Risk factors for hypercalcemia induced by active vitamin D derivatives during supplementation for post-total...

Area of Science:

• Endocrinology
• Surgical Complications
• Metabolic Disorders

Background:

• Post-thyroidectomy hypoparathyroidism with hypocalcemia affects 20%-30% of patients.
• Management involves supplementation, sometimes with active vitamin D, risking iatrogenic hypercalcemia.
• Predictive factors for this complication are not well-defined.

Purpose of the Study:

• To identify predictive factors for iatrogenic hypercalcemia in patients with postoperative hypoparathyroidism.
• To compare clinical, biological, and therapeutic parameters between patients who developed and those who did not develop iatrogenic hypercalcemia.

Main Methods:

• Retrospective analysis of 198 patients undergoing total thyroidectomy with postoperative hypoparathyroidism.
• Division into groups based on development of iatrogenic hypercalcemia (n=28) versus uncomplicated course (n=170).
• Comparison of demographic, surgical, preoperative, and early postoperative clinical and biological data.

Main Results:

• Iatrogenic hypercalcemia occurred in 14% of patients, primarily within the first postoperative month, with 25% requiring hospitalization.
• Patients with hypercalcemia showed significantly lower early postoperative parathyroid hormone (PTH) levels (postoperative day 1 and 2).
• Earlier initiation of active vitamin D supplementation was observed in the hypercalcemia group (1.14 days vs 1.60 days).

Conclusions:

• Iatrogenic hypercalcemia complicates approximately 1 in 7 cases of postoperative hypoparathyroidism, potentially requiring rehospitalization.
• Low early postoperative PTH levels and earlier active vitamin D initiation are associated with iatrogenic hypercalcemia.
• Close monitoring of calcium-phosphate profiles and cautious adjustment of supplementation are crucial in the early weeks post-surgery.