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Sisay Deme,1 Berihu Fisseha,1 Gebreslassie Kahsay,1 Haimanot Melese,1 Abayneh Alamer,1 Sileshi Ayhualem2 1Department of Physiotherapy, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia; 2Department of human Anatomy, School of Medicine, College of Medicine and Health science, University of Gondar, Gondar, EthiopiaCorrespondence: Sisay DemeMekelle University, P.O. Box: 1871, Mekelle, EthiopiaTel +251 923272360Email sisaydeme21@gmail.comBackground: Musculoskeletal disorders contributed from chronic kidney disease are increasing worldwide. Musculoskeletal disorders had a significant health burden and are leading causes of co-morbidities, disability and low productivity, which potentially affect individual’s functional status and quality of life.Purpose: The aim of this study was to assess the prevalence of musculoskeletal disorders and its associated factors among patients with chronic kidney attending in Saint Paul Hospital, Addis Ababa, Ethiopia.Patients and Methods: An institution-based cross-sectional study was conducted on 302 enrolled study participants through systematic random sampling techniques. Face-to-face interview, physical examination and chart reviews were used to collect data using semi-structured questionnaire adapted from a standard Nordic Musculoskeletal Questionnaire and other literatures. Data were entered into Epi Info version 7 and exported to SPSS version 23 for analysis. Bivariate logistic regression analysis was employed with a p-value less than 0.25. Finally, those variables having a p-value less than 0.05 with 95% CI in multivariate analysis were taken as statistically significant.Results: The prevalence of musculoskeletal disorders among CKD individuals was found to be 58.6% (95% CI; 53.0, 64.1). Being female (AOR = 0.49; 95% CI 0.26, 0.94), age between 40 and 49 (AOR = 3.34; 95% CI 1.07, 10.44), stage III (AOR = 0.24; 95% CI 0.06, 0.89) and stage IV (AOR = 0.24; 95% CI 0.06, 0.89) chronic kidney disease, having HTN (AOR = 7.47; 95% CI 3.47, 16.06), parathyroid hormone level ≥ 100 pg/mL (AOR = 0.43; 95% CI 0.21, 0.87), calcium level < 8.4 mg/dl (AOR = 5.89; 95% CI 2.66, 13.56) and serum 25 hydroxy vitamin D level < 20 ng/mL (AOR = 3.91; 95% CI 1.32, 11.56) were significantly associated with musculoskeletal disorders.Conclusion: MSDs were shown to be moderately common in CKD patients. Female gender, age between 40 and 49 yrs, stage III and stage IV CKD, hypertension, higher PTH level, lower calcium level and lower vitamin D level were statistically significant in their association with musculoskeletal disorders.Keywords: musculoskeletal disorders, chronic kidney disease, prevalence, associated factors

BACKGROUND: We sought to better understand the experience of patients with transient hypoparathyroidism utilizing patient interviews and quality of life (QOL) surveys. METHODS: This is a prospective analysis of 62 patients after total thyroidectomy at a high-volume institution. Semi-structured patient interviews and QOL surveys were conducted preoperatively and postoperatively at 2 weeks, 6 weeks, 6 months, and 1 year and compared based on postoperative parathyroid hormone (PTH) levels. RESULTS: Postoperative PTH levels were 20 pg/mL in 48% (n=30). Hypocalcemic symptoms at 2 weeks were reported in 28 of 55 patients (51%), but patients felt “well prepared” and reported it “wasn’t a big deal.” If symptoms persisted at 6 weeks, they became more bothersome. At 6 months and 1 year, patients reported calcium supplementation prevented most symptoms and did not interfere with daily activities. QOL as measured by the European Organization for Research and Treatment of Cancer (EORTC) and the 12-Item Short Form Survey (SF-12) demonstrated a slight improvement at 1 year postoperatively regardless of PTH level. CONCLUSIONS: Early postoperative transient hypoparathyroidism is common but when appropriately managed, did not have a substantial negative impact on overall QOL.

Cel pracyCelem badania była ocena częstości występowania i nasilenia zaburzeń lękowych i depresyjnych wśród pacjentów z pierwotną nadczynnością przytarczyc (PNP), ustalenie związku nasilenia zaburzeń ze stężeniami jonów wapnia i parathormonu w surowicy oraz oceny przydatności skal samooceny w przesiewowej ocenie zaburzeń depresyjnych wśród chorych z PNP.MetodaBadaniu przy użyciu 17-punktowej Skali Depresji Hamiltona (HAM-D), Inwentarza Samooceny Becka-II (BDI-II) oraz Szpitalnej Skali Leku i Depresji (HADS) poddano 101 pacjentów z PNP. Grupę kontrolną stanowiło 50 chorych z rozpoznaniem wola obojętnego tarczycy.WynikiAnaliza wyników badania przy użyciu skali HAM-D wykazała częstsze występowanie i większe nasilenie objawów depresyjnych w całej populacji pacjentów oraz wśród kobiet z PNP. Nie uwidoczniono takiej zależności wśród badanych mężczyzn. W badaniu przy użyciu BDI-II wykazano częstsze występowanie i większe nasilenie objawów depresyjnych w całej populacji pacjentów oraz wśród kobiet z PNP. Nie uwidoczniono takiej zależności wśród badanych mężczyzn. Badanie przy użyciu HADS nie wykazało istotnych różnic między częstością występowania objawów depresyjnych i lękowych pomiędzy grupą badaną i kontrolną w całej populacji oraz po uwzględnieniu podziału na płeć.WnioskiBadanie uwidoczniło związek między PNP a występowaniem zaburzeń depresyjnych. Związku takiego nie wykazano dla zaburzeń lękowych. Nie wykazano zależności nasilenia zaburzeń depresyjnych od stężenia jonów wapnia i parathormonu w surowicy. Wykazano istotną statystycznie niewielką ujemną korelację nasilenia zaburzeń lękowych ze stężeniem jonów wapnia w surowicy w całej badanej grupie, w grupie kobiet ponadto dodatnią korelację stężenia parathormonu w surowicy z nasileniem zaburzeń lękowych. Badanie wykazało, że testy samooceny nie są wystarczającym narzędziem do przesiewowej diagnostyki zaburzeń depresyjnych wśród pacjentów z PNP.

