Management of long term post-surgical hypoparathyroidism; need for improvement and potential for remission

Arshad Muhammad Fahad; Nisha Thambuchetty; Saba P Balasubramanian

doi:10.1530/endoabs.109.OC1.3

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Endocrine Abstracts (2025) 109 OC1.3 | DOI: 10.1530/endoabs.109.OC1.3

SFEBES2025 Oral Communications Bone and Calcium (6 abstracts)

Management of long term post-surgical hypoparathyroidism; need for improvement and potential for remission

Muhammad Fahad Arshad ^1,2 , Nisha Thambuchetty ² & Saba P Balasubramanian ^1,2

Author affiliations

¹University of Sheffield, Sheffield, United Kingdom. ²Sheffield Teaching Hospitals, Sheffield, United Kingdom

Introduction: Several international guidelines have recommended regular monitoring in patients with long-term hypoparathyroidism; however, care remains suboptimal. Also, patients with post-surgical hypoparathyroidism (PoSH) can be weaned off calcium/ vitamin D supplements with pro-active attempts. Aim of this study was to evaluate compliance of European Society of Endocrinology (ESE) guidelines in real-world in patients with PoSH cohort and determine the proportion of patients weaned.

Methods: All patients with PoSH (requiring supplements >6 months post-operatively) over 10 years (2009-2018) were identified using healthcare records at a tertiary centre. Demographic, clinical, and biochemical data was collected and using ESE guidelines as set standards, clinical practice was audited. Intention to adhere to ESE guidelines was evaluated and if supplements were successfully weaned.

Results: 51 patients with PoSH were identified and median (IQR) age was 49.7 (32.4-61.4) years with female/male ratio of 3:1. Most patients had thyroid surgery (n=46), followed by parathyroid surgery (n=4), or both (n=1). The median (IQR) follow-up duration was 51 (23-72) months. Key findings showed that 63% (n=32) patients did not have vitamin D levels of >75 nmol/l during follow-up. 24% (n=12) patients had urine biochemistry performed, of which 42% (5/12) had hypercalciuria. At least one episode of hypercalcaemia, hyperphosphatemia, and hypomagnesemia was recorded in 15% (n=8), 65% (n=33) and 24% (n=12) patients, respectively. Intention to adhere to ESE guidelines was 61% and 35% (n=18) patients were weaned off supplements at a median (IQR) interval of 21.5 (8.1-61.3) months. The median (IQR) annual rate of rise in eGFR was 1.9 (0.7-5.0) ml/min/1.73m²/year, however, recovery in renal functions was observed in those weaned.

Conclusion: This study illustrates the need for improving monitoring in patients with PoSH. Significant number of patients can be weaned off supplements with pro-active efforts. Patients with PoSH are at greater risk for decline in renal functions.