Endocrine Abstracts

Introduction: Secondary hyperparathyroidism is the main disorder of mineral and bone metabolism associated with chronic kidney disease. This disorder is characterized by hypersecretion of parathyroid hormone (PTH). Given the high cost and unavailability of calcimimetics, surgery remains a good alternative. In the immediate postoperative period after parathyroidectomy, hypocalcemia is common and close monitoring is critical.

Objective: The aim of our work was to evaluate the surgical results of parathyroidectomy in terms of efficacy and postoperative hypocalcemia.

Methods: This is a retrospective study including 45 patients operated on in our department during the period from 2010 to 2023. The analytical study evaluated the predictive criteria of hypocalcemia after surgery.

Results: The mean age of our patients was 46 years with a sex ratio of 1.5. The mean preoperative PTH level was 2030 ng/l. The mean preoperative corrected serum calcium level was 2.4 mmol/. Twenty-five patients underwent subtotal parathyroidectomy (7/8). Fifteen patients had selective parathyroidectomy (3/4) and five of them underwent selective surgery. According to KDOQI 2003 criteria, the surgical success rate was 87%. The mean postoperative PTH level was 202 ng/l. Subtotal parathyroidectomy provided the best surgical success rates. In our study, 38 patients developed postoperative hypocalcemia. It was severe in 47% of cases. Among them, 13 patients developed Hungry Bone syndrome. Alkaline phosphatase level >500 IU/l and preoperative hypocalcemia were respectively the main factors predicting postoperative hypocalcemia.

Conclusion: In our study, preoperative serum alkaline phosphatase and calcium concentrations were found to be predictors of postoperative hypocalcemia in patients with secondary hyperthyroidism who underwent parathyroidectomy. These variables may help clinicians identify patients undergoing hemodialysis who are at higher risk of hypocalcemia following parathyroid surgery and thus monitor them more closely during the postoperative period. Such high-risk patients may benefit from postoperative calcium and vitamin D supplementation.