Hypoparathyroidism with situs inversus totalis: A case report.

BACKGROUND: Hypoparathyroidism (HP) is a rare endocrine disorder, while situs inversus totalis (SIT) is a rare condition in which the internal organs are positioned in a mirrored pattern compared to their usual positions. This case illustrates some potential shared mechanisms between HP and SIT, highlighting the importance of accurate identification and prompt first emergency, offering insights for future research. CASE SUMMARY: This report discusses a case of a middle-aged patient with adolescent-onset HP with concurrent SIT. The patient experienced recurrent episodes of increased neuromuscular excitability (manifesting as spasms in the hands and feet and laryngospasms) and even periods of unconsciousness. Initially, these symptoms led to a misdiagnosis of epilepsy. Nevertheless, upon thorough examination and treatment in the general medicine ward, the correct diagnosis was established. Corresponding treatment resulted in improved management of the patient's symptoms. CONCLUSION: Co-occurrence of HP and SIT may be associated with genetic mutations, chromosomal anomalies, or hereditary factors, as may other similar conditions.

Phenotype of patients with late diagnosis of 22q11 deletion: a review and retrospective study.

BACKGROUND: Chromosome 22q11.2 deletion syndrome (22q11DS) is the most common microdeletion syndrome, typically presenting in neonates with congenital cardiac anomalies, hypocalcaemia and thymic hypoplasia. Some patients are diagnosed later in adolescence and adulthood, with less known about the clinical phenotype of these patients. AIM: To summarise key clinical features in cases of 22q11DS diagnosed during adolescence and adulthood. METHODS: This is a retrospective cohort study of 22q11DS patients diagnosed after 13 years of age over 2010-2021, with a literature review of published cases highlighting other late diagnoses. The study was performed in a large multicentre tertiary health network in Melbourne, Australia. Patients diagnosed with 22q11DS after the age of 13 years were included in the study. Main outcome measures were key clinical features in cases of late diagnosis of 22q11DS. RESULTS: A literature search yielded 53 published case reports and one cohort study for review (62 subjects). Additionally, 10 cases of late diagnosis of 22q11DS were identified through a retrospective electronic medical chart review. Findings suggest that intellectual disability and learning difficulties, hypocalcaemia with hypoparathyroidism and facial dysmorphism remain key features in patients with a late diagnosis of 22q11DS, with hypocalcaemia being the most common presentation leading to diagnosis. Patients diagnosed in adulthood may lack classical clinical features of congenital cardiac anomalies and thymic hypoplasia. Immunological consequences of 22q11DS are also an important late-onset consideration. Atypical features may include basal ganglia calcification. CONCLUSIONS: Chromosome 22q11DS has diverse clinical features and a highly variable phenotype, likely contributing to underdiagnosis and later diagnoses.

Predictors of lumbar spine trabecular bone score in women with postsurgical hypoparathyroidism.

Hypoparathyroidism is a rare disease that markedly reduces bone remodeling, leading to increased bone mineral density and changes in bone microarchitecture. However, it is currently unclear how these changes affect fracture risk. In this study, we investigated bone mass by dual-energy x-ray absorptiometry, the occurrence of morphometric vertebral fractures, and bone microarchitecture by assessing trabecular bone score in women with postsurgical hypoparathyroidism. We included 67 women with hypoparathyroidism aged 52.9 ± 12.3 years and 63 age- and body mass index-matched controls, which were assessed for femoral and lumbar spine bone mineral density, trabecular bone score, and vertebral fractures by dual-energy x-ray absorptiometry. Women with hypoparathyroidism had significantly higher bone mineral density at the lumbar spine, femoral neck, and total hip compared with controls despite similar trabecular bone score values. Vertebral fracture assessment indicated that two women with hypoparathyroidism presented vertebral fractures, both aged over 65 years. Conversely, no vertebral fractures were detected in control women. In a multivariate linear regression model, we found that older age, diabetes, and lower lumbar spine mineral density were significant predictors of lower trabecular bone score values. Our findings indicate that vertebral fractures are not common among women with postsurgical hypoparathyroidism aged under 65 years. Moreover, trabecular bone score values were similar in women with hypoparathyroidism and age-matched controls and were associated with traditional risk factors for fractures, such as older age, type 2 diabetes, and lower spine bone mineral density. LAY SUMMARY: Chronic parathyroid hormone deficiency decreases bone turnover and modifies skeletal properties, although the impact of these changes on fracture risk remains unclear. We studied 67 women with postsurgical hypoparathyroidism and 63 age and body mass index-matched healthy controls and found that bone mineral density is increased in women with hypoparathyroidism despite similar trabecular bone score values and a low occurrence of morphometric vertebral fractures. This suggests that the low bone turnover in hypoparathyroidism increases bone mass, but this is not accompanied by improved bone microarchitecture, indicating that trabecular bone score may be a valuable tool to complement the assessment of skeletal health and the risk of fractures in this condition.

