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Khirurgii

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Year 2010 Vol. 18 No 6

GENERAL AND SPECIAL SURGERY

KHRYSHCHANOVICH V.YA., TRETYAK S.I., MOKHORT T.V., BOGOMAZOVA E.V.

WELL–BEING AND CALCIUM-PHOSPHORUS HOMEOSTASIS IN PATIENTS WITH HYPOPARATHYROIDISM RECEIVING STANDARD TREATMENT WITH CALCIUM AND VITAMIN D

Objectives. To study calcium homeostasis and well-being of the patients with hypoparathyroidism by comparison of the obtained results with those in the patients who underwent thyroid surgery but with saved parathyroid function.
Methods. Cross-sectional controlled study in 69 patients with the postsurgical hypoparathyroidism (the period of the postoperative observation made up 38,7±10,3 months (S.D.) on stable treatment with calcium and vitamin D (or analogs) and in 26 control patients with a history of thyroid surgery but saved parathyroid function, who were matched for sex, age and time since surgery. Assessment of well–being and parathyroid homeostasis were studied using validated questionnaires (SF–36 v. 2ÔÌ, NAIF), serum calcium/phosphorus homeostasis, and in the hypoparathyroid patients also screening for secondary disease by means of kidney ultrasound and ophthalmological split lamp examination.
Results. Serum calcium was in the accepted therapeutic range in 10 of hypoparathyroid patients, in the majority cases calcium/phosphorus homeostasis was clearly non–physiological. Nephrolithiasis was detected in 6 and cataracts in 3 of 69 hypoparathyroid patients. As compared with controls, hypoparathyroid patients had signicantly lower parameters of quality of a life in SF–36 v. 2ÔÌ (ð < 0,05), NAIF (ð = 0,048) with predominant decreases in the scale scores for vitality, physical and social functioning, role–physical/emotional functioning.
Conclusions. Current standard treatment in hypoparathyroidism is not only associated with an altered calcium/phosphorus homeostasis but also fails to restore well–being in these patients. Future studies need to address the impact of more physiological treatment options like parathyroid hormone (1–34) or parathyroid transplantation on well–being and mood in these patients.

