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World Journal of Surgery

, Volume 25, Issue 9, pp 1155–1159 | Cite as

Hemithyroidectomy: Long-term effects on parathyroid function—preliminary report

  • Pia Lindblom
  • Johan Westerdahl
  • Anders Bergenfelz
Article

Abstract

Early hypocalcemia after thyroid surgery has frequently been reported, whereas data regarding long-term effects on calcium homeostasis are scarce. We have previously studied patients after hemithyroidectomy with an oral calcium load test and found normal parathyroid hormone (PTH) suppression. However, the 1,25-dihydroxyvitamin D concentration was decreased and the phosphate concentration increased, implying parathyroid insufficiency. We therefore proceeded to investigate PTH secretion and suppression in 10 euthyroid patients subjected to hemithyroidectomy due to benign thyroid disease before and at 1 year after surgery. In addition, biochemical variables known to influence calcium homeostasis were analyzed. Basal, maximal, and total PTH secretion were unaltered 1 year postoperatively. However, maximal PTH secretion was reached at a lower serum level of ionized calcium, and there was a tendency toward increased parathyroid sensitivity to ionized calcium. Furthermore, compared to preoperatively, total serum calcium, 1,25-dihydroxyvitamin D, and free thyroxine (T4) concentrations were decreased at follow-up. Total serum calcium and 1,25-dihydoxyvitamin D concentrations were decreased 1 year after hemithyroidectomy. These changes were not due to parathyroid insufficiency. Instead, our results imply increased parathyroid sensitivity to calcium and possibly reduced peripheral sensitivity to PTH.

Keywords

Parathyroid Gland Ionize Calcium Concentration Benign Thyroid Disease Calcio Calcium Infusion Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

II existe plusieurs publications sur I’hypocalcémie précoce aprés chirurgie de la thyroïde; en revanche, il y a peu de données concernant les effetsà distance en ce qui concerne I’homéostase calcique Nous avons déjà analysé les résultats chez despatients ayant eu une hémithyroïdectomie par un test de charge de calcium per os et avons retrouvé une suppression normale de la PTH. Cependant la concentration en 1–25 dihydroxy-vitamine D était diminuée et la concentration en phosphates, augmentée, suggérant une insuffisance parathyroïdienne. Nous avons donc décidé d’examiner la sécrétion de PTH et sa suppression chez dix patients euthyroïdes ayant eu une hémithyroïdectomie en rapport avec une maladie bénigne de la thyroïde, avant, età unan après chirurgie. De plus, on a analysé les variables biochimiques reconnues pour leur influence sur I’homéostase calcique. La sécrétion basale, maximale et totale n’étaient pas perturbéesà un an en postopératoire. Cependant la sécrétion maximale de PTH a été atteinteà un niveau plus bas de calcémie et il y avait donc une tendance vers une hypersensibilité au calcium ionisé. De plus, comparées aux valeurs préopératoires, la calcémie totale, le taux de 1–25 dihydroxy vitamine D et les concentrations de T4 libre étaient diminuées lors du suivi. La calcémie totale et les concentrations en 1-25-dihydoxy-vitamine D étaient diminuées un an après hémithyroïdectomie. Ces changements n’étaient pas en rapport avec une insuffisance parathyroïdienne. Au contraire, nos résultats indiquent une sensibilité accrue de la parathyroïde au calcium et possiblement, une réduction de la sensibilité périphériquè ala PTH.

Resumen

Se ha descrito que, tras cirugía tiroidea, aparece una hipocalcemia precoz pero son escasas las referencias de sus efectos, a largo plazo, sobre la homeostasis del calcio. En un estudio previo constatamos, en pacientes hemitiroidectomizados sometidos a un test de sobrecarga por administración oral de calcio, que se producia una supresión normal de la PTH. Sin embargo, la concentración de la 1.25 dihidroxi-vitamina D estaba disminuida y la concentración de fosfatos aumentada, hechos que implican una insuficiencia paratiroidea. Por estas razones, en 10 pacientes eutiroideos sometidos a hemitiroidectomia por enfermedad benigna del tiroides, investigamos la secreción y supresión de PTH en el preoperatorio y al anõ de la intervención. Se analizaron además, otras variables bioquimicas capaces de modificar la homeostasis del calcio. Al anõ de la intervención quirúrgica no se había alterado ni la secreción basal máxima ni total de la PTH. Sin embargo, la secreción máxima de PTH se alcanzó con niveles séricos bajos del calcio ionizado, existiendo una tendencia al incremento de la sensibilidad de las paratiroides al calcio iónico. Además, en relación con los valores preoperatorios se observó, a lo largo del seguimiento, de estos pacientes, una disminución del calcio sérico total, de la 1.25 dihidroxi-vitamina D y de la concentración libre de la T-4. Al anõ de la hemitiroidectomía tanto la concentración sérica del calcio total como de la 1.25 dihidroxi-vitamina D estaban disminuidas. Estas alteraciones no se debieron a una insuficiencia paratiroidea; por el contrario, nuestros resultados sugieren que se produce una mayor sensibilidad al calcio de las paratiroides y probablemente también una disminución de la susceptibilidad periférica a la PTH.

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Copyright information

© Springer International 2001

Authors and Affiliations

  • Pia Lindblom
    • 1
  • Johan Westerdahl
    • 1
  • Anders Bergenfelz
    • 1
  1. 1.Department of SurgeryLund University HospitalLundSweden

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