Prevalence of chronic postsurgical hypoparathyroidism not adequately controlled: an analysis of a nationwide cohort of 337 patients.

Purpose: The identification of patients with chronic hypoparathyroidism who are adequately (AC) or not adequately controlled (NAC) has clinical interest, since poor disease control is related to complications and mortality. We aimed to assess the prevalence of NAC patients in a cohort of subjects with postsurgical hypoparathyroidism. Methods: We performed a multicenter, retrospective, cohort study including patients from 16 Spanish hospitals with chronic hypoparathyroidism lasting ≥3 years. We analyzed disease control including biochemical profile and clinical wellness. For biochemical assessment we considered three criteria: criterion 1, normal serum calcium, phosphorus and calcium x phosphorus product; criterion 2, the above plus estimated glomerular filtration rate ≥60 ml/min/1.73 m2; and criterion 3, the above plus normal 24-hour urinary calcium excretion. A patient was considered AC if he or she met the biochemical criteria and was clinically well. Results: We included 337 patients with postsurgical hypoparathyroidism (84.3% women, median age 45[36-56] years, median time of follow-up 8.9[6.0-13.0] years). The proportions of NAC patients with criteria 1, 2 and 3 were, respectively, 45.9%, 49.2% and 63.1%. Patients who had dyslipidemia at the time of diagnosis presented a significantly higher risk of NAC disease (criterion 3; OR 7.05[1.44-34.45]; P=0.016). NAC patients (criterion 2) had a higher proportion of subjects with incident chronic kidney disease and eye disorders, and NAC patients (criterion 3) had a higher proportion of incident chronic kidney disease, nephrolithiasis and dyslipidemia than AC patients. Conclusion: The present study shows a strikingly high prevalence of NAC patients in the clinical practice of Spanish endocrinologists. Results suggest that NAC disease might be associated with some prevalent and incident comorbidities.

Hypoparathyroidism: an update on new therapeutic approaches.

BACKGROUND: Hypoparathyroidism is a rare endocrine disease characterized by insufficient parathyroid hormone (PTH) secretion by the parathyroid glands, leading to hypocalcemia. In contrast to most hormone deficiencies for which hormone replacement is currently the mainstay of therapy, hypoparathyroidism has conventionally been treated with calcium supplements and active analogs of vitamin D. Although the advent of a replacement therapy with 1-34 and 1-84 PTH represented a major step in the therapeutic history of hypoparathyroidism, several new molecules and different management strategies have recently been developed. PURPOSE: This review investigates the therapeutic approaches currently under investigation for the treatment of hypoparathyroidism. Clinical trials results have been considered and discussed.

Whitaker syndrome: A case report of autoimmune polyendocrine syndrome type 1 with dilated cardiomyopathy.

