Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

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ABSTRACT

Objective

To present an update on the diagnosis and treatment of hypoparathyroidism based on the most recent scientific evidence.

Materials and methods

The Department of Bone and Mineral Metabolism of the Sociedade Brasileira de Endocrinologia e Metabologia (SBEM; Brazilian Society of Endocrinology and Metabolism) was invited to prepare a document following the rules set by the Guidelines Program of the Associação Médica Brasileira (AMB; Brazilian Medical Association). Relevant papers were retrieved from the databases MEDLINE/PubMed, LILACS, and SciELO, and the evidence derived from each article was classified into recommendation levels according to scientific strength and study type.

Conclusion

An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil.

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Most cited references 176

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Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

Michael Holick, Neil C Binkley, Heike Bischoff-Ferrari … (2011)

The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes. Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.

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Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO).

S. Moe, T Drüeke, J. Cunningham … (2006)

Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are an important cause of morbidity, decreased quality of life, and extraskeletal calcification that have been associated with increased cardiovascular mortality. These disturbances have traditionally been termed renal osteodystrophy and classified based on bone biopsy. Kidney Disease: Improving Global Outcomes (KDIGO) sponsored a Controversies Conference on Renal Osteodystrophy to (1) develop a clear, clinically relevant, and internationally acceptable definition and classification system, (2) develop a consensus for bone biopsy evaluation and classification, and (3) evaluate laboratory and imaging markers for the clinical assessment of patients with CKD. It is recommended that (1) the term renal osteodystrophy be used exclusively to define alterations in bone morphology associated with CKD, which can be further assessed by histomorphometry, and the results reported based on a unified classification system that includes parameters of turnover, mineralization, and volume, and (2) the term CKD-Mineral and Bone Disorder (CKD-MBD) be used to describe a broader clinical syndrome that develops as a systemic disorder of mineral and bone metabolism due to CKD, which is manifested by abnormalities in bone and mineral metabolism and/or extra-skeletal calcification. The international adoption of these recommendations will greatly enhance communication, facilitate clinical decision-making, and promote the evolution of evidence-based clinical practice guidelines worldwide.

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Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years.

Lodovico Rosato, Nicola Avenia, Paolo Bernante … (2004)

Complication rates associated with thyroid surgery can be evaluated only through analysis of case studies and follow-up data. This study covers postoperative data from 14,934 patients subjected to a follow-up of 5 years. Among them, 3130 (20.9%) underwent total lobectomy (TL), 9599 (64.3%) total thyroidectomy (TT), 1448 (9.7%) subtotal thyroidectomy with a monolateral remnant (MRST), and 757 (5.1%) subtotal thyroidectomy with bilateral remnants (BRST). A total of 6% of the patients had already been operated on. Persistent hypoparathyroidism occurred after 1.7% of all the operations, and temporary hypoparathyroidism was noted in 8.3%. Permanent palsy of the laryngeal recurrent nerve (LRN) occurred in 1.0% of patients, transient palsy in 2.0%, and diplegia in 0.4%. The superior laryngeal nerve was damaged in 3.7%; dysphagia occurred in 1.4% of cases, hemorrhage in 1.2%, and wound infection in 0.3%. No deaths were reported. A significant rate of LRN damage was noted, which has an important impact on the patient's social life. Hypoparathyroidism after total thyroidectomy is an important complication that can be successfully treated by therapy, although it is not always easily managed in special circumstances such as in young persons or pregnant women. The complications associated with thyroid surgery must be kept in mind so the surgeon can carefully evaluate the surgical and medical therapeutic options, have more precise surgical indications, and be able to give the patient adequate information.

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Author and article information

Journal

Journal ID (nlm-ta): Arch Endocrinol Metab

Journal ID (iso-abbrev): Arch Endocrinol Metab

Journal ID (publisher-id): aem

Title: Archives of Endocrinology and Metabolism

Publisher: Sociedade Brasileira de Endocrinologia e Metabologia

ISSN (Print): 2359-3997

ISSN (Electronic): 2359-4292

Publication date (Electronic): 01 January 2018

Publication date Collection: Jan-Feb 2018

Volume: 62

Issue: 1

Pages: 106-124

Affiliations

[1 ] normalizedUniversidade Federal de São Paulo orgnameUniversidade Federal de São Paulo orgdiv1Disciplina de Endocrinologia orgdiv2Departamento de Medicina São Paulo SP Brasil originalDepartamento de Medicina, Disciplina de Endocrinologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil

[2 ] normalizedUniversidade Federal do Paraná orgnameUniversidade Federal do Paraná orgdiv1Hospital de Clínicas Curitiba PR Brasil originalServiço de Endocrinologia e Metabologia, Hospital de Clínicas da Universidade Federal do Paraná (SEMPR, UFPR), Curitiba, PR, Brasil

[3 ] normalizedUniversidade de Pernambuco orgnameUniversidade de Pernambuco orgdiv1Faculdade de Medicina orgdiv2Disciplina de Endocrinologia, Hospital Agamenon Magalhães Recife PE Brasil originalDisciplina de Endocrinologia, Hospital Agamenon Magalhães, Faculdade de Medicina, Universidade de Pernambuco (UPE), Recife, PE, Brasil

[4 ] normalizedUniversidade Federal do Rio de Janeiro orgnameUniversidade Federal do Rio de Janeiro orgdiv1Disciplina de Endocrinologia orgdiv2Departamento de Clínica Médica Rio de Janeiro RJ Brasil originalDepartamento de Clínica Médica, Disciplina de Endocrinologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil

[5 ] normalizedUniversidade Católica de Brasília orgnameUniversidade Católica de Brasília orgdiv1Disciplina de Endocrinologia Brasília DF Brasil originalDisciplina de Endocrinologia, Universidade Católica de Brasília (UCB), Brasília, DF, Brasil

[6 ] normalizedUniversidade de São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto orgdiv2Departamento de Medicina Interna Ribeirão Preto SP Brasil originalDepartamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, USP, Ribeirão Preto, SP, Brasil

[7 ] normalizedUniversidade de São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina orgdiv2Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço São Paulo SP Brasil originalDepartamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil

[8 ] normalizedUniversidade Federal de São Paulo orgnameUniversidade Federal de São Paulo orgdiv1Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço São Paulo SP Brasil originalDepartamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil

[9 ] normalizedUniversidade de São Paulo orgnameUniversidade de São Paulo orgdiv1Hospital das Clínicas da Faculdade orgdiv2Divisão de Endocrinologia e Laboratório de Endocrinologia Celular e Molecular São Paulo SP Brasil originalDivisão de Endocrinologia e Laboratório de Endocrinologia Celular e Molecular (LIM-25), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil

Author notes

Correspondence to: Sergio Setsuo Maeda Rua Ministro Gastão Mesquita, 250, ap. 307 05012-010 – São Paulo, SP, Brasil ssetsuo@ 123456terra.com.br

Article

Publisher ID: 2359-3997000000015

DOI: 10.20945/2359-3997000000015

PMC ID: 10118685

PubMed ID: 29694629

SO-VID: a81bce15-b31f-4991-acb5-83069693cf82

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 13 June 2017

Date accepted : 14 November 2017

Page count

Figures: 0, Tables: 3, Equations: 0, References: 155, Pages: 19

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Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

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ABSTRACT

Objective

Materials and methods

Conclusion

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SciELO Brazil

Most cited references 176

Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO).

Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years.

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Cited by 7

Most referenced authors 1,675