Postsurgical Hypoparathyroidism Treatment and Lower Quality of Life

The reduced quality of life often expressed by patients with chronic postsurgical hypoparathyroidism (hypoPT) may be caused in part by conventional treatment, according to a study in the Journal of Bone and Mineral Research Plus.

Researchers evaluated the effects of conventional treatment modalities on quality of life using a newly developed HPQ 28 questionnaire, which measures the typical symptoms and complaints expressed by people with hypoPT.

The cross-sectional study was conducted in 2 endocrinologic centers in Germany and prospectively enrolled 49 patients with hypoPT who needed treatment at least 6 months following thyroid surgery.

Patients’ laboratory values were determined immediately following blood sampling for total serum calcium, serum albumin, serum magnesium, serum phosphate, and 25-OH-vitamin D3; 24-hour urine collections were analyzed for calcium, creatinine, and phosphate with standard laboratory methods. Patients also completed the HPQ 28 questionnaire during their visit.

Participants were aged mean 57.3±10.5 years and had a mean disease duration of 12.6±9.8 years, 84% were female, and 84% underwent a total thyroidectomy. Most patients (86%, n = 42) received treatment with the active vitamin-D analogs calcitriol, alfacalcidol, or dihydrotachysterol (DHT).

No significant differences were observed among the different treatments with respect to serum or urinary parameters. Pearson correlation analysis between calcitriol or alfacalcidol intake and laboratory parameters showed no significant correlation with any parameters, and no statistically significant group differences were found between the active vitamin-D compounds administered in the hypoTH group.

Spearman rank analysis (r_s = 0.29; P = .049) revealed a significant positive correlation between magnesium intake and the gastrointestinal symptoms scale of the HPQ 28. The analysis for calcium intake also showed a significant correlation with the neurovegetative complaints scale (r_s=0.29; P = .044).

Calcitriol dose correlated positively and significantly with “pain and cramps,” “depression and anxiety,” “numbness and tingling,” and “heart palpitations” on the HPQ 28, with a rank correlation coefficient r_s of around 0.6. Linear regression analysis showed a significant influence for calcitriol on the “pain and cramps” scale (r_c² = 0.33; P = .017), “depression and anxiety scale” (r_c² = 0.25; P = .038), and the item “numbness and tingling” (r_c² = 0.51; P = .003) and “heart palpitations” (r_c² = 0.53; P = .002).

The correlation of the calcitriol dose with the “pain and cramps”  “depression and anxiety” scales, and the item “numbness and tingling” remained significant after correction for serum calcium. This effect was independent of sex, age, underlying disease, kind of surgery, serum 25-hydroxyvitamin D₃, or phosphate values. High calcitriol doses had no effect on any of the laboratory values.

The researchers acknowledged their findings were limited by the low numbers of participants who took each individual vitamin D compound. Patient numbers were also too small to correct for all influencing parameters at the same time, as the test could only be performed for one factor at a time.

“Our data would imply that in part the reduced quality of life in these patients might be caused by one or a combination of the conventional treatment modalities,” the researchers said. “For the clinician treating patients with hypoparathyroidism, our data would suggest carefully considering patients’ symptoms and complaints not only as caused by the disease itself but by the treatment,” the investigators said.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Stamm B, Blaschke M, Wilken L, et al. The influence of conventional treatment on symptoms and complaints in patients with chronic postsurgical hypoparathyroidism. JBMR Plus. Published online November 29, 2021. doi:10.1002/jbm4.10586