Key Clinical Message: This case report highlights dilated cardiomyopathy as a cardiovascular complication in autoimmune polyendocrine syndrome type 1 (APS-1), emphasizing the need for early recognition and a multidisciplinary approach. Comprehensive care and regular follow-up are crucial in managing these atypical presentations to optimize patient outcomes. Abstract: APS-1, also known as Whitaker syndrome, is characterized by a triad of mucocutaneous candidiasis, adrenal insufficiency, and hypoparathyroidism. This rare autosomal recessive disorder results from mutations in the autoimmune regulator (AIRE) gene. Cardiovascular and pulmonary manifestations in APS-1 are infrequently reported in the literature. We present a case of a 28-year-old male who presented with shortness of breath and pedal edema. Physical examination revealed alopecia, absence of eyebrows, hyperpigmentation on joints, oral candidiasis, and nail dystrophy. Echocardiography demonstrated dilated cardiomyopathy (DCM) and pericardial effusion. Chest x-ray showed left-sided pleural effusion. Laboratory investigations revealed hypocalcemia, hyperphosphatemia, low parathyroid hormone (PTH), low cortisol, and high adrenocorticotropic hormone (ACTH) levels. The combination of chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency confirmed the diagnosis of APS-1. To the best of our knowledge, this is the first Pakistani and second worldwide reported case of APS-1 presenting with such a combination of manifestations. Early recognition and multidisciplinary management are crucial for improving outcomes in these patients.

Case report: Familial hypoparathyroidism with elevated parathyroid hormone due to an inactivating PTH mutation.

Introduction: So far, only 11 PTH mutations have been described as causes of familial isolated hypoparathyroidism (FIH). In this report, we describe a family with FIH but with significant elevation of functionally inactive PTH due to a PTH mutation. We also show a positive therapeutic outcome of recombinant human PTH (teriparatide) therapy in one of the siblings who was not well controlled on large doses of calcitriol and calcium replacement therapy. Case description: The proband is a 34-year-old woman who has a history of chronic severe hypocalcemia (HypoCa) since birth. She and her three brothers (33-year-old male twins, and a 21-year-old male) were diagnosed with pseudohypoparathyroidism type 1b (PHPT 1b) based on the presence of chronic HypoCa (serum Ca 1.6-1.85 mmol/l) since birth associated with significantly elevated plasma PTH levels in the range of 310-564 pg/dl (normal range 10-65) and absence of signs of Albright hereditary osteodystrophy. Molecular studies: WES showed no pathogenic, likely pathogenic or variants of unknown significance in any known calcium-associated genetic disorder but a bi-allelic variant in the PTH itself ((NM_000315.4:c.128G>A, p.Gly43Glu). This was confirmed by Sanger sequencing in the patient and her affected brothers. Management: Because the patient's HypoCa was not controlled on large doses of calcitriol and calcium carbonate, a trial of teriparatide 20 mcg SC daily was started and resulted in normalization of calcium, decline in PTH levels and significant improvement in her general wellbeing. Conclusion: High PTH in the presence of congenital hypocalcemia is not always due to receptor or post-receptor defect and can be due to a biologically inactive mutated PTH. In such cases, treatment with teriparatide may result in stabilization of biochemical profile and improvement in quality of life.

Efficacy and Safety of TransCon PTH in Adults with Hypoparathyroidism: 52-Week Results From the Phase 3 PaTHway Trial.

