Complications, symptoms, presurgical predictors in patients with chronic hypoparathyroidism:​ a systematic review

Yao, Liang; Hui, Xu; Li, Meixuan; Li, Jing; Ahmed, Muhammad Muneeb; Lin, Clement; Kandi, Maryam; Sreekanta, Ashwini; Makhdami, Nima; Tamilselvan, Divya; Ali, Dalal S.; Dandurand, Karel; Yang, Kehu; Bilezikian, John P.; Brandi, Maria Luisa; Clarke, Bart L.; Mannstadt, Michael; Rejnmark, Lars; Khan, Aliya A.; Guyatt, Gordon

Affiliations

¹Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

²Evidence-Based Social Sciences Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China

³Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China

⁴Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

⁵Faculty of Health Sciences, McMaster University, Canada

⁶Internal Medicine Resident, Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada

⁷Faculty of Health Sciences and Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada

⁸Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada

⁹Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

¹⁰Fondazione Italiana sulla Ricerca sulle Malattie dell’Osso (F.I.R.M.O. Foundation), Florence, Italy

¹¹Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, USA

¹²Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

¹³Dept of Endocrinology and Internal Medicine, Aarhus University hospital, Aarhus, Denmark

Abstract and keywords

The complications and symptoms of hypoparathyroidism remain incompletely defined. Measuring serum parathyroid hormone (PTH) and calcium levels early after total thyroidectomy may predict the development of chronic hypoparathyroidism. The study aimed (i) to identify symptoms and complications associated with chronic hypoparathyroidism and determine the prevalence of those symptoms and complications (Part I), and (ii) to examine the utility of early postoperative measurements of PTH and calcium in predicting chronic hypoparathyroidism (Part II). We searched Medline, Medline In-Process, EMBASE, and Cochrane CENTRAL to identify complications and symptoms associated with chronic hypoparathyroidism. We used two predefined criteria (at least three studies reported the complication and symptom and had statistically significantly greater pooled relative estimates). To estimate prevalence, we used the median and interquartile range (IQR) of the studies reporting complications and symptoms. For testing the predictive values of early postoperative measurements of PTH and calcium, we used a bivariate model to perform diagnostic test meta-analysis. In Part I, the 93 eligible studies enrolled a total of 18,973 patients and reported on 170 complications and symptoms. We identified nine most common complications or symptoms probably associated with chronic hypoparathyroidism. The complications or symptoms and the prevalence are as follows: nephrocalcinosis/nephrolithiasis (median prevalence among all studies 15%), renal insufficiency (12%), cataract (17%), seizures (11%), arrhythmia (7%), ischemic heart disease (7%), depression (9%), infection (11%), and all-cause mortality (6%). In Part II, 18 studies with 4325 patients proved eligible. For PTH measurement, regarding the posttest probability, PTH values above 10 pg/mL 12–24 hours postsurgery virtually exclude chronic hypoparathyroidism irrespective of pretest probability (100%). When PTH values are below 10 pg/mL, posttest probabilities range from 3% to 64%. Nine complications and symptoms are probably associated with chronic hypoparathyroidism. A PTH value above a threshold of 10 pg/mL 12–24 hours after total thyroidectomy is a strong predictor that the patients will not develop chronic hypoparathyroidism. Patients with PTH values below the threshold need careful monitoring as some will develop chronic hypoparathyroidism.

Keywords: HYPOPARATHYROIDISM; PARATHYROID-RELATED DISORDERS; DISORDERS OF CALCIUM/PHOSPHATE METABOLISM; EPIDEMIOLOGY; HUMAN; GENETIC RESEARCH; ASSOCIATION STUDIES

Links

DOI: 10.1002/jbmr.4673

PubMed: 36375810

WoS: 000883107500001

History

Received: 2022-02-07

Revised: 2022-07-22

Accepted: 2022-08-08

Cited Works (3)

Year	Entry
2015	Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Orthop Res. September 2015;30(9):1738-1744.
2020	Starr JR, Tabacco G, Majeed R, Omeragic B, Bandeira L, Rubin MR. PTH and bone material strength in hypoparathyroidism as measured by impact microindentation. Osteoporos Int. February 2020;31(2):327-333.
2013	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. November 2013;28(11):2277-2285.

Cited By (5)

Year	Entry
2022	Bilezikian JP, Khan AA, Clarke BL, Mannstadt M, Potts JT, Brandi ML. The Fifth International Workshop on the Evaluation and Management of Primary Hyperparathyroidism. J Bone Miner Res. November 2022;37(11):2290-2292.
2022	Khan AA, Bilezikian JP, Brandi ML, Clarke BL, Potts JJ, Mannstadt M; International Workshop on Primary Hyperparathyroidism. The Second international Workshop on the Evaluation and Management of Hypoparathyroidism. J Bone Miner Res. December 2022;37(12):2566-2567.
2022	Khan AA, Bilezikian JP, Brandi ML, Clarke BL, Gittoes NJ, Pasieka JL, Rejnmark L, Shoback DM, Potts JT, Guyatt GH, Mannstadt M. Evaluation and management of hypoparathyroidism summary statement and guidelines from the second international workshop. J Bone Miner Res. December 2022;37(12):2568-2585.
2022	Van Uum S, Shrayyef M, M'Hiri I, Dandurand K, Ali DS, Bilezikian JP, Collins MT, Mannstadt M, Rubin MR, Siggelkow H, Tabacco G, Tay Y-KD, Vokes T, Winer KK, Yao L, Guyatt G, Rejnmark L, Khan AA. Initial assessment and monitoring of patients with chronic hypoparathyroidism: a systematic current practice survey. J Bone Miner Res. December 2022;37(12):2630-2641.
2022	Khan AA, Guyatt G, Ali DS, Bilezikian JP, Collins MT, Dandurand K, Mannstadt M, Murphy D, M'Hiri I, Rubin MR, Sanders R, Shrayyef M, Siggelkow H, Tabacco G, Tay Y-KD, Van Uum S, Vokes T, Winer KK, Yao L, Rejnmark L. Management of hypoparathyroidism. J Bone Miner Res. December 2022;37(12):2663-2677.