This study aimed to assess the relationship between vitamin D [25(OH)D] status and parathyroid hormone (PTH) in Saudi adults to determine the optimum 25(OH)D cut-off in the Saudi adult population. A total of 1093 apparently healthy Saudi subjects (720 women and 373 men) aged 50.7 ± 13.9 years were included in this cross-sectional study. Serum 25(OH)D, PTH, calcium and albumin levels were determined. The over-all prevalence of 25(OH)D deficiency (

Thyroid and parathyroid are anatomically close to each other. Blood supply to parathyroid may get cut off inadvertently or all parathyroid tissue may get removed removed during near total or total thyroidectomy.As a result of near total and total thyroidectomy it may lead to hypocalcemia crisis post-operatively causing tingling, numbness, tetany, neuro-muscular dysfunction.Hypocalcemia is the most common etiological factor for prolonged hospitalization in patients undergoing total thyroidectomy.Recent studies concludes that, hypocalcemia can be prevented by assessing S. PTH levels pre-operatively and intra-operatively one hour after removing the gland.This study includes 30 patients, who underwent near total and total thyroidectomy from August 2018-July2020 with thyroid swelling where indicated for surgery.Patients who underwent total thyroidectomy for malignancy (10 out of 30) developed hypocalcemia, this attributed to the extensive surgical dissection performed in malignant disorders in order to obtain tumour clearance.For the Stratication of thyroidectomy patients who may develop hypocalcemia into low and high risk category, a single 1-hour post-thyroidectomy PTH level is very useful.

Introduction: Insufficiency fractures are uncommon injuries, but may occur in the lower extremity due to repetitive stress on abnormal bone tissue. Management of these injuries may include weight bearing restrictions, bracing, or even surgical intervention. In addition, a proper metabolic healing environment is required to encourage healthy bone growth following an injury. Case Presentation: This case report discusses a patient who underwent surgical repair of a closed nondisplaced proximal tibia insufficiency fracture. Several reoperations were required due to hardware failure and bone resorption following operative nonunion repair. It was determined that her elevated PTH due to end-stage renal disease (ESRD) likely inhibited bone regeneration during the course of her treatment. A successful kidney transplant rapidly normalized the patient’s PTH levels and permitted bony healing of her tibial stress fracture. Conclusion: Several studies have demonstrated a relationship between metabolic abnormalities and fracture healing. We are the first to present a case where bony union in an ESRD patient with secondary hyperparathyroidism was only achieved following a kidney transplant. Surgeons should be cognizant of the effect that metabolic abnormalities may have in the development of insufficiency fractures and subsequently achieving bony union following such fractures. Keywords: Fracture, non-union, intramedullary nail, hyperparathyroidism, end-stage renal disease.

Background Paediatric patients with chronic kidney disease are known to have an increased risk of fracture. However, data pertaining to children with end stage kidney disease (ESKD) receiving renal replacement therapy (RRT) is limited. Objectives The aim of this study is to determine the incidence of fracture and associated factors in this specific group of patients. Methods We conducted a retrospective review on all paediatric patients with ESKD at the tertiary Paediatric Nephrology Centre in Hong Kong. Children who presented before 18 years with active follow-ups for 12 or more months by November 2020 were included. Results RRT was initiated in 69 children (55% boys) at a mean age of 9.2 ±5.9 years. At the time of evaluation, 21 (30.4%), 10 (14.5%) and 38 (55.1%) patients received peritoneal dialysis (PD), haemodialysis (HD) and kidney transplant respectively. 3 patients (4.3%) had prior kidney graft loss and resumed on dialysis. One patient (1.5%) reported a fracture prior to RRT. Over a median of 5.2 years (IQR 3.0–8.3) follow-up, 10 fracture episodes were observed in 7 patients (10.1%) at a mean duration of 7.8 ±8 years since RRT initiation, corresponding to a cumulative fracture incidence of 227.8 per 10000 patient year (95% CI, 86.6–369.0). This rate was 5-folds higher than published data from our local general paediatric population (45 per 10,000 person-years; 95% CI, 43.9–46.1; p=0.01). Of note, all patients experienced single fracture episode except one child who developed 4 fracture episodes. Children who sustained fractures were significantly younger at the time of RRT initiation (3.5 vs 10.4 years; p=0.02) and had a longer time on dialysis (12 vs 2.7 years; p Conclusions Children with ESKD receiving RRT are at a higher risk of fracture. Longer duration of dialysis and a higher average parathyroid hormone level were potential modifiable factors associated with fractures.

