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Mariano Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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importance of arachidonic acid as a mediator of Parathyroid gland response
Kidney International, 2003Co-Authors: Antonio Canalejo, Sagrario Canadillas, Evaristo Ballesteros, Mariano RodriguezAbstract:Importance of arachidonic acid as a mediator of Parathyroid gland response. The intracellular signaling mechanisms that mediate the regulation of Parathyroid hormone (PTH) secretion by Parathyroid glands are becoming increasingly more understood. Extracellular calcium modulates Parathyroid Function by acting on a G protein-coupled calcium-sensing receptor, which activates the hydrolysis of membrane phospholipids by phospholipases C, D, and A2 to generate intracellular signals. Arachidonic acid (AA) produced by phospholiphase A2 (PLA2) appears to play a crucial role throughout the generation of downstream-oxygenated products. Recent studies demonstrate the activation of the PLA2 via an intracellular calcium increase, and that the elevation of cytosolic calcium also overcomes the repressive effect of high extracellular phosphate on AA production. Furthermore, a role of the mitogen-activated protein (MAP) kinase cascade has also been documented in PLA2 activation.
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Parathyroid Function as a determinant of the response to calcitriol treatment in the hemodialysis patient
Kidney International, 1999Co-Authors: Mariano Rodriguez, Francisco Caravaca, Elvira Fernandez, Maria J Borrego, Victor Lorenzo, J J Cubero, Alejandro Martinmalo, Angels Betriu, Alejandro Jimenez, Armando TorresAbstract:Parathyroid Function as a determinant of the response to calcitriol treatment in the hemodialysis patient. Background Bolus calcitriol (CTR) is used for the treatment of secondary hyperParathyroidism in dialysis patients. Although CTR treatment reduces Parathyroid hormone (PTH) levels in many dialysis patients, a significant number fail to respond. Methods To learn whether or not an analysis of Parathyroid Function could further illuminate the response to CTR, a PTH-calcium curve was performed before and after at least two months of CTR treatment in 50 hemodialysis patients with a predialysis intact PTH of greater than 300 pg/ml. Results For the entire group ( N = 50), CTR treatment resulted in a 24% reduction in predialysis (basal) PTH from 773 ± 54 to 583 ± 71 pg/ml ( P P N = 25) and nonresponders (NRs, N = 25). Before CTR, the NR group was characterized by a greater basal (959 ± 80 vs. 586 ± 51 pg/ml, P P P r = 0.59, P = 0.002) but not in the R group ( r = 0.06, P = NS). In the R group, an inverse correlation was present between ionized calcium and the basal/maximal PTH ratio, an indicator of whether calcium is suppressing basal PTH secretion relative to the maximal secretory capacity (maximal PTH) r = -0.55, P = 0.004; in the NR group, this correlation approached significance but was positive ( r = 0.34, P = 0.09). After CTR treatment, serum calcium increased in both groups, and despite marked differences in basal PTH (Rs, 197 ± 25 vs. NRs, 969 ± 85 pg/ml), an inverse correlation between ionized calcium and basal/maximal PTH was present in both groups (Rs, r = -0.61, P = 0.001, and NRs, r = -0.60, P = 0.001). Conclusions ( a ) Dynamic testing of Parathyroid Function provided insights into the pathophysiology of PTH secretion in hemodialysis patients. ( b ) The magnitude of hyperParathyroidism was the most important predictor of the response to CTR. ( c ) Before CTR treatment, PTH was sensitive to calcium in Rs, and serum calcium was PTH driven in NRs, and ( d ) after the CTR-induced increase in serum calcium, calcium suppressed basal PTH relative to maximal PTH in both groups.
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effect of phosphate on the Parathyroid gland direct and indirect
Current Opinion in Nephrology and Hypertension, 1996Co-Authors: Mariano Rodriguez, Yolanda Almaden, Alexis Hernandez, Armando TorresAbstract:HyperParathyroidism is a common finding in patients with renal failure. Phosphorus retention is known to be an important factor in the development of secondary hyperParathyroidism. Exciting new work has demonstrated that a high extracellular phosphorus concentration directly stimulates Parathyroid hormone secretion and synthesis. Dietary phosphorus also modulates Parathyroid Function indirectly by decreasing calcitriol production, and it interferes with the calcaemic response to Parathyroid hormone. The information available suggests that the control exerted by phosphorus is critical, via indirect and direct actions, in preventing the development of secondary hyperParathyroidism.
