Patients with hypoparathyroidism who experience severe symptoms and a low quality of life, despite receiving regular medication, would consider a parathyroid transplant as an appealing treatment option, a study has found.
The study, “Patients’ views about parathyroid transplantation for post-thyroidectomy hypoparathyroidism,” was published in the journal Langenbecks Archives of Surgery.
The most common cause of hypoparathyroidism is injury to the parathyroid glands during surgical removal of the thyroid, which can occur in up to 30 percent of the patients who undergo this type of surgery.
About a quarter of these patients will develop permanent hypoparathyroidism, even after being on treatment with oral calcium and vitamin D supplements. These supplements “cannot resolve all problematic aspects of the disease, such as abnormal bone remodeling” and lower quality of life, the researchers said.
Moreover, this type of treatment is associated with long-term complications, including kidney problems such as kidney stones, calcium deposits, and kidney impairments, cataracts, and brain calcifications.
The administration of parathyroid hormone (PTH) may normalize bone parameters, but there are no data about its benefits for the patients’ well-being.
A recent case report discussing a successful parathyroid transplant has, according to the study, “triggered renewed hopes” for many patients, including members of Hypopara UK, a U.K. patient support group for those living with a parathyroid condition.
The report described the case of a woman with therapy-resistant hypoparathyroidism who underwent a successful allotransplant (the transplant of organs from a non-identical donor) of the two parathyroid glands in the forearm.
In addition to the few management options for those living with permanent hypoparathyroidism, little is known about the impact of the condition on quality of life.
Conducted by researchers at Oxford University Hospitals NHS Foundation Trust in the U.K., the present study was aimed at investigating patients’ views on the severity of their symptoms and the acceptability of a parathyroid transplant as a potential new treatment for hypoparathyroidism.
All registered members of HypoParaUK were asked to complete an online survey; 252 responded, and their answers were analyzed.
Most declared they experienced severe symptoms despite regular medical treatment, the most troublesome being fatigue, a low sense of well-being, and numbness and/or tingling. They also considered their quality of life low.
Only a few of these patients (4%) never felt excessively tired and numbness/tingling, while 30 to 35% had these symptoms nearly all the time.
Currently, there is no established technique or protocol for attempting a parathyroid transplant. Three possible scenarios, together with their feasibility and risk-benefits, were presented to patients: a less invasive technique consisting of an intramuscular (into the muscle) injection of parathyroid cells from a donor, which is potentially unreliable; or two different procedures where the parathyroid gland from a donor is surgically inserted into the patient’s forearm, with or without an intermediate step of cell growth in a patch of donor’s skin. The latter options are more reliable but likely require long-term use of immunosuppressants.
Patients were “aware that none of these treatments are available and their development would require extensive and timely clinical work,” the researchers stressed.
Almost half (44%) of the participants were extremely interested in the less invasive option of intramuscular injection of parathyroid cells from a donor.
Fewer patients (14%) showed interested in the other two more invasive procedures involving implantation of a parathyroid allograft into their forearm. Regarding those two transplant options, patients were mostly worried about the use of immunosuppressant medication.
However, two-thirds of patients volunteered to be involved in the future development of parathyroid transplantation, either by being potential candidates or by providing support to patients in a similar situation.
Most patients who responded to the survey experienced severe symptoms and had a low quality of life, revealing that some people with hypoparathyroidism “require a more radical and effective treatment,” according to the researchers.
Parathyroid transplantation is seen by these patients as an “attractive and acceptable therapeutic option,” warranting a future clinical trial “to explore its feasibility and success rate,” they concluded.