Publication: Under-recognized Hypoparathyroidism in Thalassemia
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Issued Date
2018-11-29
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ISSN
13085735
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2-s2.0-85057568777
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of clinical research in pediatric endocrinology. Vol.10, No.4 (2018), 324-330
Suggested Citation
Hataitip Tangngam, Pat Mahachoklertwattana, Preamrudee Poomthavorn, Ampaiwan Chuansumrit, Nongnuch Sirachainan, La or Chailurkit, Patcharin Khlairit Under-recognized Hypoparathyroidism in Thalassemia. Journal of clinical research in pediatric endocrinology. Vol.10, No.4 (2018), 324-330. doi:10.4274/jcrpe.0020 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/44995
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Title
Under-recognized Hypoparathyroidism in Thalassemia
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Abstract
Objective: Symptomatic hypoparathyroidism [symptomatic hypocalcemia without elevated serum parathyroid hormone (PTH)] in patients with thalassemia is relatively rare. Asymptomatic mild hypocalcemia without elevated PTH, which is considered hypoparathyroidism, may be more common but under-recognized. Methods: Sixty-six transfusion-dependent thalassemic patients and 28 healthy controls were enrolled. Serum calcium (Ca), phosphate (P), creatinine (Cr), albumin, intact PTH, 25-hydroxyvitamin D (25-OHD), plasma intact fibroblast growth factor-23 (FGF-23), urinary Ca, P and Cr were measured. Tubular reabsorption of P was calculated. Results: Thalassemic patients had significantly lower median serum Ca levels than the controls [8.7 (7.8-9.7) vs 9.6 (8.7-10.1) mg/dL, p<0.001]. Hypoparathyroidism was found in 25 of 66 (38%) patients. Symptomatic hypoparathyroidism was not encountered. Thalassemic patients also had significantly lower median plasma FGF-23 levels than the controls [35.7 (2.1-242.8) vs 53.2 (13.3-218.6) pg/mL, p=0.01]. In patients with hypoparathyroidism, median plasma FGF-23 level was significantly lower than that of normoparathyroid patients [34.8 (2.1-120.0) vs 43.1 (3.2-242.8) pg/mL, p=0.048]. However, serum P, Cr, intact PTH and 25-OHD levels were not significantly different in the two groups. Conclusion: Hypoparathyroidism was not uncommon in patients with transfusion-dependent thalassemia treated with suboptimal iron chelation. Plasma intact FGF-23 level in hypoparathyroid patients was lower than that of normoparathyroid patients.