p 0,4), 50 - 69, 98%(p 0,52) e ?70, 92%(p 0,16); 97% das mulheres teve hipocalcemia e 91% dos homens (p 0,26). Duração da cirurgia: < 130 minutos, 130 - 185, ?185, hipocalcemia em 4, 2 e 1 pacientes respectivamente. Dos 60 pacientes com lesões malignas, 58 apresentaram hipocalcemia e 76 dos 81 casos benignos (p 0,537). No grupo de tireoidectomias, 95% tiveram hipocalcemia (p<0,05). 71% foram hipocalcemias assintomáticas, 10% apresentaram sintomas e em 19% não havia dados. Oito pacientes quedaram com hipoparatireoidismo permanente e em 11 não havia dados. Conclusões: a maioria apresentou hipocalcemia. Não se observou correlação entre hipocalcemia e idade, género, duração da cirurgia nem resultado da anatomia patológica. Nas tireoidectomias observou-se correlação com hipocalcemia. Um de cada 10 pacientes apresentou sintomas de hipocalcemia. La incidência de hipoparatireoidismo permanente foi de 6%.


Subject(s)
Humans , Thyroidectomy , Hypocalcemia/epidemiology , Postoperative Complications , Hypoparathyroidism
20.
Rev. Fac. Cienc. Méd. Univ. Cuenca ; 37(2): 51-58, Septiembre 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1025037

ABSTRACT

La insuficiencia cardiaca debida a hipocalcemia es una extraña forma de cardiopatía metabólica, reversible en la mayoría de casos, secundaria a alteraciones endocrinológicas que provocan la disminución persistente del calcio sérico, como el hipoparatiroidismo. A continuación, se presenta el caso de una mujer de 23 años, a quien, al ingreso, se le diagnóstico de insuficiencia cardiaca severa. Durante su hospitalización, se evidenció sin-tomatología asociada con hipocalcemia, secundario a hipoparatiroidismo, por lo que inmediatamente se inició la reposición con calcio. Para prevenir el riesgo de muerte súbita, por la prolongación persistente del intervalo Q-T, se colocó un cardiodesfibrilador implantable; sin embargo, luego de 6 meses de tratamiento, a pesar de la suplementación con calcio oral, no se evidenció mejoría en la fracción de eyección, determinando un pronóstico incierto de la enfermedad


Heart failure due to hypocalcemia is a strange presentation of metabolic heart disease; it is reversible in most cases, and secondary to endocrinal alterations that cause the persistent decrease in serum calcium, such as hypoparathyroidism.A case of a 23-year-old woman who was diagnosed with severe heart failure is presented. During her hospitalization, there was evidence of symptoms associated with hypocalcemia, secondary to hypoparathyroidism, so the patient was treated with replacement of calcium immediately. To prevent the risk of sudden death, by the persistent prolongation of the Q-T interval, an implantable cardiac defibrillator was placed; however, after 6 months of treatment, despite oral calcium supplementation, there was no improvement in the ejection fraction, determining an uncertain prognosis of the disease.


Subject(s)
Humans , Female , Adult , Heart Failure , Hypocalcemia , Hypoparathyroidism , Diagnosis , Edema , Heart Diseases
SELECTION OF CITATIONS
SEARCH DETAIL