Background Estimation of parathyroid hormone (PTH) after thyroid surgery helps to predict the development of hypocalcemia and allows early intervention and management with oral calcium and/or vitamin D supplementation in the postoperative period. Patients and methods This retrospective study included 57 patients who underwent total or completion thyroidectomy within 4 years. Measurement of serum PTH level was done 3 h after surgery for its change and prediction of hypocalcemia. Results The mean age was 42.11 years, females constituted 46 patients (80.7%), the main surgical procedure was total thyroidectomy in 51 patients (89.5%), and the main cause for surgery was multinodular goiter in 33 patients (57.8%). Three hours after surgery 47 patients (82.5%) had serum PTH levels of >10 pg/ml (mean 28.06) and 44 patients (77.2%) had normal serum calcium (mean 8.66). Most of these 47 patients (82.46%) didn't require postoperative supplementation, while from other 10 patients (17.5%) with serum PTH level of, Highlights • Symptomatic parathyroid dysfunction is a common complication after total or completion thyroidectomy. • Some studies recommend the routine estimation of parathyroid hormone level after thyroid surgery. • Routine usage of oral calcium and/or vitamin D reduce hypocalcemia incidence.

To define critical elements that contribute to successful parathyroidectomy based on a high-volume single-surgeon experience and explore learning curve characteristics.Systematic analysis of prospectively maintained quality assurance database.Academic tertiary care endocrine surgery practice.In total, 4737 consecutive patients who underwent thyroid or parathyroid surgery from 2004 to 2020 were identified. Demographic data acquisition was undertaken on a subset of these patients who had initial surgery for primary hyperparathyroidism during the academic years 2005 to 2018. Patients with renal or syndromic hyperparathyroidism and those undergoing reoperative surgery were excluded.From 1710 patients who underwent parathyroid surgery, 1082 met inclusion criteria in order to focus on a homogeneous data set. These patients had a mean age of 60.1 ± 12.5 years and 76.4% were female. The overall cure rate was 98.3%, reflecting a success rate that increased from 95.5% during the first 200 cases to 99.7% over the final 300 cases. The complication rate was 1.7%. Over 2 decades, the patient phenotype evolved toward milder disease and smaller adenomas. A learning curve of 200 cases was required to become a proficient parathyroid surgeon; to achieve exceptional results required several hundred additional cases. Parathyroid surgery represents a higher proportion of an endocrine surgery practice than previously (54.0% in 2019 compared with 25.5% in 2004).A focused practice dedicated to endocrine surgery yields surgical volumes exceeding 500 cases annually. There has been a steady shift toward parathyroid surgery. A lengthy learning curve can be shortened by pursuit of several specific strategies that are outlined in detail.

Background: More surgeons have known the importance of parathyroid grand and recurrent laryngeal nerve protection in the surgery, but there is still plenty of scope to improve the surgical techniques. This study aims at investigating whether the improved method of finding recurrent laryngeal nerve (RLN) can protect parathyroid grand and RLN. Methods: One hundred fifty-eight patients were enrolled and divided randomly into the test and control group according to different methods of finding RLN in the surgery. In the experimental group the author could quickly find the laryngeal recurrent nerve in the lower part of the neck and separate along the surface of the recurrent laryngeal nerve to the point where the recurrent laryngeal nerve gets into the larynx close to the thyroid gland named lateral approach, while in the control group the author severed the middle and lower thyroid vein and raised the lower thyroid pole to look for the RLN near the trachea by the blunt separation. Results: The author identified 152 and 159 parathyroid glands in the test and control group, respectively and there were a lower ratio of auto-transplantation and less operative time in the test group compared with that in the control group. The author also found that the parathyroid hormone level (1 day and 2 months) in the test group was higher than that in the control group. There were no differences in metastatic LN and recurrent laryngeal nerve palsy in the 2 groups. Conclusion: The improved method of finding RLN is a simple, efficient and safe way, and easy to implement.

Introduction: Primary hyperparathyroidism is one of the most common endocrine disorders requiring surgical parathyroidectomy for its definitive treatment. Surgical exploration is traditionally performed through conventional open neck approach. A wide range of minimal access and minimally invasive endoscopic techniques (gas less and with gas) have been attempted in the past two decades. In this context, we evaluated the feasibility and safety of an innovative transoral endoscopic parathyroidectomy (EP) technique, which represents a paradigm shift in transluminal endocrine surgery. Materials and Methods: This is a prospective study conducted at a tertiary care Endocrine Surgery Department in South India between May 2016 and August 2017. We employed a novel transoral, lower vestibular route for EP. All the clinical, investigative, operative, pathological and post-operative data were collected from our prospectively filled database. Statistical analysis was performed with SPSS 20.0 version. Operative Technique: Under inhalational general anaesthesia, access to the neck was obtained with 3 ports (central frenulotomy and two lateral port sites), dissected in subplatysmal plane and insufflated with 6 mm Hg CO2 for working space. Rest of surgical steps is similar to conventional open parathyroidectomy. Results: Out of the 38 hyperparathyroidism cases operated during the study, 12 (32%) were operated by this technique. Mean operative time was 112 ± 15 min (95–160). The post-operative course was uneventful with no major morbidity, hypocalcemia or recurrent laryngeal nerve palsy. Cure and diagnosis were confirmed by >50% fall in intraoperative parathyroid hormone levels and histopathology (all were benign solitary adenomas). Conclusions: Through this study, we opine that this novel transoral vestibular route parathyroidectomy is a feasibly applicable approach for primary sporadic hyperparathyroidism, especially with solitary benign adenomas.