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the effect of long term intravenous calcitriol administration on Parathyroid Function in hemodialysis patients
Journal of The American Society of Nephrology, 1991Co-Authors: Mariano Rodriguez, Arnold J Felsenfeld, C Williams, James A Pederson, Francisco LlachAbstract:Secondary hyperParathyroidism is common in dialysis patients. Intravenous calcitriol has proven to be an effective therapy for the reduction of Parathyroid hormone (PTH) levels. However, the effect of i.v. calcitriol on Parathyroid Function, defined as the sigmoidal PTH-calcium curve developed during hypocalcemia and hypercalcemia, has not been evaluated during the prolonged administration of i.v. calcitriol. Six hemodialysis patients with marked secondary hyperParathyroidism, PTH levels greater than 500 pg/mL (normal, 10 to 65 pg/mL), were treated for 42 wk with 2 micrograms of i.v. calcitriol after each hemodialysis. Parathyroid Function was evaluated before and after 10 and 42 wk of calcitriol therapy. Between baseline and 42 wk, the basal PTH level decreased from 890 +/- 107 to 346 +/- 119 pg/mL (P less than 0.02) and the maximally stimulated PTH level decreased from 1293 +/- 188 to 600 +/- 140 pg/mL (P less than 0.01). In addition, calcitriol administration significantly decreased PTH levels throughout the hypocalcemic range of the PTH-calcium curve. Although the slope of the PTH-calcium curve (with maximal PTH as 100%) decreased between baseline and 42 wk (P less than 0.05), the set point of calcium did not change. Two patients with a decrease in both basal and maximally stimulated PTH levels after 10 wk of calcitriol, developed marked hyperphosphatemia between 10 and 42 wk; this resulted in an exacerbation of hyperParathyroidism despite continued calcitriol therapy. In conclusion, prolonged i.v. calcitriol administration is an effective treatment for secondary hyperParathyroidism in hemodialysis patients provided that reasonable control of the serum phosphate is achieved. In addition, the slope of the PTH-calcium curve may be a better indicator of Parathyroid cell sensitivity than the set point of calcium.
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a comparison of Parathyroid gland Function in haemodialysis patients with different forms of renal osteodystrophy
Nephrology Dialysis Transplantation, 1991Co-Authors: Arnold J Felsenfeld, Mariano Rodriguez, R Dunlay, Francisco LlachAbstract:: Parathyroid Function was studied in three different histological forms of renal osteodystrophy: osteitis fibrosa (OF), low-turnover aluminium-associated bone disease (LTAABD), and aplastic bone disease without aluminium (ABD). Parathyroid Function was determined by the evaluation of the sigmoidal Parathyroid hormone-(PTH)-calcium curve, which was obtained by the performance of a reduced calcium and an increased calcium haemodialysis. Parameters of the sigmoidal PTH-calcium curve evaluated included maximally stimulated (PTHMax) and inhibited (PTHMin) PTH, the set point of calcium for PTH (ICA50), defined as the ionised calcium concentration at which PTHMax was reduced by 50%, the ratio of basal PTH to maximally stimulated PTH (PTHBase:PTHMax), the ionised calcium concentration at which basal (ICABase), maximally stimulated (ICAMax), and maximally inhibited (ICAMin) PTH values were observed, and the slope of the PTH-calcium curve. Both PTHMax and PTHMin were greater in OF than the other two groups (P less than 0.02). The ratio of basal to maximally stimulated PTH was greater (P less than 0.02) in OF (61 +/- 7%) than LTAABD (33 +/- 5%) and ABD (36 +/- 7%). The ICA50 and the ICAMax were greater (P less than 0.03) in OF than the other two groups; however, no differences were observed in the ICABase and ICAMin. The slope of the PTH-calcium curve (% maximal PTH), which should indicate the sensitivity of Parathyroid cells, was greater in OF than LTAABD (P less than 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)
Melanie L Lyden - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Parathyroid glands with indocyanine green fluorescence angiography after thyroidectomy