CONTEXT: Conventional therapy for hypoparathyroidism aims to alleviate symptoms of hypocalcemia but does not address insufficient parathyroid hormone (PTH) levels. OBJECTIVE: Assess the long-term efficacy and safety of TransCon PTH (palopegteriparatide) for hypoparathyroidism. DESIGN: Phase 3 trial with a 26-week double-blind, placebo-controlled period followed by a 156-week open-label extension (OLE). SETTING: 21 sites across North America and Europe. PARTICIPANTS: 82 adults with hypoparathyroidism were randomized and received study drug and 78 completed week 52. INTERVENTION(S): All OLE participants received TransCon PTH administered once daily. MAIN OUTCOME MEASURE(S): Multi-component efficacy endpoint: proportion of participants at week 52 who achieved normal serum calcium (8.3-10.6 mg/dL) and independence from conventional therapy (≤600 mg/day of elemental calcium and no active vitamin D). Other efficacy endpoints included patient-reported outcomes (PROs) and bone mineral density (BMD). Safety was assessed by 24-hour urine calcium and treatment-emergent adverse events (TEAEs). RESULTS: At week 52, 81% (63/78) met the multi-component efficacy endpoint, 95% (74/78) achieved independence from conventional therapy, and none required active vitamin D. PROs showed sustained improvements in quality of life, physical functioning, and well-being. Mean BMD Z-scores decreased toward age- and sex-matched norms from baseline to week 52. Mean (SD) 24-hour urine calcium excretion decreased from 376 (168) mg/day at baseline to 195 (114) mg/day at week 52. Most TEAEs were mild or moderate and none led to trial discontinuation during the OLE. CONCLUSIONS: At week 52 of the PaTHway trial, TransCon PTH showed sustained efficacy, safety, and tolerability in adults with hypoparathyroidism.

Refractory Hypocalcemia Following Total Thyroidectomy in an Adult Patient With Bariatric Surgery.

Obesity poses a global health challenge with significant individual and societal impacts. Bariatric surgery, including Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion/duodenal switch (BPD/DS), is effective for long-term weight management but can lead to serious nutritional deficiencies, particularly hypocalcemia. This report presents the rare case of a 35-year-old woman with severe, recurrent hypocalcemia following BPD/DS surgery, complicated by iatrogenic hypoparathyroidism from prior thyroidectomy. Despite aggressive oral and intravenous calcium and vitamin D supplementation, the patient's hypocalcemia remained refractory, necessitating multiple hospitalizations. Laboratory studies confirmed severe hypocalcemia, low parathyroid hormone (PTH), and deficiencies in fat-soluble vitamins, complicating her clinical management. As conventional treatments failed, the patient underwent surgical revision from BPD/DS to RYGB anatomy, aimed at improving calcium absorption by restoring functional small bowel length. Postoperatively, her serum calcium levels normalized, and she was successfully discharged on oral calcium supplementation, with stable calcium levels at follow-up. This case underscores the challenges of managing hypocalcemia in patients with BPD/DS anatomy and hypoparathyroidism. The greater malabsorption associated with BPD/DS can severely impair calcium absorption, leading to refractory hypocalcemia. This report is the first documented case where surgical conversion from BPD/DS to RYGB effectively treated this condition. The findings underscore the critical need for preoperative risk assessment for, and careful postoperative management of, hypoparathyroidism in bariatric surgery patients with complex medical histories. This case report outlines a potential treatment pathway for managing refractory hypocalcemia, emphasizing the importance of preserving calcium-absorbing bowel function in patients with BPD/DS anatomy. It provides valuable insights into treating severe hypocalcemia and demonstrates a successful surgical intervention that could inform the management of similar cases.

Primary Ηypoparathyroidism in a Patient With Sarcoidosis: A Case Report.

Sarcoidosis is a complex, multisystem granulomatous disorder with a variable clinical presentation, commonly involving the lungs but potentially affecting any organ system. This case report describes a rare occurrence of primary hypoparathyroidism coexisting with sarcoidosis in a 45-year-old male patient. The patient presented with a chronic cough and progressive breathlessness. Diagnostic imaging and histopathological evaluation confirmed stage 1 sarcoidosis, characterized by non-caseating granulomas and elevated angiotensin-converting enzyme (ACE) levels. Surprisingly, the patient also exhibited significant hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels, which led to the diagnosis of primary hypoparathyroidism, an unusual finding in the context of sarcoidosis. The patient was treated with corticosteroids for sarcoidosis and calcium supplementation for hypocalcemia, resulting in symptom resolution and normalization of biochemical parameters. This case highlights the importance of considering multiple endocrine disorders, such as hypoparathyroidism, in patients with sarcoidosis, especially when calcium dysregulation is observed. The coexistence of these conditions presents unique diagnostic and therapeutic challenges, necessitating a multidisciplinary approach to patient care.

