Post-surgical Hypoparathyroidism Can Lead to Fatigue, Low Energy

However, fatigue and low energy do not appear to reduce overall quality of life

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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People who go on to develop hypoparathyroidism after surgery in the neck feel more tired and have less energy than control patients who do not develop the disease, a study from the U.K. has found.

However, fatigue and low energy do not appear to reduce overall quality of life, which is contrary to previous studies where people with post-surgical hypoparathyroidism were found to experience lower quality of life.

Researchers noted that perhaps generic quality-of-life measures “may not be sensitive enough” to pick up changes in quality of life in these patients. “A disease-specific tool may be required,” they wrote.

The study, “Quality of life in post-surgical hypoparathyroidism (PoSH) in thyroid and parathyroid surgery,” was published in the World Journal of Surgery.

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Hypoparathyroidism occurs when the parathyroid glands, which are located in the neck, produce too little of parathyroid hormone. Often, this happens when the parathyroid glands are removed or damaged during surgery to the neck.

The parathyroid hormone helps the body keep the right balance of calcium and phosphorus. This means that having not enough of it can cause a range of symptoms from tingling in the lips, fingertips, and toes to muscle cramping and twitching, tiredness, and changes in mood.

When the cause is surgery, these symptoms usually resolve within weeks or months. However, they may sometimes persist for longer despite treatment, taking a toll on quality of life.

It can be difficult to put together a good number of people who can serve as controls in a study, and many of the previous studies on quality of life have failed to do just that.

The researchers at University of Sheffield managed to get round this difficulty by sending out an online questionnaire in what they claim is “the largest [matched] control study to date” to look at how post-surgical hypoparathyroidism may change quality of life.

Study receives 439 responses to online questionnaire

They received a total of 439 responses to the questionnaire. All responders had undergone surgical exploration of both sides of the neck to find the parathyroid glands or a thyroidectomy to remove all of the thyroid gland some time from 1973 to 2019.

More than half (57.4%) had undergone a thyroidectomy to remove a cancer. The remaining had either a benign (non-cancerous) tumor (27.3%); multiple endocrine neoplasia, which typically involves tumors in hormone-producing glands (13.7%); or an unknown medical condition (1.6%).

Most (86.3%) were women and the median age was 52 years, ranging from 19 to 92 years. Of the 439 patients who responded to the questionnaire, 89 (20.3%) developed post-surgical hypoparathyroidism. Each was matched to three other patients of about the same age and sex who had undergone the same type of surgery but did not develop post-surgical hypoparathyroidism.

To gauge a patient’s opinion about quality of life, the researchers used the SF-36, which contains a set of generic quality-of-life measures. When the researchers watched for how much people with post-surgical hypoparathyroidism scored out of the total possible score that can be achieved, they found it was similar to control patients (54.2% vs. 60.6%).

But when they looked at vitality, which is a measure of fatigue and energy within the SF-36, they found it was significantly lower in people with post-surgical hypoparathyroidism. This held true for those who had undergone a thyroidectomy for a cancer or multiple endocrine neoplasia, but not a benign tumor.

As part of the questionnaire, the researchers also included the Hypocalcemia Symptom Score (HcSS), a yet-to-be-validated tool that assesses symptoms arising directly from too little calcium in the body (hypocalcemia). 

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Symptoms arising from calcium imbalance may be linked to fatigue, low energy

There were about as many patients with calcium levels within the normal range as there were patients who said their calcium levels were low or very low (43% vs. 44%). Of note, calcium levels had been monitored in the six previous months in these participants.

However, compared to control patients, those with post-surgical hypoparathyroidism had lower overall scores in the HcSS.

HcSS scores showed a moderate correlation with those of SF-36’s vitality, suggesting that symptoms arising from problems with the balance of calcium may be linked to fatigue and low energy, according to the team.

This also means that “a disease-specific tool may identify further aspects of quality of life not explored as part of the SF-36,” the researchers wrote.

All participants who took part in this study were members of one of two patient groups (Butterfly Thyroid Cancer Trust or the Association for Multiple Endocrine Neoplasia Disorders), or had undergone surgery at Sheffield Teaching Hospitals NHS Foundation Trust.