World Journal of Surgery, 2019Co-Authors: Anatoliy V Rudin, Travis J Mckenzie, Geoffrey B Thompson, David R Farley, Melanie L LydenAbstract:Indocyanine green fluorescence angiography (ICGA) is a new adjunct that has been used in surgical procedures to assess blood flow. This study evaluated the utility of ICGA compared to visual inspection to predict Parathyroid Function, guide autotransplantation and potentially decrease permanent hypoParathyroidism. This was a retrospective study of patients who underwent total or near-total thyroidectomy (T-NT) between January 2015 and March 2018. Patients with preoperative hyperParathyroidism and those undergoing reoperation were excluded. Patients who had ICGA were compared to T-NT patients without ICGA. Data were analyzed to assess the frequency of autotransplantation and incidence of hypoParathyroidism between groups. In total, 210 patients underwent T-NT: 86 with ICGA and 124 without. Autotransplantation was more common in the ICGA group at 36% compared to 12% in the control (p = 0.0001). There was no correlation with at least one normal Parathyroid gland on ICGA and postoperative PTH levels (p = 0.75). There was a difference in having normal postoperative PTH when there were at least two normal Parathyroid glands (n = 50) compared to patients with less than two normal ICGA glands (n = 36, p = 0.044). Visual assessment and ICGA assessment of vascularity were in agreement, 245/281 (87%). There were 19 glands (6.8%) that would have undergone autotransplant based on visual inspection that had adequate blood supply on ICGA. Transient hypoParathyroidism was present in 45 out of 124 controls (36%) and 32 out of 86 (37%) in the ICG group. ICGA is a novel technique that may improve the assessment of Parathyroid gland blood supply compared to visual inspection. ICGA can guide more appropriate autotransplantation without compromising postoperative Parathyroid Function. At least two vascularized glands on ICGA may predict postoperative Parathyroid gland Function.
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evaluation of Parathyroid glands with indocyanine green fluorescence angiography after thyroidectomy
World Journal of Surgery, 2019Co-Authors: Anatoliy V Rudin, Travis J Mckenzie, Geoffrey B Thompson, David R Farley, Melanie L LydenAbstract:Background Indocyanine green fluorescence angiography (ICGA) is a new adjunct that has been used in surgical procedures to assess blood flow. This study evaluated the utility of ICGA compared to visual inspection to predict Parathyroid Function, guide autotransplantation and potentially decrease permanent hypoParathyroidism.
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evaluation of Parathyroid glands with indocyanine green fluorescence angiography after thyroidectomy
World Journal of Surgery, 2019Co-Authors: Anatoliy V Rudin, Travis J Mckenzie, Geoffrey B Thompson, David R Farley, Melanie L LydenAbstract:Background Indocyanine green fluorescence angiography (ICGA) is a new adjunct that has been used in surgical procedures to assess blood flow. This study evaluated the utility of ICGA compared to visual inspection to predict Parathyroid Function, guide autotransplantation and potentially decrease permanent hypoParathyroidism. Methods This was a retrospective study of patients who underwent total or near-total thyroidectomy (T-NT) between January 2015 and March 2018. Patients with preoperative hyperParathyroidism and those undergoing reoperation were excluded. Patients who had ICGA were compared to T-NT patients without ICGA. Data were analyzed to assess the frequency of autotransplantation and incidence of hypoParathyroidism between groups. Results In total, 210 patients underwent T-NT: 86 with ICGA and 124 without. Autotransplantation was more common in the ICGA group at 36% compared to 12% in the control (p = 0.0001). There was no correlation with at least one normal Parathyroid gland on ICGA and postoperative PTH levels (p = 0.75). There was a difference in having normal postoperative PTH when there were at least two normal Parathyroid glands (n = 50) compared to patients with less than two normal ICGA glands (n = 36, p = 0.044). Visual assessment and ICGA assessment of vascularity were in agreement, 245/281 (87%). There were 19 glands (6.8%) that would have undergone autotransplant based on visual inspection that had adequate blood supply on ICGA. Transient hypoParathyroidism was present in 45 out of 124 controls (36%) and 32 out of 86 (37%) in the ICG group. Conclusions ICGA is a novel technique that may improve the assessment of Parathyroid gland blood supply compared to visual inspection. ICGA can guide more appropriate autotransplantation without compromising postoperative Parathyroid Function. At least two vascularized glands on ICGA may predict postoperative Parathyroid gland Function.
Paul Lips - One of the best experts on this subject based on the ideXlab platform.
