Abstract
Aim: Postoperative hypoparathyroidism (postop hypoPT) is usually seen after aggressive neck surgery, and can be fatal if left untreated. To the best our knowledge there is no study in literature that directly investigates the association between diabetes mellitus (DM) and postop hypoPT. In this study, we aimed to determine whether DM increases the risk of permanent postop hypoPT.
Materials and Methods: Patients presenting to endocrinology outpatient clinic with a diagnosis of permanent postoperative hypoparathyroidism, were studied retrospectively. Patients older than 18 years of age were included in the study if one year had passed after the neck operation.
Results: The average age of 131 patients who met the inclusion criteria was 49 ± 12. 93.9% of the patients were women and the patients were generally obese or overweight (mean body mass index= 30±5.29 kg/m2). While 14.5% of the patients were diabetic and 32.8% prediabetic (47.3% had impaired carbohydrate tolerance), 52.7% had normal glucose metabolism.
Conclusion: The rate of DM / prediabetes (preDM) in patients diagnosed with postop hypoPT and the prevalence of DM / preDM in Turkish population were similar. Even though DM is associated with endothelial dysfunction, our findings suggest that DM is not a risk factor for postop hypoPT.
References
- Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014; 101: 307-20.
- Stack BC Jr, Bimston DN, Bodenner DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Postoperative Hypoparathyroidism Definitions and Management. Endocr Pract 2015; 21: 674-85. doi: 10.4158/EP14462.DSC
- Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid 2018; 28: 830-41.
- Kim JA, Montagnani M, Koh KK, Quon MJ. Reciprocal relationships between insulin resistance and endothelial dysfunction: molecular and pathophysiological mechanisms. Circulation 2006; 113: 1888-904.
- Abdul-Ghani M, DeFronzo RA, Del Prato, Chilton R, Singh R, Ryder REJ. Cardiovascular disease and type 2 diabetes: has the dawn of a new era arrived? Diabetes Care 2017; 40: 813-20.
- Tabit CE, Chung WB, Hamburg NM, Vita JA. Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications. Rev Endocr Metab Disord 2010; 11: 61-74.
- Kolluru GK, Bir SC, Kevil CG. Endothelial dysfunction and diabetes: effects on angiogenesis, vascular remodeling, and wound healing. Int J Vasc Med 2012: 918267.
- American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44 (Suppl 1): S15-S33. doi: 10.2337/dc21-S002
- Satman I, Omer B, Tutuncu Y, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-80.
- Aytekin Oğuz, Özge Telci Çaklılı, Burcu Tümerdem Çalık, Pure Investigators. The Prospective Urban Rural Epidemiology (PURE) study: PURE Turkiye. Turk Kardiyol Dern Ars 2018; 46: 613-23.
- Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of Hypoparathyroidism: Etiologies and Clinical Features. J Clin Endocrinol Metab 2016; 101: 2300-12.
- Sitges-Serra A. Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy. J Clin Med 2021; 10: 543.
- Vokes T. Quality of life in hypoparathyroidism. Bone 2019; 120: 542-7.
- Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med 2008; 359: 391-403.
- Abate EG, Clarke BL. Review of Hypoparathyroidism. Front Endocrinol (Lausanne) 2017; 7: 172.
- Bilezikian JP, Khan A, Potts JT Jr, et al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res 2011; 26: 2317-37.
- De Sanctis V, Soliman A, Fiscina B. Hypoparathyroidism: from diagnosis to treatment. Curr Opin Endocrinol Diabetes Obes 2012; 19: 435-42.
- Iacobone M, Scerrino G, Palazzo FF. Parathyroid surgery: an evidence-based volume-outcomes analysis: European Society of Endocrine Surgeons (ESES) positional statement. Langenbecks Arch Surg 2019; 404: 919-27. https://doi.org/10.1007/s00423-019-01823-9
- Torselli-Valladares DE, Lorente-Poch L, González-Martín A, Sancho-Insenser JJ, Sitges-Serra A. Patterns of recurrent and persistent hyperparathyroidism according to whether initial parathyroidectomy was performed at high or low volume centers (abstract). Br J Surg 2020; 107: 16.
