Neurological

Postoperative treatment of hypoparathyroidism and reduced quality of life

The reduced quality of life that patients with chronic postoperative hypoparathyroidism (HypoPT) often express may be caused in part by conventional treatment, according to a study in the Journal of Bone and Mineral Research Plus.

Researchers assessed the impact of conventional treatment modalities on quality of life using a newly developed HPQ 28 questionnaire that measures the typical symptoms and signs of people with HypoPT.

The cross-sectional study was conducted in 2 endocrinological centers in Germany and prospectively included 49 patients with HypoPT who had to be treated at least 6 months after thyroid surgery.

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The laboratory values ​​of the patients were determined immediately after blood collection for total serum calcium, serum albumin, serum magnesium, serum phosphate and 25-OH vitamin D3; 24-hour urine collections were analyzed for calcium, creatinine, and phosphate using standard laboratory methods. Patients also completed the HPQ 28 questionnaire during their visit.

Participants had a mean age of 57.3 ± 10.5 years and had a mean disease duration of 12.6 ± 9.8 years, 84% were female, and 84% had total thyroidectomy. Most patients (86%, n=42) received treatment with the active vitamin D analogues calcitriol, alfacalcidol, or dihydrotachysterol (DHT).

No significant differences were observed between the different treatments in terms of serum or urine parameters. Pearson’s correlation analysis between calcitriol or alfacalcidol intake and laboratory parameters showed no significant correlation with any parameters, and no statistically significant group differences were found between the active vitamin D compounds administered in the HypoTH group.

Spearman’s rank analysis (rs = 0.29; p = .049) revealed a significant positive correlation between magnesium intake and the HPQ 28 gastrointestinal symptoms scale. The analysis for calcium intake also showed a significant correlation with the neurovegetative symptoms scale (rs = 0.29 ; P = 0.044).

Calcitriol dose was positively and significantly correlated with “pain and cramps”, “depression and anxiety”, “numbness and tingling” and “palpitations” on the HPQ 28 with a rank correlation coefficient rs of approximately 0.6. Linear regression analysis showed a significant effect of calcitriol on the pain and cramps scale (rc2 = 0.33; P = 0.017), depression and anxiety scale (rc2 = 0.25; P = 0.038) and the item ” Numbness and tingling” (rc2 = 0.51; P = 0.003) and “palpitations” (rc2 = 0.53; P = 0.002).

The correlation of the calcitriol dose with the scales “pain and cramps”, “depression and anxiety” and the item “numbness and tingling” remained significant after correction for serum calcium. This effect was independent of sex, age, underlying disease, type of operation, serum 25-hydroxyvitamin D3 or phosphate levels. High doses of calcitriol had no effect on the laboratory values.

The researchers acknowledged that their results were limited by the small number of participants taking each individual vitamin D compound. The number of patients was also too small to correct all influencing parameters at the same time, since the test could only be carried out for one factor at a time.

“Our data suggest that the reduced quality of life in these patients may be caused in part by one or a combination of conventional treatment modalities,” the researchers said. “For the clinician treating patients with hypoparathyroidism, our data suggest carefully considering patients’ symptoms and signs as being caused not only by the disease itself but also by the treatment,” the researchers said.

Disclosure: Some of the study authors disclosed their affiliation with biotech, pharmaceutical, and/or device companies. For a full list of authors’ disclosures, see the original reference.

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Stamm B, Blaschke M, Wilken L, et al. The influence of conventional treatment on symptoms and signs in patients with chronic postoperative hypoparathyroidism. JBMR Plus. Published online November 29, 2021. doi:10.1002/jbm4.10586

This article originally appeared on Endocrinology Advisor

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