Three Siblings With Familial Isolated Hypoparathyroidism: A Diagnostic Journey From CASR to Novel GCM2 Variant.

We report a patient who initially presented at 4 days old with hypocalcemia, hypoparathyroidism, and elevated phosphorous level. Treatment was initiated with calcitriol, calcium carbonate (CaCO3), vitamin D, and low phosphorous formula. Family history was positive for an activating calcium sensing receptor (CASR) variant (R990G) identified previously in 2 older siblings who were treated with CaCO3 and calcitriol. However, genetic studies were negative for the CASR variant in our patient. She maintained a large calcium requirement and was admitted for multiple episodes of hypocalcemia. Further investigation revealed that the CASR variant identified in the older siblings was now considered a benign, nondisease-causing variant. Whole exome sequencing on our proband revealed a homozygous pathogenic variant in the GCM2 gene (Gln392*) consistent with a molecular diagnosis of familial isolated hypoparathyroidism. Genetic studies revealed the 2 older siblings harbor the same genetic changes and parents are heterozygous carriers for this allele. Due to persistent hypocalcemia, we initiated teriparatide. She weaned off calcitriol and achieved normocalcemia on teriparatide, CaCO3, and vitamin D. Siblings transitioned to the same treatment without complications. These findings demonstrate the importance of adequate diagnostic genetic testing and the role of variant reanalysis over time in promoting accurate diagnoses.

Incidence of transient and chronic hypoparathyroidism after total thyroidectomy - the experience of a tertiary center.

BACKGROUND: The most common cause of hypoparathyroidism (hypoPT) in adults is iatrogenic due to total thyroidectomy, while the ideal moment for considering it chronic is still under debate. Our study aims at reporting the prevalence of transient and permanent hypoPT following thyroid surgery in a tertiary surgical center, as well as serum Parathormone (PTH) variation up to 12 months after surgery stratified according to the type of thyroid disease. MATERIAL AND METHODS: 519 patients who underwent total thyroidectomy in a tertiary surgical center from 2018 to 2023 were analyzed. Postoperative hypoPT was defined as low PTH (less than 15 pg/ml) and/or hypocalcemia (albumin-corrected levels less than 8.5 mg/dl) on day 1 after surgery. Patients were considered to have permanent hypoPT if they had not recovered completely within 1 year after total thyroidectomy. PTH levels were compared according to the underlying thyroid disease. RESULTS: 140 patients (26.97%) had postoperative hypoPT. Twenty-two patients (4.23%) were considered to have permanent hypoPT 12 months after surgery. Approximately half of the patients recovered between 3 months and 12 months after surgery. HypoPT thyroiditis patients had higher PTH levels 3 months after surgery compared to papillary/follicular cancer and multinodular goiter, respectively, and all recovered 1 year after surgery. Papillary/follicular carcinoma was associated with a 29.4% rate of transient and 8.5% rate of chronic hypoPT, respectively. CONCLUSION: Most patients without incidental parathyroidectomy that still develop postoperative hypoPT will eventually recover; nevertheless, it can take up to 1 year for full resolution. Measuring serum PTH 3 months postoperative may be of interest.

Hypocalcemic cardiomyopathy with heart failure: A rare Case report.

Hypocalcemia is one of the rarest causes of reversible cardiomyopathy. Patients with refractory heart failure need to be explored for hypocalcemia and need prompt correction. Abstract: Hypocalcemia is a rare cause of reversible dilated cardiomyopathy. Correction of calcium is crucial to recover left ventricular function and structure. We presented the case of a 55-year-old female who was admitted to the hospital with refractory heart failure due to hypocalcemia induced by primary hypoparathyroidism and complicated by vitamin D deficiency. The patient's cardiac symptoms improved dramatically upon correction of hypocalcemia, and vitamin D. Therefore, the key clinical message of this case report is, that hypocalcemia, although rare, should be considered as one of the differential diagnoses when heart failure is refractory and early diagnosis and treatment is necessary as it is the cause of reversible cardiomyopathy and could reduce morbidity and mortality.