- Erbil Y, Bozbora A, Ozbey N, et al. Predictive value of age and serum parathormone and vitamin d3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch Surg 2007; 142: 1182-7.
- Hickey L, Gordon CM. Vitamin D deficiency: new perspectives on an old disease. Curr Opin Endocrinol Diabetes 2004; 11: 18-25.
- Whisner CM, Martin BR, Schoterman MH, et al. Galacto-oligosaccharides increase calcium absorption and gut bifidobacteria in young girls: a double-blind cross-over trial. Br J Nutr 2013; 110: 1292-303.
- Sippel RS, Ozgül O, Hartig GK, Mack EA, Chen H. Risks and consequences of incidental parathyroidectomy during thyroid resection. ANZ J Surg 2007; 77: 33-6.
- Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surgv 2002; 128: 389-92.
- Villarroya-Marquina I, Lorente-Poch L, Sancho J, Sitges-Serra A. Influence of gender and women's age on the prevalence of parathyroid failure after total thyroidectomy for multinodular goiter. Gland Surg 2020; 9: 245-51.
- Nawrot I, Woźniewicz B, Tołłoczko T, et al. Allotransplantation of cultured parathyroid progenitor cells without immunosuppression: clinical results. Transplantation 2007; 83: 734-40.
- Al-Dhahri SF, Mubasher M, Mufarji K, Allam OS, Terkawi AS. Factors predicting post-thyroidectomy hypoparathyroidism recovery. World J Surg 2014; 38: 2304-10.
Abstract
Amaç: Postoperatif hipoparatiroidizm (postop hipoPT) genellikle agresif boyun cerrahisinden sonra görülür ve tedavi edilmezse ölümcül olabilir. Bildiğimiz kadarıyla literatürde diabetes mellitus (DM) ile postop hipoPT arasındaki ilişkiyi doğrudan araştıran bir çalışma bulunmamaktadır. Bu çalışmada DM'nin kalıcı postop hipoPT riskini artırıp artırmadığını belirlemeyi amaçladık.
Gereç ve Yöntem: Endokrinoloji polikliniğine postoperatif kalıcı hipoparatiroidizm tanısı ile başvuran hastalar retrospektif olarak incelendi. Boyun ameliyatının üzerinden en az bir yıl geçmiş olan 18 yaş üstü hastalar çalışmaya dâhil edildi.
Bulgular: Dâhil edilme kriterlerine uyan 131 hastanın yaş ortalaması 49 ± 12 idi. Hastaların %93,9'u kadındı ve hastalar genel olarak obez veya fazla kiloluydu (ortalama vücut kitle indeksi= 30±5,29 kg/m2). Hastaların %14,5'i diyabetik ve %32,8'i prediyabetik (%47,3'ü bozulmuş karbonhidrat toleransına sahipti), %52,7'si normal glukoz metabolizmasına sahipti.
Sonuç: Postop hipoPT tanısı alan hastalarda DM / prediyabet (preDM) sıklığı ile Türk popülasyonunda DM / preDM prevalansı benzerdi. Diyabet, endotel disfonksiyonu ile ilişkili olmasına rağmen, çalışmamızdaki bulgular DM'nin postop hipoPT için bir risk faktörü olmadığını düşündürmektedir.
References
- Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014; 101: 307-20.
- Stack BC Jr, Bimston DN, Bodenner DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Postoperative Hypoparathyroidism Definitions and Management. Endocr Pract 2015; 21: 674-85. doi: 10.4158/EP14462.DSC
- Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid 2018; 28: 830-41.
- Kim JA, Montagnani M, Koh KK, Quon MJ. Reciprocal relationships between insulin resistance and endothelial dysfunction: molecular and pathophysiological mechanisms. Circulation 2006; 113: 1888-904.
