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Hypoparathyroidism


Authors: Richard Sotorník
Authors‘ workplace: Interní klinika 3. LF UK a FNKV, Praha
Published in: Čas. Lék. čes. 2023; 162: 136-147
Category: Review Article

Overview

Hypoparathyroidism is a rare endocrine disease caused by an absence or insufficient production of parathormone. Parathormone deficiency leads to lower serum calcium concentration that is responsible for patients' neuromuscular symptoms. Conventional treatment consists of calcium and active vitamin D metabolites administration but doesn't constitute an adequate substitution of missing parathormone. Although the treatment substantially alleviates patients' troubles, chronic complications may develop because of hyperphosphatemia and conventional medication. Solution to this resides in recombinant parathormone administration, however the only one drug available is being now recalled from the market. The mainstay of hypoparathyroidism prevention is the judicious indication of total thyroidectomy representing the main cause of the disease.

Keywords:

calcium – hypocalcemia – phosphate – vitamin D – hypoparathyroidism – parathormone


Sources

1. Powers J, Joy K, Ruscio A, Lagast H. Prevalence and incidence of hypoparathyroidism in the United States using a large claims database. J Bone Miner Res 2013; 28: 2570–2576.

2.    Vadiveloo T, Donnan PT, Leese GP. A population-based study of the epidemiology of chronic hypoparathyroidism. J Bone Miner Res 2018; 33: 478–485.

3.    Cianferotti L, Parri S, Gronchi G et al. Prevalence of chronic hypoparathyroidism in a mediterranean region as estimated by the analysis of anonymous healthcare database. Calcif Tissue Int 2018; 103: 144–150.

4.    Cusano NE, Bilezikian JP. Update on hypoparathyroidism. Curr Opin Rheumatol 2019; 31: 381–387.

5.    Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab 2020; 105: 1722–1736.

6.    Kazaure HS, Sosa JA. Surgical hypoparathyroidism. Endocrinol Metab Clin North Am 2018; 47: 783–796.

7.    Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Cardiovascular and renal complications to postsurgical hypoparathyroidism: A Danish nationwide controlled historic follow-up study. J Bone Miner Res 2013; 28: 2277–2285.

8.    Clarke BL, Brown EM, Collins MT et al. Epidemiology and diagnosis of hypoparathyroidism. J Clin Endocrinol Metab 2016; 101: 2284–2299.

9.    Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. The epidemiology of nonsurgical hypoparathyroidism in Denmark: A nationwide case finding study. J Bone Miner Res 2015; 30: 1738–1744.

10.  Astor MC, Løvås K, Debowska A et al. Epidemiology and health-related quality of life in hypoparathyroidism in Norway. J Clin Endocrinol Metab 2016; 101: 3045–3053.

11.  Kim SH, Rhee Y, Kim YM et al. Prevalence and complications of nonsurgical hypoparathyroidism in Korea: A nationwide cohort study. PLoS One 2020; 15: e0232842.

12.  Edafe O, Antakia R, Laskar N et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014; 101: 307–320.

13.  Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg 2015; 102: 359–367.

14.  Kim SM, Kim HK, Kim KJ et al. Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid 2015; 25: 830–833.

15.  Almquist M, Ivarsson K, Nordenström E, Bergenfelz A. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. Br J Surg 2018; 105: 1313–1318.

16.  Orloff LA, Wiseman SM, Bernet VJ et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid 2018; 28: 830–841.

17.  Shoback DM, Bilezikian JP, Costa AG et al. Presentation of hypoparathyroidism: Etiologies and clinical features. J Clin Endocrinol Metab 2016; 101: 2300–2312.

18.  Bollerslev J, Rejnmark L, Zahn A et al. European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: Recommendations of the ESE educational program of parathyroid disorders. Eur J Endocrinol 2022; 186: R33–R63.

19.  Cianferotti L, Marcucci G, Brandi ML. Causes and pathophysiology of hypoparathyroidism. Best Pract Res Clin Endocrinol Metab 2018; 32: 909–925.