Severe Prolonged Hypocalcemia Following Four-Gland Parathyroidectomy in a Patient With Established Renal Failure.

Hypocalcemia after parathyroidectomy is a common complication. It is typically transient in patients with mild parathyroid-related bone disease. Distinguishing between hungry bone syndrome (HBS) and hypoparathyroidism following parathyroidectomy in established renal failure (ERF) patients presents a significant diagnostic challenge. This case study describes a 44-year-old male with severe hypocalcemia following a four-gland parathyroidectomy, highlighting the diagnostic considerations and management strategies.

Risk Factors for Transient and Permanent Hypoparathyroidism Following Thyroidectomy: A Comprehensive Review.

Hypoparathyroidism is a common complication following thyroidectomy, resulting in significant disturbances in calcium homeostasis due to low parathyroid hormone (PTH) levels. This comprehensive review examines the risk factors associated with transient and permanent hypoparathyroidism post-thyroidectomy, emphasizing surgical, patient-related, and perioperative factors. Transient hypoparathyroidism, characterized by temporary hypocalcemia resolving within weeks to months, is often managed with short-term calcium and vitamin D supplementation. In contrast, permanent hypoparathyroidism persists beyond six months post-surgery, necessitating lifelong supplementation and potentially PTH replacement therapy. The review delves into the anatomy and physiology of the parathyroid glands, mechanisms leading to hypoparathyroidism, and incidence rates. Surgical factors such as the extent of thyroidectomy, surgeon expertise, and intraoperative parathyroid gland preservation are critical in determining the risk of hypoparathyroidism. Patient factors, including age, sex, pre-existing conditions, and perioperative management, influence outcomes. Diagnostic and monitoring strategies, along with management protocols for both transient and permanent hypoparathyroidism, are discussed. Prevention strategies, emerging research, future surgical techniques, and intraoperative monitoring directions are highlighted to improve clinical outcomes. This review aims to enhance understanding, inform surgical practices, and optimize postoperative care to minimize the incidence and impact of hypoparathyroidism in thyroidectomy patients.

Hypophysitis and central nervous system involvement in association with Sjögren's syndrome along with hypoparathyroidism: a case report.

BACKGROUND: Patients with autoimmune diseases can develop multiple autoimmune diseases over a long period of time, and the presence of more than one autoimmune disease in a single patient is defined as polyautoimmunity. Polyautoimmunity may be clinical evidence that autoimmune diseases share similar immunological mechanisms. CASE PRESENTATION: We report a 30-year-old woman with a unique combination of autoimmune diseases predominantly affecting the central nervous system, with hypoparathyroidism, hypophysitis, medulla involvement, and pons and temporal lobe involvement associated with primary Sjögren's syndrome (pSS), occurring independently over a long period. The patient who had a history of muscle cramps and one seizure incident, presented with vomiting and blurred vision. She was diagnosed with hypophysitis and hypoparathyroidism with calcifications in the basal ganglia and cerebellum. She recovered after four months of corticosteroid treatment for hypophysitis and was started on treatment for hypoparathyroidism. Eight months later, she developed vomiting, hiccups, vertigo, and ataxia with a focal lesion in the medulla. She recovered with immunosuppressive treatment for 2 years. Fifty-eight months after the onset of hypophysitis, she developed diplopia and dry mouth and eyes. MRI showed infiltrative lesions in the left pons and left temporal lobe. Based on positive anti-Sjögren's syndrome-related antigen A antibodies and low unstimulated whole salivary flow rate, pSS was diagnosed. She received corticosteroids and continued mycophenolate mofetil treatment with recovery of neurological symptoms. CONCLUSION: This case highlights the need for long-term follow-up to detect autoimmune disease processes involving various organs.

Guideline From the Brazilian Society of Surgical Oncology and Brazilian College of Surgeons in Preventing and Managing Acute Hypoparathyroidism After Thyroid Surgery.

