Endocrine Abstracts

Hypoparathyroidism is an endocrine deficiency whose substitution treatment with PTH 1-84 is only available in compassionate use in Argentina. There is a subgroup of patients in which the conventional therapy with calcium, calcitriol, phosphorous chelators, magnesium and diuretics does not reach an adequate clinical and/or biochemical compensation. Although teriparatide (PTH 1-34) is not approved for patients with hypoparathyroidism, it is a plausible therapeutic resource.

Objective: To show our experience in the use of teriparatide in patients with primary and secondary hypoparathyroidism.

Material and Methods: Retrospective study, we assessed the medical records of 8 patients with hypoparathyroidism who were treated with teriparatide, 2 with primary-idiopathic and 6 post-thyroidectomy. Six women, mean age: 41.8 years (34-56), time of diagnosis: 10.9 years (2-40). The main cause to prescribe teriparatide was symptomatic hypocalcemia in 4 patients and hypocalcemia in their lab tests in the other 4; all of them with high doses of medication, negative impact in their quality of life and some needed multiple hospitalizations because of hypocalcemia. We assessed the doses of carbonate and citrate of calcium, calcitriol and diuretics before and after 6 months of teriparatide, clinical response, lab tests outcomes and follow-up.

Results: Of the six patients with post-surgical hypoparathyroidism, 4 had papillary thyroid carcinoma, 1 multinodular goiter and 1 Grave’s disease. The dose of teriparatide was 20 mg in 7 and 40 mg in 1, mean time of treatment: 3.45 years (0.8-7). The decrease in medication could not be assessed in one patient because it was necessary to start the treatment with teriparatide immediately after thyroid surgery. Conclusions: The treatment with teriparatide achieved significant and steady improvement in the values of calcium and phosphorus in most patients. The daily intake of carbonate and citrate of calcium, and of calcitriol decreased about 50%. Teriparatide treatment avoided frequent hypocalcemia-related hospitalizations. Long-term safety studies are necessary when teriparatide is used as an alternative to PTH 1-84.