The literature data and the finding of our studies on the analysis of the correlation between the level of parathyroid hormone and supply of vitamin D of children (n=107) of early age are presented in the article. The serum level of vitamin D in the analyzed group of children was 24.8 [17.6–32.5] ng/ml, the median of the parathyroid hormone was 21.0 [12.3–25.5] pg/ml. It has been established that children with optimal supply of vitamin D have significantly lower parathyroid hormone levels vs. the children with vitamin D insufficiency (25 (OH) D from 20 to 30 ng/ml) and deficiency (calcidiol values below 20 ng/ml). The correlation between the level of vitamin D and parathyroid hormone was r=-0.18, p=0.035. The best supply of vitamin D was found in children of the first year of life – 25 (OH) D concentration was 29.95 [16.2–40.3] ng/ml. The parathyroid hormone level (16.5 [10.7–23.8] pg/ml) in these children was reliably lower (p=0.05) vs. the children of the second and third years of life. A positive correlation was established between the age of patients and the parathyroid hormone level (r=0.2, p=0.05). Preventive doses of vitamin D were received by 42.1% of children. The blood serum concentration of 25 (OH) D in them was higher (32.7 ng/ml), and the parathyroid hormone level was significantly lower (14.9 pg/ml) vs. the children who did not receive cholecalciferol preparations (p

Background. Parathyroidectomy is the only effective method to improve the clinical and laboratory manifestations of the primary hyperparathyroidism (PHPT) and reduce the risk of urinary calculi formation. However, there are controversies about the existence of renal form of PHPT and about the effectiveness of surgery with regard to the risk of stone formation. Aims. To evaluate the effectiveness of PHPT surgical treatment in relation to clinical, laboratory parameters, as well as the risk of stone formation. Materials and methods. In a prospective single-arm observation one-center nonrandomized study we included patients with PHPT in whom parathyroidectomy was performed in 2012–2015. We analyzed clinical and laboratory parameters before and after surgery in a period from 1 to 3 years. Results. The study included 105 patients, of whom 35 (33.3%) had urolithiasis. Blood calcium after the surgery decreased from 2.72 mmol/l [2,56; 2,97] to 2,3 mmol/l [2,2; 2,35], p < 0.001. Blood calcium concentration decreased to normal values in all patients. Parathyroid hormone level decreased from 206 pg/ml [123; 347] to 72,8 pg/ml [30; 113], p < 0.001. Clinical symptoms questionnaire estmation decreased from 4 points [3; 6] to 2 points [1; 4], p < 0.001. In patients with urolithiasis clinical symptoms before treatment were more pronounced – 5 points [3; 7] vs. 4 points [3; 5] (p = 0.015) and decreased more significantly – by 3 points [2; 4] vs 2 points [1; 3]. The daily calcium urine excretion decreased from 11.4 mmol/day [8.9; 13.9] to 5.4 mmol/day [4.1; 6.8], p < 0.001. In 2 cases (5.7%; CI, 0.7–19.2%) we observed the progression of urolithiasis after surgery. The age of patients correlated with daily calcium urine excretion after surgery (r = 0.69; p = 0.028). Conclusions. Parathyroidectomy normalizes blood calcium and parathyroid hormone, improves clinical symptoms and reduces the risk of stone formation.

Objective: To describe an unusual case of primary hyperparathyroidism due to a benign cystic parathyroid adenoma involving parathyroid crisis, profoundly elevated serum calcium and parathyroid hormone levels, and near-remission prior to surgery.Methods: We describe the presentation, evaluation, and treatment of an elderly female with parathyroid crisis due to a benign cystic parathyroid adenoma. Issues related to management of parathyroid crisis, parathyroid cancer, and atypical parathyroid lesions are highlighted. Previously reported cases of spontaneous remission of hyperparathyroidism are briefly reviewed.Results: Our patient was admitted with altered mental status, palpable neck mass, serum calcium level of 22.5 mg/dL, and parathyroid hormone level of 3,131 pg/mL. After immediate stabilization maneuvers, evaluation and treatment proceeded under a presumptive diagnosis of parathyroid cancer. Prior to surgery, parathyroid hormone level had spontaneously reduced by 20-fold. Resection of the parathyroid tumor with en bloc ipsilateral thyroid lobectomy was performed. Pathology demonstrated a benign cystic parathyroid adenoma.Conclusion: To the best of our knowledge, this is the only case of spontaneous near-remission days following admission for parathyroid crisis in which the diagnosis of benign adenoma was confirmed by pathology. This report may therefore contribute to an improved understanding of the natural history of primary hyperparathyroidism associated with atypical parathyroid lesions. The presenting serum calcium and parathyroid hormone levels in this case are among the highest ever reported for primary hyperparathyroidism due to benign adenoma and are at the upper end of values typically observed with parathyroid cancer.Abbreviations: PHPT primary hyperparathyroidism PTH parathyroid hormone