The risk of hypoparathyroidism and hypocalcemia is a critical concern in thyroid surgery. Preserving parathyroid gland vascularization during surgery is essential for effective prevention. Preoperative and postoperative management, including calcium and Vitamin D supplementation, is paramount. Measurement of parathyroid hormone levels after surgery is the best predictor of hypoparathyroidism. This guideline offers recommendations for the prevention, diagnosis, and treatment of acute hypoparathyroidism and hypocalcemia after thyroid surgery.

Induced Pluripotent Stem Cell-Derived Parathyroid Organoids Resemble Parathyroid Morphology and Function.

The primary role of the parathyroid glands is to maintain calcium homeostasis through the secretion of parathyroid hormone (PTH). The limited proliferative capacity and differentiation of parathyroid cells hinder the generation of cell therapy options. In this study, parathyroid organoids are successfully generated from human-induced pluripotent stem cells (hiPSCs). At the end of the 20 days of differentiation, the parathyroid organoids exhibited distinct parathyroid morphology. Stereomicroscope, scanning electron microscopy (SEM), and transmission electron microscopy (TEM) analysis demonstrated the 3D arrangement of the cell layers in which intracellular structures of parathyroid cells resemble human parathyroid cellular morphology. Comprehensive molecular analyses, including RNA sequencing (RNA-Seq) and liquid chromatography/mass spectrometry (LC-MS/MS), confirmed the expression of key parathyroid-related markers. Protein expression of CasR, CxCr4, Gcm2, and PTH are observed in parathyroid organoids. Parathyroid organoids secrete PTH, demonstrate active intercellular calcium signaling, and induce osteogenic differentiation via their secretome. The tissue integration potential of parathyroid organoids is determined by transplantation into parathyroidectomized rats. The organoid transplanted animals showed significant elevations in PTH-related markers (CasR, CxCr4, Foxn1, Gcm2, and PTH). PTH secretion is detected in organoid-transplanted animals. The findings represent a significant advancement in parathyroid organoid culture and may offer a cellular therapy for treating PTH-related diseases, including hypoparathyroidism.

Hypoparathyroidism after total thyroidectomy: reactive to symptoms supplementation.

INTRODUCTION: After total thyroidectomy (TT), postoperative hypoparathyroidism (PH) is the most frequent complication. Yet, management strategies for PH remain disputed. The aim of this study was to evaluate outcomes of a reactive supplementation in case of symptomatic PH. Additionally, risk factors for symptomatic PH and readmission due to PH were analyzed. MATERIALS AND METHODS: All consecutive patients who underwent TT or completion from 2017 to 2022 were considered for inclusion. During this period, a reactive to symptom vitamin-calcium supplementation was used. The primary outcome was the occurrence of severe PH after discharge resulting in readmission. RESULTS: Overall, 307 patients were included, of which 98 patients (31.9%) developed symptomatic PH including 43 patients before discharge. Independent risk factors for developing symptomatic PH were age (p = 0.010) and postoperative day 1 (POD1) PTH level (p < 0.001). Overall, 264 patients (86%) did not present PH before discharge and were discharged home. Among them, 55 patients (20.8%) experienced symptomatic PH, requiring readmission in 18 patients. The overall readmission rate owing to symptomatic PH requiring intravenous supplementation despite oral vitamin-calcium supplementation was 6.8% (n = 18). Independent risk factors for symptomatic PH-related readmission were age (p = 0.007) and POD1 PTH level (p < 0.001). Adequate cut-off values for predicting readmission were POD1 albumin-adjusted calcium = 2.1 mmol/l (Sensibility = 0.95, Specificity = 0.30) and POD1 PTH = 11.5 pg/ml (Sensibility = 0.90, Specificity = 0.71). CONCLUSION: Supplementing only symptomatic patients was safe and efficient. This attitude does not alter on morbidity, mortality or readmission rate which is in line with current literature.