Our Summary

This research paper explores the connection between long-term use of proton pump inhibitors (PPIs), a type of medication often used to reduce stomach acid, and a condition called hypocalcemia, which is a deficiency of calcium in the bloodstream. The study focused on people who had undergone a parathyroidectomy, a surgical procedure to remove parathyroid glands from the neck, which is known to sometimes cause hypocalcemia as a complication.

The study analyzed data from patients with a history of a condition called primary hyperparathyroidism who had been treated with a parathyroidectomy between 2012 and 2022. The researchers wanted to compare the rates of hypocalcemia in the months following the surgery between patients who had been taking PPIs and those who hadn’t.

Out of a total of 34,595 patients, around 19.5% had been taking PPIs before their surgery. The results showed that these patients were significantly more likely to experience hypocalcemia, both in the short term (up to 6 months after surgery) and permanently (6 to 12 months after surgery). They were also more likely to need emergency care after the surgery.

In simple terms, this study is the first to show that people who are on PPIs have a higher risk of experiencing a calcium deficiency in their blood after undergoing a parathyroidectomy.

FAQs

  1. What is the association between long-term use of proton pump inhibitors and parathyroidectomy?
  2. What is the rate of hypocalcemia following parathyroidectomy in patients on proton pump inhibitors?
  3. Is there an increased risk of hypocalcemia after parathyroidectomy in patients on proton pump inhibitors?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to discuss with their healthcare provider the potential impact of proton pump inhibitors on their risk of developing hypocalcemia after surgery. Patients who are taking proton pump inhibitors should be closely monitored for signs of hypocalcemia and may require additional calcium supplementation to help prevent complications.

Suitable For

Patients with primary hyperparathyroidism who are recommended for parathyroidectomy are typically those who have persistent high levels of parathyroid hormone, high levels of calcium in the blood, symptoms of hypercalcemia such as kidney stones, osteoporosis, or other complications related to high calcium levels. Patients with severe symptoms or complications of hyperparathyroidism may also be recommended for parathyroidectomy.

Timeline

  • Before parathyroidectomy: Patients with primary hyperparathyroidism may experience symptoms such as fatigue, weakness, bone pain, kidney stones, and elevated calcium levels in the blood. They may undergo diagnostic tests such as blood tests, imaging studies, and a sestamibi scan to locate the abnormal parathyroid gland.

  • During parathyroidectomy: The surgery is performed to remove the abnormal parathyroid gland causing the hyperparathyroidism. The patient is placed under general anesthesia, and the surgeon locates and removes the affected gland through a small incision in the neck.

  • After parathyroidectomy: Patients may experience temporary hypocalcemia due to the remaining parathyroid glands being temporarily unable to produce enough parathyroid hormone. Symptoms of hypocalcemia may include numbness or tingling in the hands and feet, muscle cramps, and confusion. Patients may need to take calcium and vitamin D supplements to help maintain normal calcium levels. Over time, the remaining parathyroid glands typically compensate for the removed gland, and calcium levels stabilize. Some patients may experience permanent hypocalcemia, requiring long-term calcium and vitamin D supplementation.

  • Follow-up care: Patients will have follow-up appointments with their surgeon to monitor calcium levels and overall health. They may also undergo regular blood tests to check for any signs of recurrent hyperparathyroidism. Overall, most patients experience improvement in their symptoms and quality of life after parathyroidectomy.

What to Ask Your Doctor

  1. What is the risk of hypocalcemia following parathyroidectomy for patients on proton pump inhibitors?
  2. How will my use of proton pump inhibitors affect my recovery from parathyroidectomy?
  3. What steps can be taken to mitigate the risk of hypocalcemia in patients on proton pump inhibitors undergoing parathyroidectomy?
  4. Are there any alternative medications or treatment options that may be better suited for me given my use of proton pump inhibitors?
  5. How closely will I be monitored for hypocalcemia following parathyroidectomy, especially if I am on proton pump inhibitors?
  6. What symptoms should I watch for that may indicate hypocalcemia, and when should I seek medical attention if I experience them?
  7. Are there any lifestyle changes or dietary considerations I should be aware of to help prevent hypocalcemia after parathyroidectomy, particularly as a patient on proton pump inhibitors?

Reference

Authors: Lorenz FJ, Goldenberg D. Journal: Am J Otolaryngol. 2023 Mar-Apr;44(2):103761. doi: 10.1016/j.amjoto.2022.103761. Epub 2022 Dec 23. PMID: 36586320