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vitamin d status Parathyroid Function bone turnover and bmd in postmenopausal women with osteoporosis global perspective
Journal of Bone and Mineral Research, 2009Co-Authors: Natalia O Kuchuk, Saskia M F Pluijm, Arkadi Chines, Natasja M Van Schoor, Paul LipsAbstract:Poor vitamin D status is common in the elderly and is associated with bone loss and fractures. The aim was to assess worldwide vitamin D status in postmenopausal women with osteoporosis according to latitude and economic status, in relation to Parathyroid Function, bone turnover markers, and BMD. The study was performed in 7441 postmenopausal women from 29 countries participating in a clinical trial on bazedoxifene (selective estrogen receptor modulator), with BMD T-score at the femoral neck or lumbar spine ≤ −2.5 or one to five mild or moderate vertebral fractures. Serum 25(OH)D, PTH, alkaline phosphatase (ALP), bone turnover markers osteocalcin (OC) and C-terminal cross-linked telopeptides of type I collagen (CTX), and BMD of the lumbar spine, total hip, femoral neck, and trochanter were measured. The mean serum 25(OH)D level was 61.2 ± 22.4 nM. The prevalence of 25(OH)D 75 nM was 5.9%, 29.4%, 43.5%, and 21.2%, respectively, in winter and 3.0%, 22.2%, 47.2%, and 27.5% in summer. Worldwide, a negative correlation between 25(OH)D and latitude was observed. With increasing 25(OH)D categories of 75 nM, mean PTH, OC, and CTX were decreasing (p < 0.001), whereas BMD of all sites was increasing (p < 0.001). A threshold in the positive relationship between 25(OH)D and different BMD parameters was visible at a 25(OH)D level of 50 nM. Our study showed a high prevalence of low 25(OH)D in postmenopausal women with osteoporosis worldwide. Along with latitude, affluence seems to be an important factor for serum 25(OH)D level, especially in Europe, where it is strongly correlated with latitude.
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vitamin d status Parathyroid Function bone turnover and bmd in postmenopausal women with osteoporosis global perspective
Journal of Bone and Mineral Research, 2009Co-Authors: Natalia O Kuchuk, Natasja M Van Schoor, Saskia M F Pluijm, Arkadi Chines, Paul LipsAbstract:Poor vitamin D status is common in the elderly and is associated with bone loss and fractures. The aim was to assess worldwide vitamin D status in postmenopausal women with osteoporosis according to latitude and economic status, in relation to Parathyroid Function, bone turnover markers, and BMD. The study was performed in 7441 postmenopausal women from 29 countries participating in a clinical trial on bazedoxifene (selective estrogen receptor modulator), with BMD T-score at the femoral neck or lumbar spine 75 nM was 5.9%, 29.4%, 43.5%, and 21.2%, respectively, in winter and 3.0%, 22.2%, 47.2%, and 27.5% in summer. Worldwide, a negative correlation between 25(OH)D and latitude was observed. With increasing 25(OH)D categories of 75 nM, mean PTH, OC, and CTX were decreasing (p < 0.001), whereas BMD of all sites was increasing (p < 0.001). A threshold in the positive relationship between 25(OH)D and different BMD parameters was visible at a 25(OH)D level of 50 nM. Our study showed a high prevalence of low 25(OH)D in postmenopausal women with osteoporosis worldwide. Along with latitude, affluence seems to be an important factor for serum 25(OH)D level, especially in Europe, where it is strongly correlated with latitude.
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a global study of vitamin d status and Parathyroid Function in postmenopausal women with osteoporosis baseline data from the multiple outcomes of raloxifene evaluation clinical trial
The Journal of Clinical Endocrinology and Metabolism, 2001Co-Authors: Paul Lips, Tu Duong, Anna Oleksik, Dennis Black, Steven R Cummings, Thomas NickelsenAbstract:Vitamin D deficiency leads to secondary hyperParathyroidism, increased bone turnover, and bone loss and, when severe, to osteomalacia. Vitamin D deficiency is common in elderly people, especially the institutionalized. The definition of vitamin D deficiency is hampered by the fact that large interlaboratory differences exist in assays for serum 25-hydroxyvitamin D (25OHD), the main circulating metabolite. The international Multiple Outcomes of Raloxifene Evaluation study, a large prospective intervention trial in postmenopausal women with osteoporosis, offered the opportunity to compare vitamin D status and Parathyroid Function throughout many countries over the world. For this study, baseline data were available from 7564 postmenopausal women from 25 countries on 5 continents. All women had osteoporosis, i.e. bone mineral density (BMD) at femoral neck or lumbar spine was lower than t-score −2.5, or they had 2 vertebral fractures. Serum 25OHD was measured by RIA, and serum PTH was measured by immunoradiom...
