Page 217 - EJMO-9-1

Eurasian Journal of Medicine and
Oncology Anticoagulant therapy on parathyroid

parathyroid infarction and one (0.66%) exhibited delayed
parathyroid infarction. Of the 110 patients in the control
group, 106 had temporary hypoparathyroidism, while
four developed permanent hypoparathyroidism; three
patients (2.72%) had acute parathyroid infarction. One
patient with delayed parathyroid infarction, who also had
diabetes and poor glycemic control after discharge, was
observed. This suggests that suboptimal glycemic control
may be associated with delayed parathyroid infarction, a
hypothesis that warrants further investigation.

Figure 1. Efficacy comparison between the two groups Because the study did not exclude patients with
comorbid conditions, including diabetes, hypertension,
level below 12 pg/mL. Patients meeting this criterion hyperlipidemia, and coronary heart disease, it is
routinely received calcium supplementation, with the dose possible that these underlying illnesses influenced both
adjusted based on the absence of overt clinical symptoms. clinical outcomes and response to treatment. Such
Hence, clinical presentations of hypocalcemia, such as comorbidities may introduce confounding factors, such
perioral numbness, were excluded from the diagnostic as altered metabolism, vascular compromise, or changes
criteria for hypoparathyroidism. in medication regimens, thereby complicating the
interpretation of post-operative recovery and parathyroid
Serum PTH and calcium levels were routinely measured function. Future studies with stricter inclusion criteria
on post-operative days 1, 3, 5, 15, 30, 90, and 180, with a or subgroup analyses stratified by relevant comorbidities
total follow-up period of 6 months. A PTH concentration will be necessary to clarify the true impact of these factors
below 12 pg/mL was considered indicative of parathyroid on outcomes. For instance, diabetes can compromise
dysfunction, including cases defined as “parathyroid microcirculation and delay the recovery of parathyroid
infarction”. Post-operative hypoparathyroidism could occur function, while some patients with coronary heart disease
even when the parathyroid glands remained anatomically may have been on long-term anticoagulant or antiplatelet
intact and normal during surgery, due to inadvertent therapy, potentially introducing bias to the findings. Future
vascular compromise, positional changes, or ischemia of investigations should consider stricter inclusion/exclusion
tissues adjacent to the parathyroid glands. These factors criteria or subgroup analyses by specific comorbidities to
could ultimately lead to parathyroid necrosis. Clinically, better isolate the effects of these factors on clinical outcomes.
this condition manifests as hypocalcemia, with symptoms For patients who develop permanent hypoparathyroidism,
including muscle spasms in the hands and feet, carpopedal the associated risk of hypocalcemia crises, psychiatric
tetany, and paresthesia. manifestations, gastrointestinal disturbances, chronic
The concept of parathyroid infarction was first kidney disease, and the burden of lifelong calcium
15,16
introduced globally in this study, with a conceptual patent supplementation significantly impair quality of life.
filed in China. Based on the time of onset, parathyroid 4.2. Causes of post-operative hypoparathyroidism
infarction is classified into two categories: Acute parathyroid
infarction, which occurs within 24 h after surgery, often Multiple factors contribute to post-operative
presents with a PTH level of 0; and delayed parathyroid hypoparathyroidism, including patient-specific variables
infarction, characterized by normal parathyroid function (e.g., pre-existing conditions), the nature of the thyroid
within the first 24 h, followed by sudden dysfunction after disease, biochemical parameters, and surgical factors.
17
24 h, which can persist for up to 3 months. The severity of A previous study found that higher pre-operative PTH
the disease is further categorized based on the PTH level: levels in patients with Graves’ disease were predictive of
• Mild: 8 – 12 pg/mL temporary post-operative hypocalcemia. The susceptibility
to hypocalcemia after Graves’ disease may be linked to
• Moderate: 4 – 8 pg/mL hyperthyroidism-related bone turnover. Malignant thyroid
18
• Severe: 0.01 – 4 pg/mL disease often necessitates more extensive surgical procedures,
• Extremely severe: 0 pg/mL (undetectable)
including central neck dissection, which increases the
Permanent hypoparathyroidism is defined as likelihood of post-operative hypoparathyroidism. In
persisting beyond 6 months. In this study, all 151 patients addition, age and female sex, which may be associated with
8
in the anticoagulant group experienced temporary lower Vitamin D status, are risk factors for post-operative
hypoparathyroidism. Among them, five (3.31%) had acute hypoparathyroidism.

Volume 9 Issue 1 (2025) 209 doi: 10.36922/ejmo.8105