Endocrine Abstracts

Background: Acquired hypoparathyroidism due to thyroid surgery for thyroid cancer is the most common postsurgical etiology in a tertiary health center in Ecuador. Therefore, the data published from our country is limited. An observational cross-sectional study was carried out to determine the clinical, biochemical and therapeutic characteristics of patients with permanent hypoparathyroidism in the endocrinology department.

Results: 102 patients were included in this trial, 96.1% were women. In the patients with suspected thyroid cancer (75.49%), the detection of nodules was incidental in a 13.73%. Total thyroidectomy without lymph node dissection was performed in 54.9%, thyroidectomy plus central dissection in 41.18%, and total thyroidectomy with right or left lateral dissection in 3.92%. The most prevalent definitive diagnosis was the one associated with malignancy in 61 patients (59.80%), and 98.3% of those due to papillary carcinoma. Tumor size in 57.38% was greater than 2 cm. Lymph node metastases occurred in 49.18%, with more than 5 nodes in 33.33%. According to the operating protocol, parathyroid resection was reported in only one patient (1.64%), however, in 19 (31.15%) there was no description of this data. During follow-up the clinical characteristics were variable. 21.57% were asymptomatic and 78.43% presented one or more of the following symptoms or signs: limb paraesthesias (44.36%), Chvostek’s sign (25.56%), Trousseau’s sign (11.28%), facial paresthesias (7.53%), spontaneous tetany (4.5%), arrhythmias (1.5%), fatigue (1.5%), laryngospasm (0.75%). Calcium carbonate supplementation in 67.4% of the patients was maintained at a dose between 1500 and 3000 mg/day, in 31.37% lower doses between 500 and 1000 mg/day were needed, only in 3.92% higher doses were necessary, equal or greater at 4000 mg/day. Regarding calcitriol, 33.33% were not supplemented with this drug, in the rest of the patients the most common dose was 0.5 to 1 mg/day. An association was found between suboptimal clinical control of hypoparathyroidism and patients who had more than 1 surgery (P=0.046). There was also an association between a tumor size greater than 2 cm and the requirement of calcium doses greater than 1500 mg/day (P=0.001).

Conclusion: The characterization in our study showed several similarities with those reported in the literature. Future research is needed to determine the impact of the disease on the quality of life of the people affected, establish costs and improve the use of resources and optimize interventions in our patients.

Keywords: Hypoparathyroidism, postoperative, thyroidectomy, calcium, calcitriol.