- Abdul-Ghani M, DeFronzo RA, Del Prato, Chilton R, Singh R, Ryder REJ. Cardiovascular disease and type 2 diabetes: has the dawn of a new era arrived? Diabetes Care 2017; 40: 813-20.
- Tabit CE, Chung WB, Hamburg NM, Vita JA. Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications. Rev Endocr Metab Disord 2010; 11: 61-74.
- Kolluru GK, Bir SC, Kevil CG. Endothelial dysfunction and diabetes: effects on angiogenesis, vascular remodeling, and wound healing. Int J Vasc Med 2012: 918267.
- American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44 (Suppl 1): S15-S33. doi: 10.2337/dc21-S002
- Satman I, Omer B, Tutuncu Y, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-80.
- Aytekin Oğuz, Özge Telci Çaklılı, Burcu Tümerdem Çalık, Pure Investigators. The Prospective Urban Rural Epidemiology (PURE) study: PURE Turkiye. Turk Kardiyol Dern Ars 2018; 46: 613-23.
- Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of Hypoparathyroidism: Etiologies and Clinical Features. J Clin Endocrinol Metab 2016; 101: 2300-12.
- Sitges-Serra A. Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy. J Clin Med 2021; 10: 543.
- Vokes T. Quality of life in hypoparathyroidism. Bone 2019; 120: 542-7.
- Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med 2008; 359: 391-403.
- Abate EG, Clarke BL. Review of Hypoparathyroidism. Front Endocrinol (Lausanne) 2017; 7: 172.
- Bilezikian JP, Khan A, Potts JT Jr, et al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res 2011; 26: 2317-37.
- De Sanctis V, Soliman A, Fiscina B. Hypoparathyroidism: from diagnosis to treatment. Curr Opin Endocrinol Diabetes Obes 2012; 19: 435-42.
- Iacobone M, Scerrino G, Palazzo FF. Parathyroid surgery: an evidence-based volume-outcomes analysis: European Society of Endocrine Surgeons (ESES) positional statement. Langenbecks Arch Surg 2019; 404: 919-27. https://doi.org/10.1007/s00423-019-01823-9
- Torselli-Valladares DE, Lorente-Poch L, González-Martín A, Sancho-Insenser JJ, Sitges-Serra A. Patterns of recurrent and persistent hyperparathyroidism according to whether initial parathyroidectomy was performed at high or low volume centers (abstract). Br J Surg 2020; 107: 16.
- Erbil Y, Bozbora A, Ozbey N, et al. Predictive value of age and serum parathormone and vitamin d3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch Surg 2007; 142: 1182-7.
- Hickey L, Gordon CM. Vitamin D deficiency: new perspectives on an old disease. Curr Opin Endocrinol Diabetes 2004; 11: 18-25.
- Whisner CM, Martin BR, Schoterman MH, et al. Galacto-oligosaccharides increase calcium absorption and gut bifidobacteria in young girls: a double-blind cross-over trial. Br J Nutr 2013; 110: 1292-303.
- Sippel RS, Ozgül O, Hartig GK, Mack EA, Chen H. Risks and consequences of incidental parathyroidectomy during thyroid resection. ANZ J Surg 2007; 77: 33-6.
- Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surgv 2002; 128: 389-92.
- Villarroya-Marquina I, Lorente-Poch L, Sancho J, Sitges-Serra A. Influence of gender and women's age on the prevalence of parathyroid failure after total thyroidectomy for multinodular goiter. Gland Surg 2020; 9: 245-51.
- Nawrot I, Woźniewicz B, Tołłoczko T, et al. Allotransplantation of cultured parathyroid progenitor cells without immunosuppression: clinical results. Transplantation 2007; 83: 734-40.
- Al-Dhahri SF, Mubasher M, Mufarji K, Allam OS, Terkawi AS. Factors predicting post-thyroidectomy hypoparathyroidism recovery. World J Surg 2014; 38: 2304-10.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 13, 2022 |
| Submission Date | September 22, 2021 |
| Published in Issue | Year 2022Volume: 61 Issue: 2 |