Francisco Llach - One of the best experts on this subject based on the ideXlab platform.
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Parathyroid gland Function in chronic renal failure
Kidney International, 1993Co-Authors: Arnold J Felsenfeld, Francisco LlachAbstract:The concept that the PTH-calcium curve is representative of Parathyroid Function has been discussed. Comparisons of Parathyroid Function have been made between normal humans and hemodialysis patients and also between hemodialysis patients with different forms of renal osteodystrophy. From these comparisons, it is apparent that the magnitude of HPT is much greater in patients with renal failure than in normal humans, and as represented by the ratio of basal to maximal PTH, the Parathyroid gland appears to be stimulated at basal serum calcium levels in hemodialysis patients. Similarly, based on an analysis of the PTH-calcium curve, we were able to determine that several differences in Parathyroid Function were present in hemodialysis patients with different forms of renal osteodystrophy. As compared to hemodialysis patients with LTAABD and aplastic bone disease, patients with osteitis fibrosa have a greater magnitude of hyperParathyroidism, a greater sensitivity of the Parathyroid cell (slope), a higher set point of calcium, and greater PTH stimulation at basal serum calcium (ratio of basal to maximal PTH). Calcitriol treatment of hemodialysis patients with osteitis fibrosa resulted in a significant decrease in PTH throughout the PTH-calcium curve and also reduced the sensitivity (slope) of the PTH-calcium curve. The concept of hysteresis has been discussed as well as the role that the ambient basal serum calcium concentration may have on the determination of the PTH-calcium curve. Finally, the effect that successful renal transplantation has on HPT has been examined. In conclusion, we believe that the PTH-calcium curve provides a reliable assessment of Parathyroid Function, and as such, has considerable application for the study of Parathyroid disorders in the clinical setting.
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the effect of long term intravenous calcitriol administration on Parathyroid Function in hemodialysis patients
Journal of The American Society of Nephrology, 1991Co-Authors: Mariano Rodriguez, Arnold J Felsenfeld, C Williams, James A Pederson, Francisco LlachAbstract:Secondary hyperParathyroidism is common in dialysis patients. Intravenous calcitriol has proven to be an effective therapy for the reduction of Parathyroid hormone (PTH) levels. However, the effect of i.v. calcitriol on Parathyroid Function, defined as the sigmoidal PTH-calcium curve developed during hypocalcemia and hypercalcemia, has not been evaluated during the prolonged administration of i.v. calcitriol. Six hemodialysis patients with marked secondary hyperParathyroidism, PTH levels greater than 500 pg/mL (normal, 10 to 65 pg/mL), were treated for 42 wk with 2 micrograms of i.v. calcitriol after each hemodialysis. Parathyroid Function was evaluated before and after 10 and 42 wk of calcitriol therapy. Between baseline and 42 wk, the basal PTH level decreased from 890 +/- 107 to 346 +/- 119 pg/mL (P less than 0.02) and the maximally stimulated PTH level decreased from 1293 +/- 188 to 600 +/- 140 pg/mL (P less than 0.01). In addition, calcitriol administration significantly decreased PTH levels throughout the hypocalcemic range of the PTH-calcium curve. Although the slope of the PTH-calcium curve (with maximal PTH as 100%) decreased between baseline and 42 wk (P less than 0.05), the set point of calcium did not change. Two patients with a decrease in both basal and maximally stimulated PTH levels after 10 wk of calcitriol, developed marked hyperphosphatemia between 10 and 42 wk; this resulted in an exacerbation of hyperParathyroidism despite continued calcitriol therapy. In conclusion, prolonged i.v. calcitriol administration is an effective treatment for secondary hyperParathyroidism in hemodialysis patients provided that reasonable control of the serum phosphate is achieved. In addition, the slope of the PTH-calcium curve may be a better indicator of Parathyroid cell sensitivity than the set point of calcium.
