Endocrine Abstracts

Primary Hyperparathyroidism (PHPT) is characterised by elevated serum calcium concentrations with inappropriately normal or elevated parathyroid hormone (PTH) concentrations. Parathyroidectomy is the only definitive treatment for PHPT. Hypoparathyroidism is a potential complication of this surgery, may be either transient or permanent, and is treated with calcium supplementation and activated vitamin D titrated to maintain serum calcium levels within safe parameters. Under-treatment results in hypocalcaemia which can cause problems including paraesthesia, arrhythmias, and tetany; whereas over-treatment may result in hypercalcaemia which can result in problems including lethargy, pancreatitis, and renal failure. Our Trust guidelines recommend that patients undergoing parathyroidectomy identified as high-risk for post-operative hypoparathyroidism are discharged with empirical calcium and 1-alfacalcidol supplementation to facilitate an early and safe discharge. Calcium and PTH are checked at 14 days post-operatively and adjusted according to an algorithm. Depending on these blood results treatment may be continued at full dose until the next clinic appointment, reduced with further blood tests planned, or stopped completely. In 2022 the average length of time from surgery to outpatient calcium check was 45 days (range 7-386 days; n = 79). In 2023 a Parathyroid Specialist Nurse was appointed and one of their tasks was to co-ordinate the 14 day post-operative blood test check. In 2023, after the introduction of the Specialist Nurse, the average length of time from surgery to outpatient calcium check had improved to 19 days (range 8-75 days; n = 101), with patients on average having their calcium check 26 days sooner, thus reducing the length of time they are potentially under- or over-treated with 1-alfacalcidol and calcium supplementation. The introduction of a Parathyroid Specialist Nurse has therefore improved the standard of post-operative care for patients undergoing a parathyroidectomy and improved compliance with our Trust guidelines, despite case numbers increasing from 79 to 101 (an increase of 22%).