Background: Previous studies have indicated that parathyroid hormone (PTH) has been linked to post-myocardial infarction (MI) development. The aim of this cross-sectional study was to evaluate the relationship between PTH level and heart failure due to post infarction remodeling during the first 72 hours of hospitalization. Methods: Seventy patients with a diagnosis of acute MI (age ≥18 years, 22 females and 48 males) were enrolled. Patients were admitted to the Imam Raza Educational, Research and Treatment Center, Mashhad University of Medical Sciences, Iran between July 2014 to September 2015. We measured PTH and vitamin D level. Blood samples were taken after 24 hours and 72 hours. Results: During the first 72 hours, the PTH level significantly increased in patients with Post-MI heart failure. 68% of the subjects had an inappropriate vitamin D level at the time of admission. Mean levels of vitamin D and PTH increased compared with the baselines (95% CI, 0.15 to 10.03, P: 0.044), (95% CI, 6.5 to 24.8, P:0.001) respectively. Conclusion: Acute elevations of serum PTH levels increased early remodeling heart failure after MI. Serum vitamin D status was independent of high serum PTH level. Based on the current evidence, PTH excess may be a risk factor for heart failure, so early treatment and omitting risk factors are the most effective strategies for the patients with acute myocardial infarction. J Pharm Care 2020; 8(1): 11-15.

Parathyromatosis is a rare condition consisting of multiple nodules of benign hyperfunctioning parathyroid tissue scattered throughout the neck and superior mediastinum. As a potential cause of recurrent or persistent hyperparathyroidism, parathyromatosis is a challenging condition to diagnose and treat. The optimal evaluation and management of patients with parathyromatosis is not well established. The reported case involves a patient who was initially diagnosed with primary hyperparathyroidism. The diagnosis of Type 1 parathyromatosis was made after the patient developed recurrent hyperparathyroidism with hypercalcemia and osteoporosis 17 years after the initial operation and underwent two additional operations. The majority of parathyromatosis cases are diagnosed in the setting of secondary hyperparathyroidism. Consensus regarding the preoperative diagnosis and evaluation is lacking due to the paucity of cases of this rare clinical entity. Management involves complete surgical extirpation of all identifiable rests of parathyroid tissue. Intra-operative parathyroid hormone level monitoring and frozen section examination are excellent tools that could increase the rates of initial operative success. Despite this, long-term disease remission is rare, and medical therapy, including calcimimetics and bisphosphonates, may be required for postoperative or non-operative management.

Background:It is proved that rheumatic diseases are accompanied by pronounced changes in calcium-phosphorus metabolism, which underlies the development of osteopenia syndrome. If in previous years glucocorticosteroid therapy (GCS) was considered to be the main reason for this, then the role of pro-inflammatory agents (activity of the pathological process), provision with vitamin D (VitD), and the effect of basic therapy are currently being discussed. It is also known that a decrease blood level of vitamin D leads to a violation of the absorption of calcium and phosphorus, a further increase in the level of parathyroid hormone, which underlies the risk of a decrease in bone mineral density.Objectives:To study the level of parathyroid hormone in children with juvenile idiopathic arthritis, its relationship with the course of the disease and vitamin D status.Methods:91 patients with JIA (61 girls and 30 boys), with polyarticular (n = 41), oligoarticular (n = 29) and undifferentiated (n = 18) variants of JIA were examined. The age of the patients was 10.5 ± 1.7 years. The duration of the disease was 4.1 ± 1.1 years. All children receive basic methotrexate therapy. The control group included 25 peers of the corresponding gender. JADAS27 was counted, the levels of 25-hydroxycalciferol (25-OH D) and PTH were determined by chemiluminescent method. Corresponded to the content of vitamin D in blood serum, the normal level was noted in 14 patients, insufficiency - in 41 patients, deficiency - in 32 patients.Results:The level of PTH in children with JIA remained within physiological values (30.6 ± 2.1 pg/ml; from 12.7 to 61.8 pg/ml) despite the high frequency of a VitD decrease in blood (80.2%). The level of PTH was not significant in groups of patients with a different level of vitamin D (32.8 ± 2.1 pg/ml at deficiency group; 29.2 ± 2.4 pg/ml at insufficiency group; 29.1 ± 1.8 pg/ml at a normal level of VitD group). PTH was comparable and did not differ in children of different sexes.The highest level of PTH was in patients with a polyarticular variant of JIA (34.2 ± 4.5 pg / ml, pConclusion:A study of the level of PTH in children with JIA did not show a significant increase depending on the vitamin D status in these patients. However, the age-related state of PTH is associated with the activity of the pathological process, the prevalence of articular syndrome and prolonged illness.Disclosure of Interests:None declared