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a comparison of Parathyroid gland Function in haemodialysis patients with different forms of renal osteodystrophy
Nephrology Dialysis Transplantation, 1991Co-Authors: Arnold J Felsenfeld, Mariano Rodriguez, R Dunlay, Francisco LlachAbstract:: Parathyroid Function was studied in three different histological forms of renal osteodystrophy: osteitis fibrosa (OF), low-turnover aluminium-associated bone disease (LTAABD), and aplastic bone disease without aluminium (ABD). Parathyroid Function was determined by the evaluation of the sigmoidal Parathyroid hormone-(PTH)-calcium curve, which was obtained by the performance of a reduced calcium and an increased calcium haemodialysis. Parameters of the sigmoidal PTH-calcium curve evaluated included maximally stimulated (PTHMax) and inhibited (PTHMin) PTH, the set point of calcium for PTH (ICA50), defined as the ionised calcium concentration at which PTHMax was reduced by 50%, the ratio of basal PTH to maximally stimulated PTH (PTHBase:PTHMax), the ionised calcium concentration at which basal (ICABase), maximally stimulated (ICAMax), and maximally inhibited (ICAMin) PTH values were observed, and the slope of the PTH-calcium curve. Both PTHMax and PTHMin were greater in OF than the other two groups (P less than 0.02). The ratio of basal to maximally stimulated PTH was greater (P less than 0.02) in OF (61 +/- 7%) than LTAABD (33 +/- 5%) and ABD (36 +/- 7%). The ICA50 and the ICAMax were greater (P less than 0.03) in OF than the other two groups; however, no differences were observed in the ICABase and ICAMin. The slope of the PTH-calcium curve (% maximal PTH), which should indicate the sensitivity of Parathyroid cells, was greater in OF than LTAABD (P less than 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)
Frederic Triponez - One of the best experts on this subject based on the ideXlab platform.
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randomized clinical trial of intraoperative Parathyroid gland angiography with indocyanine green fluorescence predicting Parathyroid Function after thyroid surgery
British Journal of Surgery, 2018Co-Authors: Vidal J Fortuny, Valentina Belfontali, Samira M Sadowski, Wolfram Karenovics, Sebastien Guigard, Antoine Poncet, Frederic Ris, Frederic TriponezAbstract:BACKGROUND HypoParathyroidism, the most common complication after thyroid surgery, leads to hypocalcaemia and significant medical problems. An RCT was undertaken to determine whether intraoperative Parathyroid gland angiography with indocyanine green (ICG) could predict postoperative hypoParathyroidism, and obviate the need for systematic blood tests and oral calcium supplementation. METHODS Between September 2014 and February 2016, patients who had at least one well perfused Parathyroid gland on ICG angiography were randomized to receive standard follow-up (measurement of calcium and Parathyroid hormone (PTH) on postoperative day (POD) 1 and systematic supplementation with calcium and vitamin D; control group) or no supplementation and no blood test on POD 1 (intervention group). In all patients, calcium and PTH levels were measured 10-15 days after thyroidectomy. The primary endpoint was hypocalcaemia on POD 10-15. RESULTS A total of 196 patients underwent ICG angiography during thyroid surgery, of whom 146 had at least one well perfused Parathyroid gland on ICG angiography and were randomized. None of these patients presented with hypoParathyroidism, including those who did not receive calcium supplementation. The intervention group was statistically non-inferior to the control group (exact 95 per cent c.i. of the difference in proportion of patients with hypocalcaemia -0·053 to 0·053; P = 0·012). Eleven of the 50 excluded patients, in whom no well perfused Parathyroid gland could be identified by angiography, presented with hypoParathyroidism on POD 1, and six on POD 10-15, which was significantly different from the findings in randomized patients (P = 0·007). CONCLUSION ICG angiography reliably predicts the vascularization of the Parathyroid glands and obviates the need for postoperative measurement of calcium and PTH, and supplementation with calcium in patients with at least one well perfused Parathyroid gland. Registration number: NCT02249780 (http://www.clinicaltrials.gov).
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Parathyroid gland angiography with indocyanine green fluorescence to predict Parathyroid Function after thyroid surgery
British Journal of Surgery, 2016Co-Authors: Vidal J Fortuny, Valentina Belfontali, Samira M Sadowski, Wolfram Karenovics, Sebastien Guigard, Frederic TriponezAbstract:Background Postoperative hypoParathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative Parathyroid gland angiography in predicting normal Parathyroid gland Function after thyroid surgery. Methods Angiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified Parathyroid glands. Results Some 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized Parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had Parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized Parathyroid gland could be demonstrated developed transient hypoParathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoParathyroidism. Conclusion PTH levels on POD 1 were normal in all patients who had at least one well vascularized Parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoParathyroidism.