20.  Adam MA, Thomas S, Youngwirth L et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 2017; 265: 402–407.

21.  Aspinall S, Oweis D, Chadwick D. Effect of surgeons' annual operative volume on the risk of permanent hypoparathyroidism, recurrent laryngeal nerve palsy and haematoma following thyroidectomy: Analysis of United Kingdom registry of endocrine and thyroid surgery (UKRETS). Langenbecks Arch Surg 2019; 404: 421–430.

22.  Bollerslev J, Rejnmark L, Marcocci C et al. European Society of Endocrinology clinical guideline: Treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol 2015; 173: G1-G20.

23.  Song CM, Jung JH, Ji YB et al. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol 2014; 12: 200.

24.  Richards ML, Thompson GB, Farley DR, Grant CS. Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring. Am J Surg 2008; 196: 937–942.

25.  Nawrot I, Chudziński W, Ciąćka T et al. Reoperations for persistent or recurrent primary hyperparathyroidism: Results of a retrospective cohort study at a tertiary referral center. Med Sci Monit 2014; 20: 1604–1612.

26.  Geminiani M, Aimoni C, Scanelli G, Pastore A. Parathyroid function study in patients submitted to laryngeal surgery for squamous cell carcinoma. Acta Otorhinolaryngol Ital 2007; 27: 123–125.

27.  Negm H, Mosleh M, Fathy H, Awad A. Thyroid and parathyroid dysfunction after total laryngectomy in patients with laryngeal carcinoma. Eur Arch Otorhinolaryngol 2016; 273: 3237–3241.

28.  Lo Galbo AM, Kuik DJ, Lips P et al. A prospective longitudinal study on endocrine dysfunction following treatment of laryngeal or hypopharyngeal carcinoma. Oral Oncol 2013; 49: 950–955.

29.  Edafe O, Sandler LM, Beasley N, Balasubramanian SP. Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism. Eur Arch Otorhinolaryngol 2021; 278: 1337–1344.

30.  Miltényi Z, Keresztes K, Lakos G et al. Is the treatment of Hodgkin's disease detrimental to the parathyroid gland? Acta Haematol 2004; 112: 148–151.

31.  Mortensen LS, Smidt K, Jørgensen A et al. Long-term parathyroid- and c-cell function after radioiodine for benign thyroid diseases. Basic Clin Pharmacol Toxicol 2005; 97: 22–28.

32.  Guven A, Salman S, Boztepe H et al. Parathyroid changes after high dose radioactive iodine in patients with thyroid cancer. Ann Nucl Med 2009; 23: 437–441.

33.  Betterle C, Garelli S, Presotto F. Diagnosis and classification of autoimmune parathyroid disease. Autoimmun Rev 2014; 13: 417–422.

34.  Dadu R, Rodgers TE, Trinh VA et al. Calcium-sensing receptor autoantibody-mediated hypoparathyroidism associated with immune checkpoint inhibitor therapy: Diagnosis and long-term follow-up. J Immunother Cancer 2020; 8: e000687.

35.  Donoghue SE, Pitt JJ, Boneh A, White SM. Smith-Lemli-Opitz syndrome: Clinical and biochemical correlates. J Pediatr Endocrinol Metab 2018; 31: 451–459.

36.  Vetter T, Lohse MJ. Magnesium and the parathyroid. Curr Opin Nephrol Hypertens 2002; 11: 403–410.

37.  Khan AA, Koch CA, Van Uum S et al. Standards of care for hypoparathyroidism in adults: a Canadian and international consensus. Eur J Endocrinol 2019; 180: p1–p22.

38.  Bauer JL, Toluie S, Thompson LDR. Metastases to the parathyroid glands: a comprehensive literature review of 127 reported cases. Head Neck Pathol 2018; 12: 534–541.

39.  Han P, Trinidad BJ, Shi J. Hypocalcemia-induced seizure: demystifying the calcium paradox. ASN Neuro 2015; 7: 1759091415578050.

40.  van Veelen MJ, Visser MF, Baggen MG, Dees A. Hypocalcaemic laryngospasm in the emergency department. BMJ Case Rep 2011; 2011: bcr1120103555.

41.  Weiner M, Epstein FH. Signs and symptoms of electrolyte disorders. Yale J Biol Med 1970; 43: 76–109.

42.  Goswami R, Sharma R, Sreenivas V et al. Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism. Clin Endocrinol (Oxf) 2012; 77: 200–206.