Objective: The preoperative and postoperative calcium, parathormone levels, platelet counts, mean platelet volume values of the patients were compared in order to investigate the changes in the risk of atherosclerosis and coronary artery disease in parathyroidectomy. Method: Twelve male and 43 female patients who underwent parathyroidectomy between 01.01.2008 and 01.01.2018 at the Cumhuriyet University Surgical Oncology Clinic were included in the study. On the tenth preoperative and postoperative day, blood was drawn for the platelet, mean platelet volume, calcium and parathyroid hormone levels after a fasting period of twelve hours. The preoperative and postoperative calcium, parathormone levels, platelet counts, mean platelet volume values of the patients were compared in order to investigate the changes in the risk of atherosclerosis and coronary artery disease in parathyroidectomy. Results: The mean pre-operative blood calcium levels of the patients included in the study were 10.75 ± 1.49 mg / dl, . Mean postoperative blood calcium level was 8.59 ± 1.14 mg / dl. The mean preoperative mean platelet volume of the patients was 26.1 ± 121.55 fL, Postoperative mean platelet volume was 9.36 ± 1.26 fL. The mean preoperative parathormone level was 535,08 ± 711,08, The mean postoperative parathyroid hormone level was 74.47 ± 128.02 pg / ml. The mean preoperative blood platelet count of the patients included in the study was 418000 ± 8000 / mm³, The mean postoperative blood platelet count was 252000 ± 7000 / mm³. Conclusions: In our study, we found that the decrease in serum parathormone level, serum platelet level, mean platelet volume, after parathyroidectomy was statistically significant. Mean platelet volume and platelet count were decreased after parathyroidectomy, which are indicators of atherosclerosis and coronary artery disease; Parathyroidectomy reduces the risk of atherosclerosis and coronary artery disease. Additional clinical and laboratory studies are needed to support the risk of atherosclerosis and coronary artery disease after parathyroidectomy.

Análisis de los valores de hormona paratiroidea (PTH) intranodular obtenidos por punción con aguja fina como factor predictivo de hipoparatiroidismo posoperatorio.De los 157 pacientes a los que se realizó la medición de la PTH intranodular, se estudiaron 37 que fueron intervenidos quirúrgicamente, estableciendo 15 variables para analizar: edad, sexo, tiempo de evolución, tamaño, cirugía de tiroides asociada, tratamiento preoperatorio con calcimiméticos, litiasis renal, densitometría ósea, aclaramiento de creatinina, calcio y PTH preoperatorios, PTH determinada tras punción con aguja fina, descenso de la PTH intraoperatoria, calcio posoperatorio y malignidad de la tumoración. Estas se compararon con la prueba de ji al cuadrado o el test exacto de Fisher, siendo significativa una p0.05, construyéndose así un análisis de regresión logística.El uso de calcimiméticos previo a la cirugía, la PTH preoperatoria88 pg/dl, el calcio preoperatorio12 mg/dl, los valores de PTH intranodular2700 pg/dl, el descenso de la PTH intraoperatoria a15 pg/dl y el calcio posoperatorio8,5 mg/dl fueron variables independientes significativas en el análisis univariante (p0.05) para la predicción del hipoparatiroidismo posoperatorio.Los valores de PTH intranodular pueden predecir qué pacientes tienen mayor riesgo de sufrir un hipoparatiroidismo posoperatorio. Este factor debe tenerse en cuenta durante el estudio y el seguimiento de los pacientes para identificar precozmente posibles complicaciones.To analize if parathyroid hormone (PTH) washout levels can be considered a predictive factor of postoperative hypoparathyroidism and determine its importance relative to other features already known as intraoperative PTH, Ca and PTH preoperative, and others.Of the 157 patients to whom a fine needle aspiration (FNA) biopsy with intranodular parathyroid hormone level measurement was performed (washout PTH) 37 who underwent surgery were studied. 15 variables were taken into account when selecting patients for this study: age, gender, evolution length, size, associated thyroid surgery, preoperative treatment with calcimimetics, presence of renal lithiasis, bone densitometry alterations, creatine clearance, preoperative calcium and PTH levels, PTH scores obtained by fine needle aspiration, intraoperative PTH decrease, postoperative calcium levels and tumour malignancy. We compare the nominal values, using the Chi squared or the exact Fisher test, where p0.05 was considered statistically significant and perform a logistic regression analysis.The use of calcimimetics prior to surgery, the preoperative PTH level above 88 pg/dl, the preoperative calcium above 12 mg/dl, washout PTH above 2700 pg/dl, intraoperative PTH level decrease below 15 pg/dl, and postoperative calcium levels under 8.5 mg/dl were all independently significant variables in the univariant analysis (p0.05) in order to establish an early postoperative hypoparathyroidism. The rest of the variables were not statistically significative.The PTH washout levels can predict the appearance of postoperative hypoparathyroidism. This factor must be taken into account during the study and follow-up to identify possible complications and establish an adequate treatment on time.

An institutional protocol for selective calcium/calcitriol supplementation after completion/total thyroidectomy was established based on the 4-hour postoperative parathyroid hormone level. The aim of this study was to evaluate the outcomes of this protocol 5 years after implementation.All patients who underwent completion/total thyroidectomy from January 2012 to December 2016 were reviewed. Predictors of a 4-hour parathyroid hormone level10 pg/mL and symptomatic hypocalcemia were assessed.Of 591 patients, 448 (76%) had a 4-hour parathyroid hormone ≥10, 72 (12%) had a 4-hour parathyroid hormone of 5-10, and 71 (12%) had a 4-hour parathyroid hormone5. Hypocalcemic symptoms were infrequent (30/448, 7%) if the 4-hour parathyroid hormone was ≥10; 56% (40/71) of those with a 4-hour parathyroid hormone5 reported symptoms. With 4-hour parathyroid hormone of 5-10, symptoms were reported in 32 of 72 (44%) patients; supplementation at discharge included calcium (n = 55, 76%), calcium and calcitriol (n = 12, 17%), or none (n = 5, 7%). Ten patients subsequently received calcitriol for persistent symptoms. On multivariate analysis, predictors of 4-hour parathyroid hormone10 included incidental parathyroidectomy, malignancy, and thyroiditis; predictors of hypocalcemic symptoms included age55 and 4-hour parathyroid hormone10.After completion/total thyroidectomy, patients with a 4-hour parathyroid hormone ≥10 can be safely discharged without routine supplementation. The addition of calcitriol to calcium supplementation should be strongly considered for patients with a 4-hour parathyroid hormone of 5-10.

