Calcium Conundrums

PROGRAM DESCRIPTION: Hyper- and hypo-calcemia are common problems encountered by otolaryngologists in the academic and private practice setting. Hyperparathyroidism is the most common cause of hypercalcemia in the outpatient setting, but there are other less common causes that should be considered in the differential diagnosis particularly because of the importance in avoiding parathyroid surgery in patients with hypercalcemia due to other causes. Meanwhile, hypocalcemia is the most common complication after total or completion thyroidectomy. Permanent hypocalcemia has been reported to occur in up to 3% and temporary hypocalcemia in up to 50% of patients. Young women are much more likely to undergo thyroid surgery compared to men and hypocalcemia/hypoparathyroidism may have an adverse long term impact on bone health. An understanding of how to prevent and manage this complication is imperative for any surgeon performing thyroid surgery.
The purpose of this session is to provide a comprehensive discussion of calcium management. Calcium metabolism will be reviewed and the appropriate evaluation of a patient with hypercalcemia will be discussed. Multiple case presentations (hyperparathyroidism as well as uncommon causes of hypercalcemia) will be used to illustrate the pearls and pitfalls of hypercalcemia evaluation/treatment and parathyroid surgery.
This program was well received at the 2022 meeting. The primary change in the presentation if accepted for 2023 will be to remove the discussion of re-operative parathyroid surgery and discuss hypocalcemia avoidance and management in greater detail. Hypocalcemia will be highlighted via case presentation. Techniques for the identification and intraoperative preservation of parathyroid glands will be discussed and demonstrated on video. Postoperative calcium management options including empiric treatment with calcium regimens versus selective treatment based on parathyroid hormone, vitamin D levels, calcium levels, and other parameters will be reviewed. Guidelines from the AHNS and ATA on this topic will be presented.

OUTCOME OBJECTIVE 1: 1. Identify common and uncommon causes of hypercalcemia and the appropriate diagnostic laboratory testing

OUTCOME OBJECTIVE 2: 2. Describe techniques for preoperative and intraoperative parathyroid identification and pearls for primary parathyroid surgery

OUTCOME OBJECTIVE 3: 3. Explain techniques for intraoperative parathyroid preservation and the effectiveness, advantages and disadvantages of different postoperative hypocalcemia management strategies

BACKGROUND STATEMENT: There is a need for a review of the causes of hypercalcemia including the laboratory testing that facilitates diagnosis of less common causes, the pearls of primary parathyroid surgery, and the prevention and treatment of hypocalcemia post thyroidectomy.