Associated Factors of Long-Term Severe Hypocalcemia after Total Parathyroidectomy with Forearm Auto-Transplantation in Patients with Renal Hyperparathyroidism
Potchara Rungprasertsuk, MD¹, Sasithorn Sujarittanakarn, MD¹, Wilairat Thoviriyavej, MD¹
Affiliation : ¹ Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
Objective: To identify patient-specific factors associated with long-term severe hypocalcemia following total parathyroidectomy with forearm auto-transplantation (TPTx+AT) in patients with renal hyperparathyroidism.
Materials and Methods: A retrospective study was conducted on 70 patients who underwent TPTx+AT at Thammasat University Hospital between January 2013 and October 2023. The clinical and laboratory data of these patients were analyzed. Multivariable logistic regression was used to identify independent predictors of long-term severe hypocalcemia. Analyzed variables included age, preoperative serum calcium, parathyroid hormone, alkaline phosphatase, clinical of pruritus, bone pain, and history of postoperative intravenous calcium supplementation.
Results: Long-term severe hypocalcemia occurred in 26 of 70 patients (37.1%). Logistic regression revealed that a history of intravenous calcium administration was significantly associated with increased odds of long-term severe hypocalcemia (OR 10.29, 95% CI 1.70 to 60.32, p=0.01). Younger age was also identified as a significant predictor (OR 0.93 per year, 95% CI 0.88 to 0.98, p=0.01).
Conclusion: Younger age and postoperative intravenous calcium supplementation are independent predictors of long-term severe hypocalcemia following TPTx+AT. Identifying high-risk patients may facilitate proactive postoperative monitoring and individualized calcium management.
Received 6 November 2025 | Revised 26 February 2026 | Accepted 9 March 2026
DOI: 10.35755/jmedassocthai.2026.5.03895
Keywords : Hyperparathyroidism; Secondary; Parathyroidectomy; Transplantation; Autologous; Hypocalcemia; Postoperative complications; Renal insufficiency; Chronic; Calcium
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