Teriparatide Therapy and Reduced Postoperative Hospitalization for Postsurgical Hypoparathyroidism.

Abstract

IMPORTANCE:

Up to 20% of patients undergoing thyroidectomy develop hypocalcemia after surgery. Although usually transient, severe symptomatic hypocalcemia may occur. Teriparatide acetate (recombinant human parathyroid hormone 1-34) therapy can rapidly raise calcium levels.

OBJECTIVE:

To test the hypothesis that teriparatide therapy in patients with postthyroidectomy hypoparathyroidism would expedite relief of symptomatic hypocalcemia and reduce the duration of hospitalization compared with standard treatment.

DESIGN, SETTING, AND PARTICIPANTS:

Case series of all hospitalized patients 18 years or older treated with teriparatide for symptomatic postthyroidectomy hypocalcemia occurring immediately after thyroidectomy at Mayo Clinic, Rochester, Minnesota, between January 1, 2008, and June 30, 2014. A secondary analysis was performed with matched control and cohort groups having postthyroidectomy hypocalcemia of similar degree who received standard treatment only. Participants included 8 hospitalized patients who received teriparatide therapy after 24 hours of standard treatment (cases) and eight control patients selected from a cohort of 1193 thyroidectomies were matched for age, sex, body mass index, and nadir calcium levels.

INTERVENTION:

Teriparatide acetate therapy (20 µg twice daily) subcutaneously for 1 week, with the option of continuing at 20 µg/d for up to 3 weeks.

MAIN OUTCOMES AND MEASURES:

Safety, symptom resolution, calcium supplementation, and duration of hospitalization.

RESULTS:

Among the 16 case and control patients the median nadir calcium level was 7.1 mg/dL in both groups. Most patients underwent thyroidectomy for thyroid cancer. Teriparatide therapy was safe, with no adverse events noted, and completely eliminated symptomatic hypocalcemia in all treated patients within 24 hours of initiation. Hospital discharge occurred at a median of 1.0 day (interquartile range, 1.0-1.0 day) after teriparatide therapy initiation among cases vs 2.5 days (interquartile range, 1.8-3.0 days) after the equivalent clinical point was reached in controls (P = .01). This value was 2.0 days in the source cohort (P = .02). On hospital discharge, patients had similar calcium levels. Six months after surgery, all patients treated with teriparatide showed partial or complete parathyroid recovery. Calcium supplementation and calcium levels were comparable between the groups.

CONCLUSIONS AND RELEVANCE:

In this pilot study, teriparatide therapy in patients with postthyroidectomy hypoparathyroidism was safe, rapidly eliminated hypocalcemic symptoms, and likely reduced the duration of hospitalization. Given the limitations of this small study, a large-scale randomized trial is needed to verify these results and to assess the long-term effect of teriparatide therapy on clinical outcomes.

• Authors: Meera Shah, Irina Bancos, Geoffrey B Thompson, Melanie L Richards, Jan L Kasperbauer, Bart L Clarke, Matthew T Drake, Marius N Stan
• Journal: JAMA otolaryngology-- head & neck surgery (JAMA Otolaryngol Head Neck Surg) Vol. 141 Issue 9 Pg. 822-7 (Sep 2015) ISSN: 2168-619X [Electronic] United States
• PMID: 26312597 (Publication Type: Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Teriparatide
• Calcium

Topics

• Adult
• Calcium (blood)
• Cohort Studies
• Female
• Hospitalization
• Humans
• Hypocalcemia (blood, prevention & control)
• Hypoparathyroidism (blood, prevention & control)
• Injections, Subcutaneous
• Male
• Middle Aged
• Postoperative Complications (blood, prevention & control)
• Teriparatide (therapeutic use)
• Thyroid Neoplasms (blood, surgery)
• Thyroidectomy