Objectives/Hypothesis To assess the feasibility of a simplified approach for the use of a rapid intraoperative parathyroid hormone (IOPTH) assay based on a single 10-minute post-excision level using the workup parathyroid hormone level (wPTH) as the baseline in minimally invasive parathyroidectomy (MIP) and to compare the predictive value of this criterion with other recommended criteria. Study Design Case series with chart review. Methods A single surgeon's prospectively maintained parathyroidectomy database at an academic center was reviewed over a 2-year period from June 2009 through June 2011. Results A total of 102 patients undergoing MIP met the inclusion criteria. An IOPTH threshold of a ≥50% drop at 10 minutes post-excision from the wPTH baseline resulted in acceptable false positive (1.9%) and false negative (0.9%) rates. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of this modified criterion was 98.9%, 71.4%, 98%, 83.3%, and 97%, respectively. Conclusions In our patient cohort, the pre-incision and pre-excision IOPTH levels did not seem to change the overall accuracy of predicting surgical success in MIP if a single 10-minute post-excision IOPTH level is used along with the wPTH, and is commensurate with the commonly used Miami and Vienna criteria. A single intraoperative blood sample demonstrating a ≥50% drop from the wPTH at 10 minutes post-excision should be explored further as a feasible simplified criterion that avoids multiple IOPTH samples Level of Evidence 4. Laryngoscope, 124:2205–2210, 2014

In a 53-year-old woman, Sagliker syndrome developed during 22 years of treatment with intermittent hemodialysis as a result of severe secondary hyperparathyroidism (SHPT) complicating end-stage renal disease. She failed medical managements and lost her renal graft just after the kidney transplantation due to acute rejection. Although surgical parathyroidectomy was effective, the parathyroid hormone level became extremely high again due to recurrent hyperparathyroidism. It is possible that such patient could survive long-term with dialysis, but prevention of severe SHPT is the most important.

Introduction: Central giant cell granuloma is a benign lesion but sometimes has aggressive proliferation composed of multinucleated giant cells in a background of spindle and ovoid mesenchymal cells. Multifocal central giant cell granuloma of jaws is very rare and usually associated with hyperparathyroidism and some syndromes. We described an unusual case of a 22-year-old man with idiopathic multiple central giant cell granuloma of mandible without significant clinical findings. The parathyroid hormone level, calcium and phosphorus inorganic were in normal limit. Patient had no familial history and clinical characteristic of Cherubism, Noonanlike syndrome and neurofibromatosis. This article refers to the fact that multiple central giant cell granuloma may be associated with no signs of systemic or specific syndromes and it can be an independent and idiopathic disease.

Objective To investigate the controversial relationship between preoperative calcium and parathyroid hormone levels and the dimensions and histological features of parathyroid adenoma in patients with primary hyperparathyroidism. Study design Historical cohort. Setting Tertiary medical centre. Subjects and methods Clinical and tumour-related data were collected from the medical files of all patients who underwent parathyroidectomy for primary hyperparathyroidism in 1996–2012. Preoperative blood parathyroid hormone and calcium levels and urine calcium levels were correlated with the size, weight and volume of the parathyroid adenoma. Pathohistological features were determined in a representative sample of archived paraffin-embedded sections and analysed by calcium or parathyroid hormone level (high/low) and adenoma weight (high/low). Results A total of 378 patients were included. There was a statistically significant direct correlation of preoperative calcium and parathyroid hormone levels with tumour dimensions and of tumour weight and chief-cell percentage. At a preoperative calcium level >11.5 mg/dL and parathyroid hormone (PTH) level >165 mg/dL, we predict that the adenoma would measure more than 2.7 g, 2.18 cm and volume of 3.59 cm3. Conclusions In patients with primary hyperparathyroidism, preoperative calcium and PTH levels may be predictive of parathyroid adenoma dimensions.

The purpose: an approbation of intraoperative photodynamic identification of healthy and adenomatous parathyroid glands using 5-aminolevulinic acid (5-ALA) at thyroid and parathyroid operations.Materials and methods: intraoperative photodynamic identification using 5-ALA was performed in 25 patients with various thyroid and parathyroid diseases. 2–3 hours before the surgery the patients have received 1,5 g of 5-ALA per os. In 10 cases video-assisted operations were performed. In 3 cases at primary hyperparathyroidism video-assisted parathyroidectomy was used. In other cases the operative intervention was carried out using conventional technique. The operative wound surface was exposed to blue light of the light source KARL STORZ D-Light C (wavelength –380–440 nm) and the endoscope with the system of filters. During preand postoperative period we have been registering basic clinical parameters, including parathyroid hormone level and the level of ionized calcium monitoring before operation, in 24, 48 hours and 1 month after operation. Results: the parathyroid glands were identified in 23 of 25 patients. There were no cases of allergic reactions and other side effects of 5-ALA introduction.Conclusion: intraoperative parathyroid glands identification by the way of registration of their fluorescence at peroral administration of 5-aminolevulinic acid is possible for the overwhelming majority of patients.

