Summary of Updated Guidelines: Management of Hypoparathyroidism
Key findings
- Although rare, hypoparathyroidism can occur in many settings besides postoperatively, and it can negatively affect multiple body systems, notably the skeleton and kidney
- In response to a rapidly expanding base of evidence, an international task force has published updated guidelines on the diagnosis, prevention, evaluation, and management of hypoparathyroidism
- Serum parathyroid hormone (PTH) should be evaluated within 12 to 24 hours after total thyroidectomy, as PTH >10 pg/mL virtually excludes long-term hypoparathyroidism
- In individuals with nonsurgical hypoparathyroidism, genetic testing may be helpful in particular in the presence of a positive family history of nonsurgical hypoparathyroidism, in the presence of syndromic features, or in individuals younger than 40
- These and numerous other recommendations have been endorsed by more than 65 professional medical and surgical societies, as well as patient advocacy organizations
Within the past five years, physicians and scientists have made substantial advances in understanding the multisystem complications of hypoparathyroidism, particularly the skeletal and renal manifestations of this rare condition. More evidence is available about its diagnosis and evaluation, and new treatment and prevention approaches are being developed.
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Michael Mannstadt, MD, chief of the Endocrine Unit at Massachusetts General Hospital, recently served as senior author of a summary statement and guidelines developed by the Second International Workshop on hypoparathyroidism. The statement, published in the Journal of Bone and Mineral Research, updates guidelines published by a previous international task force in 2016.
Methods
To develop the guidance, 50 international experts in hypoparathyroidism and general endocrinologists from 15 countries met over 24 months to review key issues. A methods team used the Grading of Recommendations, Assessment, Development, and Evaluation methodology to complete four systematic reviews addressing diagnosis, management, and complications. A survey of panel members informed the recommendations for monitoring.
Highlights
Some key recommendations of the new document are:
- Clinicians may consider postsurgical hypoparathyroidism permanent if it persists for >12 months after surgery
- Serum parathyroid hormone (PTH) should be evaluated within 12 to 24 hours after total thyroidectomy, as PTH >10 pg/mL virtually excludes long-term hypoparathyroidism
- In individuals with nonsurgical hypoparathyroidism, genetic testing may be helpful in particular in the presence of a positive family history of nonsurgical hypoparathyroidism, in the presence of syndromic features, or in individuals younger than 40
- Hypoparathyroidism can be associated with nephrocalcinosis, nephrolithiasis, renal insufficiency, cataracts, seizures, cardiac arrhythmias, ischemic heart disease, depression, and increased risk of infection, so laboratory indices should be carefully evaluated and monitored
- In patients with chronic hypoparathyroidism, conventional therapy with calcium and active vitamin D metabolites should still be the first-line therapy, but when it is unsatisfactory, synthetic PTH may be used
The guidelines also include the latest thinking on the epidemiology and etiology of hypoparathyroidism, its marked financial burden, emergency management of severe acute hypocalcemia, treatment of hypoparathyroidism in children and pregnant and lactating individuals, emerging therapies, and directions for future research.
More than 65 professional medical and surgical societies and patient advocacy organizations have endorsed the new guidelines.
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