Keywords: thyroidectomy, life quality, hypoparathyroidism, management
p. 40 – 49 of the original issue
References
  1. Experience in a specialist thyroid surgery unit: a demographic study, surgical complications, and outcome / N. N. al–Suliman [et al.] // European Journal of Surgery. – 1997. – Vol. 163. – P. 13-20.
  2. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports / G. Pappalardo [et al.] // European Journal of Surgery. – 1998. – Vol. 164. – P. 501-506.
  3. Rimpl, I. Surgery of nodular goiter: postoperative hypocalcemia in relation to extent of resection and manipulation of the parathyroid glands / I. Rimpl, R. A. Wahl // Langenbecks Archiv der Chirurgie Supplement Kongressband. – 1998. – Vol. 115. – P. 1063-1066.
  4. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany / O. Thomusch [et al.] // World Journal of Surgery. – 2000. – Vol. 24. – P. 324-329.
  5. Prevalence of goiter in the Aachen area. Ultrasound volumetry of the thyroid gland of 1336 adults in an endemic goiter region / J. Riehl [et al.] // Ultraschall in der Medizin. – 1995. – Vol. 16. – P. 84-89.
  6. Well–being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D / W. Arlt [et al.] // European Journal of Endocrinology. – 2002. – Vol. 146. – P. 215-222.
  7. Avioli, L. V. The therapeutic approach to hypoparathyroidism / L. V. Avioli // American Journal of Medicine. – 1974. – Vol. 57. – P. 34-42.
  8. Haussler, M. R. Metabolites and analogues of vitamin D. Which for what? / M. R. Haussler, P. E. Cordy // Journal of the American Medical Association. – 1982. – Vol. 247. – P. 841-844.
  9. Rizzoli, R. Vitamin D treatment of hypoparathyroid patients / R. Rizzoli, J. P. Bonjour // European Journal of Endocrinology. – 1997. – Vol. 136. – P. 25-27.
  10. Schilling, T. Current therapy of hypoparathyroidism – a survey of German endocrinology centers / T. Schilling, R. Ziegler // Experimental and Clinical Endocrinology and Diabetes. – 1997. – Vol. 105. – P. 237-241.
  11. Nordin, B. E. Role of kidney in regulation of plasma calcium / B. E. Nordin, M. Peacock // Lancet. – 1969. – Vol. 2. – P. 1280-1283.
  12. Dual X-ray absorptiometry of the proximal femur: normal European values standardized with the European Spine Phantom / J. Pearson [et al.] // Journal of Bone and Mineral Research. – 1995. – Vol. 10. – P. 315-324.
  13. Ware, J. E. SF–36 Health Survey Update / J. E. Ware // Spine. – 2000. – Vol. 25, N 24. – P. 3130-3139.
  14. Banks, M. H. Validation of the General Health Questionnaire in a young community sample / M. H. Banks // Psychological Medicine. – 1983. – Vol. 13. – P. 349-353.
  15. Ïîïóëÿöèîííûå ïîêàçàòåëè êà÷åñòâà æèçíè ïî îïðîñíèêó SF–36 (ðåçóëüòàòû ìíîãîöåíòðîâîãî èññëåäîâàíèÿ êà÷åñòâà æèçíè «ÌÈÐÀÆ») / Â. Í. Àìèðäæàíîâà [è äð.] // Íàó÷.-ïðàêò. ðåâìàòîëîãèÿ. – 2008. – ¹ 1. – Ñ. 36-48.
  16. Dehydroepiandrosterone replacement in women with adrenal insufciency / W. Arlt [et al.] // New England Journal of Medicine. – 1999. – Vol. 341. – P. 1013-1020.
  17. Kowdley, K. V. Cognitive impairment and intracranial calcication in chronic hypoparathyroidism / K. V. Kowdley, B. M. Coull, E. S. Orwoll // American Journal of Medical Sciences. – 1999. – Vol. 317. – P. 273-277.
  18. Neuropsychological alterations in patients with computed tomography–detected basal ganglia calcication / D. Lopez–Villegas [et al.] // Archives of Neurology. – 1996. – Vol. 53. – P. 251-256.
  19. Usdin, T. B. Identication and functional expression of a receptor selectively recognizing parathyroid hormone, the PTH2 receptor / T. B. Usdin, C. Gruber, T. I. Bonner // Journal of Biological Chemistry. – 1995. – Vol. 270. – P. 15455-15458.
  20. TIP39: a new neuropeptide and PTH2–receptor agonist from hypothalamus / T. B. Usdin [et al.] // Nature Neuroscience. – 1999. – Vol. 2. – P. 941-943.
  21. Cloning of human 25–hydroxyvitamin D-1 alpha–hydroxylase and mutations causing vitamin D–dependent rickets type 1 / G. K. Fu [et al.] // Molecular Endocrinology. – 1997. – Vol. 11. – P. 1961-1970.
  22. Duan, Y. Parathyroid hormone deciency and excess: similar effects on trabecular bone but differing effects on cortical bone / Y. Duan, V. De Luca, E. Seeman // Journal of Clinical Endocrinology and Metabolism. – 1999. – Vol. 84. – P. 718-722.
  23. Bone histomorphometry in hypoparathyroid patients treated with vitamin D / B. L. Langdahl [et al.] // Bone. – 1996. – Vol. 18. – P. 103-108.
  24. Parathyroid allotransplantation without immunosuppression / C. Hasse [et al.] // Lancet. – 1997. – Vol. 350. – P. 1296-1297.
  25. Winer, K. K. Synthetic human parathyroid hormone 1–34 vs calcitriol and calcium in the treatment of hypoparathyroidism / K. K. Winer, J. A. Yanovski, G. B. Jr. Cutler // Journal of the American Medical Association. – 1996. – Vol. 276. – P. 631-636.
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