43.  Vadiveloo T, Donnan PT, Leese CJ et al. Increased mortality and morbidity in patients with chronic hypoparathyroidism: a population-based study. Clin Endocrinol (Oxf) 2019; 90: 285–292.

44.  Mitchell DM, Regan S, Cooley MR et al. Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab 2012; 97: 4507–4514.

45.  Zavatta G, Clarke BL. Basal ganglia calcification in hypoparathyroidism and pseudohypoparathyroidism: Local and systemic metabolic mechanisms. J Endocrinol Invest 2021; 44: 245–253.

46.  Zavatta G, Tebben PJ, McCollough CH et al. Basal ganglia calcification is associated with local and systemic metabolic mechanisms in adult hypoparathyroidism. J Clin Endocrinol Metab 2021; 106: 1900–1917.

47.  Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Postsurgical hypoparathyroidism – risk of fractures, psychiatric diseases, cancer, cataract, and infections. J Bone Miner Res 2014; 29: 2504–2510.

48.  Arlt W, Fremerey C, Callies F et al. Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D. Eur J Endocrinol 2002; 146: 215–222.

49.  Underbjerg L, Sikjaer T, Rejnmark L. Long-term complications in patients with hypoparathyroidism evaluated by biochemical findings: A case-control study. J Bone Miner Res 2018; 33: 822–831.

50.  Gosmanova EO, Houillier P, Rejnmark L et al. Renal complications in patients with chronic hypoparathyroidism on conventional therapy: a systematic literature review. Renal disease in chronic hypoparathyroidism. Rev Endocr Metab Disord 2021; 22: 297–316.

51.  Ridder LO, Harsløf T, Sikjaer T et al. Determinants of hypercalciuria and renal calcifications in chronic hypoparathyroidism: a cross-sectional study. Clin Endocrinol (Oxf) 2021; 95: 286–294.

52.  Newman DB, Fidahussein SS, Kashiwagi DT et al. Reversible cardiac dysfunction associated with hypocalcemia: A systematic review and meta-analysis of individual patient data. Heart Fail Rev 2014; 19: 199–205.

53.  Lang RM, Fellner SK, Neumann A et al. Left ventricular contractility varies directly with blood ionized calcium. Ann Intern Med 1988; 108: 524–529.

54.  Gupta P, Agstam S, Yadav A, Ghosh S. Malignant prolongation of the QTc interval due to severe vitamin D deficiency: An unusual presentation. BMJ Case Rep 2020; 13: e237157.

55.  Gosmanova EO, Chen K, Ketteler M et al. Risk of cardiovascular conditions in patients with chronic hypoparathyroidism: A retrospective cohort study. Adv Ther 2021; 38: 4246–4257.

56.  Rubin MR, Dempster DW, Zhou H et al. Dynamic and structural properties of the skeleton in hypoparathyroidism. J Bone Miner Res 2008; 23: 2018–2024.

57.  Baeke F, Takiishi T, Korf H et al. Vitamin D: Modulator of the immune system. Curr Opin Pharmacol 2010; 10: 482–496.

58.  Lorente-Poch L, Sancho JJ, Carballo L, Sitges-Serra A. Clinical profile and long-term follow-up of 32 patients with postoperative permanent hypoparathyroidism. Gland Surg 2017; 6 (Suppl. 1): s3–s10.

59.  Cho NL, Moalem J, Chen L et al. Surgeons and patients disagree on the potential consequences from hypoparathyroidism. Endocr Pract 2014; 20: 427–446.

60.  Siggelkow H, Clarke BL, Germak J et al. Burden of illness in not adequately controlled chronic hypoparathyroidism: Findings from a 13-country patient and caregiver survey. Clin Endocrinol (Oxf) 2020; 92: 159–168.

61.  Hadker N, Egan J, Sanders J et al. Understanding the burden of illness associated with hypoparathyroidism reported among patients in the PARADOX study. Endocr Pract 2014; 20: 671–679.

62.  Makras P, Yavropoulou MP, Kassi E et al. Management of parathyroid disorders: recommendations of the working group of the Bone Section of the Hellenic Endocrine Society. Hormones (Athens) 2020; 19: 581–591.

