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Post thyroid surgery hypoparathyroidism long term follow ups - What tests should be done and how frequent should they be?

If a patient is still presenting with mild symptoms of hypoparathyroidism on a daily basis what care should they expect and from whom (surgeon, endocrinologist, GP...)?

Is it true that calcium levels fluctuate throughout the day? If so, is an annual calcium blood test done at approximately the same time of the day each year an accurate measure to provide effective management of the condition?

Hi Janet,

I'm not a doctor so I can't tell you what tests should be done and how often, which may in any case vary depending on your results to date and the medication you're on. I can though refer you to BTF's affiliated organisation Hypoparathyroidism (HPTH) UK which has a leaflet produced by its Clinical Advisory Team in conjunction with the Society for Endocrinology's Bone and Mineral Special Interest Group which you may find helpful. You can download the full text of the leaflet here --> http://hpth.org.uk/resources.php?id=19. There are also some stories by HPTH UK members who have post-surgical hypoparathyroidism and how they have coped, here --> http://hpth.org.uk/resources.php?id=204.

(I am the HPTH UK Public Affairs Officer. Feel free to contact me or any of our committee members - details on the website.)

Janet, see below in capitals:
Post thyroid surgery hypoparathyroidism long term follow ups - What tests should be done and how frequent should they be?
SERUM CALCIUM IS THE IMPORTANT TEST. MOST PEOPLE WHO DEVELOP HYPOPARA AFTER THYROID/PARATHYROID SURGERY RECOVER AFTER A WHILE, SO IT IS ALWAYS APPROPRIATE TO CONSIDER WEANING OFF ALFACALCIDOL / CALCIUM SUPPLEMENTS. THIS DOES NEED TO BE SUPERVISED BY A SPECIALIST TO BE DONE SAFELY. IF THE HYPOPARA IS PERMANENT THE MONITORING CONSISTS OF TAKING NOTE OF SYMPTOMS AND MEASURING SERUM CALCIUM, VITAMIN D (DEFICIENCY OF D3 IS VERY COMMON) AND URINE CALCIUM. THE FREQUENCY OF TESTING DEPENDS ON THE INDIVIDUAL, BUT ONCE TEH LEVELS ARE STABLE, TESTING THE SERUM CALCIUM 1-2 TIMES PER YEAR IS ADEQUATE. THE OBJECTIVES ARE: NO SYMPTOMS OF LOW CALCIUM, A SRUM CALCIUM LEVEL AT THE LOW END OF THE NORMAL RANGE AND NO EXCESS CALCIUM IN THE URINE (TO AVOID KIDNEY STONE FORMATION).

If a patient is still presenting with mild symptoms of hypoparathyroidism on a daily basis what care should they expect and from whom (surgeon, endocrinologist, GP...)? SUCH CASES NEED TO BE FOLLOWED UP CLOSELY BY A DOCTOR OR NURSE WHO HAS EXPERTISE IN THER AREA. THIS INCLUDES ENDOCRINOLOGISTS, MANY THYROID SURGEONS AND SOME GPS AND SPECIALIST NURSES. ADJUSTMENTS OF THE MEDICATION SHOULD TAKE PLACE AIMING TO MEET THE OBJECTIVES AS OUTLINED ABOVE.

Is it true that calcium levels fluctuate throughout the day? If so, is an annual calcium blood test done at approximately the same time of the day each year an accurate measure to provide effective management of the condition?

THERE IS A SMALL FLUCTUATION ESPECIALLY AFTER MEALS, AND IT IS A GOOD IDEA TO TAKE THE SAMPLE AT THE SAME TIME, SO THAT THE DATA ARE AS COMPARABLE AS POSSIBLE.

P