Investigation of real life data and quality of life of patients with hipoparathyroid

Purpose: Hypoparathyroidism (HypoPT) is a rare endocrine disease in which parathyroid hormone (PTH) is low or normal despite low serum calcium and increased serum phosphorus. The most common occurrence of HypoPT is the involuntary removal or damage of the glands. Our aim in this study is to compare the demographic, etiological, physical examination, laboratory, treatment characteristics and quality of life of the patient followed up with a diagnosis of HypoPT in a tertiary endocrine center with respect to the normal healthy population. Method: In this study, patients with a diagnosis of HypoPT who admitted to the Adult Endocrinology outpatient clinic of Dicle University Medical Faculty Hospital between January 1, 2010 and December 31, 2019 were retrospectively included. All HypoPT patients aged >18 and <80 years were included in the study. A healthy control group was formed with similar age and gender distribution. Demographic findings, etiological factors, physical examination findings, laboratory findings, and treatment characteristics of the patients included in the study were recorded. SF-36 test, which is a quality of life questionnaire, was applied to the patient group and the control group. The data of the patient group were analyzed. The data of the patient and control groups were compared statistically. Results: 119 patients (HypoPT / Control: 65/54) were included in the study. In the HypoPT group, Female / Male: 59/6 ;in the control group, Female / Male: 35/19. The average age of patients with HypoPT is 42.80 ± 13.37; the mean age of the control group was 33.58 ± 11.9. Calcium value of the patient group was 7.95 ± 0.92 mg / dl; the calcium value of the control group was 9.39 ± 0.35 mg / dl (p <0.05). PTH level was evaluated as 9.99 ± 6.30 pg / ml in the patient group and 46.76 ± 11.01 pg / ml in the control group (p <0.01). It was 4.45 ± 0.94 in the P patient group and 3.56 ± 0.36 in the control group. 1.72 ± 0.17 mg / dl in the Mg patient group; 1.83 ± 0.15 mg / dl in the control group. SF-36 score in the patient group was 93.46 ± 9.90 (76-107); it was found to be 100.75 ± 9.52 (80-122) in the control group. Quality of life was significantly lower in the patient group (p˂0.05). HypoPT etiology 51 (78%) patients due to surgery; 14 (22%) patients were due to autoimmune causes. While the mean calcium value in patients with surgical hypoparathyroidism was 8.03 ± 0.93 (6.34-9.80) mg / dl; in patients with non-surgical hypoparathyroidism, mean calcium value was found to be 7.67 ± 0.85 (6.58-9.50) mg / dl. In patients with surgical hypoparathyroidism, mean PTH value was 10.16 ± 6.21 (0.6-20) pg / ml; in patients with nonsurgical HypoPT, the mean was 9.36 ± 6.82 (0.4-19) pg / ml. While the etiology of 37 (72%) patients who underwent surgery was due to multinodular goiter, 14 (28%) patients developed HypoPT due to other etiological reasons. When we look at the relation of the etiology with SF-36, the mean SF-36 value in patients with hypoPT who underwent surgery was 91.98 ± 9.83 (75-113), and the mean SF-36 value of patients without surgery was 98.86 ± 8.44 (79-115). (p <0.05). Daily calcitriol dose used in patients with hypoPT: 30 patients 0.50 mcg; 20 patients 1mcg; 3 patients 0.25mcg; 2 patients 1.5 mcg; 1 patient 0.75 mcg; 1 patient was taking 3 mcg. Eight patients were not taking calcitriol. Daily oral dose of calcium: 1000 mg for 20 patients; 18 patients 3000 mg; 18 patients 2000 mg; 5 patients were taking 4000 mg. Four patients were not taking oral calcium. Daily oral dose of cholecalciferol: 20 patients 880 IU; 18 patients 1760 IU; 18 patients 2640 IU; 5 patients were receiving 3520 IU. Four patients were not taking cholecalciferol. Treatment compliance of patients; 30 patients receiving treatment every day of the week; 30 patients who disrupt their treatment maximum 2 days a week; 5 patients who disrupted their treatment for 3 days or more a week were detected. There was a relationship between treatment compliance and numbness and spasm symptoms, and it was statistically significant (p˂0.05). Five patients had no symptoms of numbness, and 60 patients had numbness symptoms. The spasm symptom was not present in 49 patients and 16 patients. Cataract was present in 2 patients and not in 63 patients. Basal ganglia calcification was in 3 patients and not in 62 patients. Kidney stones were in 12 patients and not in 53 patients. 28 of the patients had a history of hospitalization in the last 1 year, and 37 of them did not have a history of hospitalization. While the most common symptoms in the patient group with hypoparathyroidism were numbness and spasm, the most common reason for hospitalization of patients who were hospitalized in the last 1 year was symptomatic hypocalcemia, convulsions, seizures and renal pathologies. Conclusion: Even if calcium and phosphorus levels are normal in patients with hypoparathyroidism, their quality of life is lower than in the healthy population. The most common etiological cause of hypoPT is surgery related to multinodular goiter. The most common reason for hospitalization in patients with hypoPT is treatment non-compliance. The most common complication in patients is kidney stones. Recombinant parathormone analogues promise for symptoms, complications and good quality of life in patients with HypoPT.