Importance There has been an increased interest in measuring parathyroid hormone (PTH) levels as an early predictive marker for the development of hypocalcemia after total thyroidectomy. However, significant variation exists in the timing, type of assay, and thresholds of PTH in the literature. Objective We performed a systematic review to examine the utility of PTH levels in predicting temporary postthyroidectomy hypocalcemia. Evidence Review A systematic literature review of studies published prior to May 25, 2016 was performed within PubMed, EMBASE, SCOPUS, and Cochrane databases using the following terms and keywords: “thyroidectomy,” “parathyroid hormone,” and “hypocalcaemia,” “calcium,” or “calcitriol.” Each candidate full-text publication was reviewed by 2 independent reviewers and selected for data extraction if the study examined the prognostic significance of PTH obtained within 24 hours after thyroidectomy to predict hypocalcaemia. Studies were excluded if calcium supplementation was used routinely or based on a PTH level. Study characteristics, PTH parameters used to predict hypocalcemia, and their respective accuracies were summarized. Findings The initial search yielded 2417 abstracts. Sixty-nine studies, comprising 9163 patients, were included. Overall, for an absolute PTH threshold, the median accuracy, sensitivity, and specificity were 86%, 85%, and 86%, respectively. For a percentage change over time the median accuracy, sensitivity, and specificity were 89%, 88%, and 90%, respectively. Conclusions and Relevance The existing literature regarding PTH levels to predict postthyroidectomy hypocalcemia is extremely heterogeneous. A single PTH threshold is not a reliable measure of hypocalcemia. Additional prospective studies controlled for timing of laboratory draws and a priori defined PTH thresholds need to be performed to ascertain the true prognostic significance of PTH in predicting postthyroidectomy hypocalcaemia.

The detrimental effect of high parathyroid hormone (PTH) on bone has not been adequately evaluated in vitamin D-sufficient Koreans. The aim of this study was to investigate the effect of high PTH on bone mineral density (BMD) in such a population. A total of 5,403 subjects (2,644 men and 2,759 postmenopausal women; ≥50 years old) were selected from the 2008-2010 Korea National Health and Nutrition Examination Survey (KNHANES). Subjects were divided into four groups according to vitamin D status (20 and ≥20 ng/mL) and PTH levels (≤65 and65 pg/mL). Total hip and spine BMD were evaluated in each group. High PTH level was found in 50% of vitamin D-deficient subjects and 35% of vitamin D-sufficient subjects. In the vitamin D-deficient group, subjects with normal PTH level had higher total hip and spine BMD than those with high PTH after adjusting for multiple confounding factors, regardless of gender. In the vitamin D-sufficient group, only women with high PTH showed lower total hip and spine BMD than those with normal PTH. Multivariable linear regression analysis found that PTH level was independently associated with total hip BMD in vitamin D-sufficient women as well as vitamin D-insufficient women, but no association was found in men. In conclusion, high serum PTH level has an additive detrimental effect on BMD in postmenopausal women even though they had sufficient vitamin D levels.

Objective To describe a case of adult-onset hypophosphatemic osteomalacia treated with orally administered phosphate and complicated by tertiary hyperparathyroidism. Methods We present pertinent clinical, radiologic, and laboratory details of the study patient for a period of more than 20 years and discuss the few reported cases of tertiary hyperparathyroidism attributable to prolonged phosphate therapy. Results A 49-year-old Jordanian man, who had been diagnosed at age 26 years as having sporadic adult-onset hypophosphatemic vitamin D-resistant osteomalacia, presented with severe right hip pain, severe osteopenia with lytic bone lesions, and hypercalcemia after prolonged oral treatment with phosphate and vitamin D. These clinical, radiologic, and biochemical findings, in conjunction with a very high serum parathyroid hormone level, indicated the diagnosis of tertiary hyperparathyroidism, which was substantiated histopathologically. Conclusion Physicians should be aware of the potential for development of tertiary hyperparathyroidism in patients receiving prolonged oral phosphate therapy. (Endocr Pract. 2001;7:375-378)

Skeletal resistance to parathyroid hormone is well defined in patients with chronic renal failure. In recent years, with the increased frequency of development of adynamic bone disease, it has been recognized that secondary hyperparathyroidism must exist as a 'trade off' mechanism to maintain skeletal bone remodeling in this patient population. An optimal level of intact parathyroid hormone to maintain the normal skeletal bone turnover is believed to be between 2.0 and 2.5 times the upper limit of normal parathyroid hormone. It has very recently been argued that the optimal parathyroid hormone level for maintenance of skeletal bone remodeling may be insufficient to prevent the extraskeletal complications of coronary artery calcifications, calcific valvular heart disease, and cardiac death. To provide optimal health care for these patients several new treatments have been developed, including use of new vitamin D analogs, calcimimetic agents, and noncalcium-based phosphorus binders. It is anticipated that with lower suppression of parathyroid hormone by these vitamin D analogs, intermittent suppression of parathyroid hormone with calcimimetic agents, and the use of noncalcium phosphorus binders (Renageltrade) by regulating serum calcium, the resultant phosphorus concentrations will provide an optimal parathyroid hormone activity to maintain skeletal bone remodeling, while preventing extraskeletal complications.