63.  Kršek M, Šumník Z, Zajíčková K a kol. Doporučený postup České endokrinologické společnosti pro diagnostiku a léčbu primární hyperparathyreózy a hypoparathyreózy. Vnitřní lékařství 2021; 67 (Suppl. A).

64.  Meola A, Vignali E, Matrone A et al. Efficacy and safety of long-term management of patients with chronic post-surgical hypoparathyroidism. J Endocrinol Invest 2018; 41: 1221–1226.

65.  Khan AA, AbuAlrob H, Punthakee Z et al. Canadian national hypoparathyroidism registry: An overview of hypoparathyroidism in Canada. Endocrine 2021; 72: 553–561.

66.  K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42(4 Suppl 3): s1–s201.

67.  Clarke BL, Vokes TJ, Bilezikian JP et al. Effects of parathyroid hormone rhPTH(1-84) on phosphate homeostasis and vitamin D metabolism in hypoparathyroidism: REPLACE phase 3 study. Endocrine 2017; 55: 273–282.

68.  Saha S, Goswami R. Auditing the efficacy and safety of alfacalcidol and calcium therapy in idiopathic hypoparathyroidism. J Clin Endocrinol Metab 2019; 104: 1325–1335.

69.  Mannstadt M, Clarke BL, Vokes T et al. Efficacy and safety of recombinant human parathyroid hormone (1–84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study. Lancet Diabetes Endocrinol 2013; 1: 275–283.

70.  Vokes TJ, Mannstadt M, Levine MA et al. Recombinant human parathyroid hormone effect on health-related quality of life in adults with chronic hypoparathyroidism. J Clin Endocrinol Metab 2018; 103: 722–731.

71.  Chen KS, Gosmanova EO, Curhan GC et al. Five-year estimated glomerular filtration rate in patients with hypoparathyroidism treated with and without rhPTH(1-84). J Clin Endocrinol Metab 2020; 105: e3557–e3565.

72.  Rubin MR, Zhou H, Cusano NE et al. The effects of long-term administration of rhPTH(1-84) in hypoparathyroidism by bone histomorphometry. J Bone Miner Res 2018; 33: 1931–1939.

73.  Cusano NE, Rubin MR, McMahon DJ et al. The effect of PTH(1-84) on quality of life in hypoparathyroidism. J Clin Endocrinol Metab 2013; 98: 2356–2361.

74.  Mannstadt M, Clarke BL, Bilezikian JP et al. Safety and efficacy of 5 years of treatment with recombinant human parathyroid hormone in adults with hypoparathyroidism. J Clin Endocrinol Metab 2019; 104: 5136–5147.

75.  Cusano NE, Rubin MR, McMahon DJ et al. The effect of PTH (1-84) on quality of life in hypoparathyroidism. J Clin Endocrinol Metab 2013; 98: 2356–2361.

75.  Tabacco G, Tay YD, Cusano NE et al. Quality of life in hypoparathyroidism improves with rhPTH(1-84) throughout 8 years of therapy. J Clin Endocrinol Metab 2019; 104: 2748–2756.

76.  Cusano NE, Anderson L, Rubin MR et al. Recovery of parathyroid hormone secretion and function in postoperative hypoparathyroidism: a case series. J Clin Endocrinol Metab 2013; 98: 4285–4290.

77.  Grani G, Sponziello M, Pecce V et al. Contemporary thyroid nodule evaluation and management. J Clin Endocrinol Metab 2020; 105: 2869–2883.

78.  Welch HG, Doherty GM. Saving thyroids – overtreatment of small papillary cancers. N Engl J Med 2018; 379: 310–312.

79.  Ahn SV, Lee JH, Bove-Fenderson EA et al. Incidence of hypoparathyroidism after thyroid cancer surgery in South Korea, 2007–2016. JAMA 2019; 322: 2441–2443.

80.  Gharib H, Papini E, Garber JR et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the diagnosis and management of thyroid nodules – 2016 update. Endocr Pract 2016; 22: 622–639.

81.  Muller S, Senne M, Kirschniak A et al. Impact of surgical resection extension on outcome for primary well-differentiated thyroid cancer-a retrospective analysis. World J Surg Oncol 2017; 15: 190.

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