Hypoparathyroidism: what is the best calcium carbonate supplementation intake form?

Gollino, Loraine; Biagioni, Maria Fernanda Giovanetti; Sabatini, Nathalia Regina; Tagliarini, José Vicente; Corrente, José Eduardo; Paiva, Sérgio Alberto Rupp de; Mazeto, Gláucia Maria Ferreira da Silva

doi:10.1016/j.bjorl.2017.10.010

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Otorhinolaryngology

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • Braz. j. otorhinolaryngol. 85 (1) • Jan-Feb 2019 • https://doi.org/10.1016/j.bjorl.2017.10.010 copy

Hypoparathyroidism: what is the best calcium carbonate supplementation intake form?^☆ ☆ Please cite this article as: Gollino L, Biagioni MF, Sabatini NR, Tagliarini JV, Corrente JE, Paiva SA, et al. Hypoparatyroidism: what is the best calcium carbonate supplementation intake form? Braz J Otorhinolaryngol. 2019;85:63-70.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

In hypoparathyroidism, calcium supplementation using calcium carbonate is necessary for the hypocalcemia control. The best calcium carbonate intake form is unknown, be it associated with feeding, juice or in fasting.

Objective:

The objective was to evaluate the calcium, phosphorus and calcium × phosphorus product serum levels of hypoparathyroidism women after total thyroidectomy, following calcium carbonate intake in three different forms.

Methods:

A crossover study was carried out with patients presenting definitive hypoparathyroidism, assessed in different situations (fasting, with water, orange juice, breakfast with a one-week washout). Through the review of clinical data records of tertiary hospital patients from 1994 to 2010, 12 adult women (18-50 years old) were identified and diagnosed with definitive post-thyroidectomy hypoparathyroidism. The laboratory results of calcium and phosphorus serum levels dosed before and every 30 min were assessed, for 5 h, after calcium carbonate intake (elementary calcium 500 mg).

Results:

The maximum peak average values for calcium, phosphorus and calcium × phosphorus product were 8.63 mg/dL (water), 8.77 mg/dL (orange juice) and 8.95 mg/dL (breakfast); 4.04 mg/dL (water), 4.03 mg/dL (orange juice) and 4.12 mg/dL (breakfast); 34.3 mg²/dL² (water), 35.8 mg²/dL² (orange juice) and 34.5 mg²/dL² (breakfast), respectively, and the area under the curve 2433 mg/dL min (water), 2577 mg/dL min (orange juice) and 2506 mg/dL min (breakfast), 1203 mg/dL min (water), 1052 mg/dL min (orange juice) and 1128 mg/dL min (breakfast), respectively. There was no significant difference among the three different tests (p > 0.05).

Conclusion:

The calcium, phosphorus and calcium × phosphorus product serum levels evolved in a similar fashion in the three calcium carbonate intake forms.

KEYWORDS
Calcium; Calcium carbonate; Hypoparathyroidism; Phosphorus; Thyroidectomy

General characteristics	n = 12
Age (years)^a a Values expressed as mean ± SD.	43.3 ± 7.3
Caucasion^b b n (%); n, number of patients; CaCO3, calcium carbonate.	11 (91.7%)
Education attainment: secondary degree of secondary school^b b n (%); n, number of patients; CaCO3, calcium carbonate.	4 (33.2%)
Various workers^b b n (%); n, number of patients; CaCO3, calcium carbonate.	7 (58.3%)
Time after thyroidectomy (years)^a a Values expressed as mean ± SD.	8.60 ± 5.4
CaCO₃ supplement use^b b n (%); n, number of patients; CaCO3, calcium carbonate.	12 (100%)
CaCO₃ supplement dose (mg/day)^a a Values expressed as mean ± SD.	2141 ± 1193
Elemental calcium intake (mg/day)^a a Values expressed as mean ± SD.	856 ± 477
Calcitriol supplement use^b b n (%); n, number of patients; CaCO3, calcium carbonate.	10 (83.3%)
Calcitriol supplement dose (µg/day)^a a Values expressed as mean ± SD.	0.38 ± 0.18

Serum	CaCO₃ supplementation			p-value
	Water	Juice	Breakfast
Calcium (mg/dL)	8.54 ± 3.32	8.54 ± 3.32	8.73 ± 3.32	0.809
Phosphorus (mg/dL)	3.8 ± 0.69	3.74 ± 0.72	4 ± 0.65	0.640
Magnesium (mg/dL)	1.93 ± 0.17	1.88 ± 0.13	1.92 ± 0.17	0.693
Total protein (g/dL)	6.84 ± 0.58	6.89 ± 0.55	7.05 ± 0.76	0.716
Albumin (g/dL)	3.93 ± 0.38	3.98 ± 0.24	3.98 ± 0.38	0.939
Globulin (g/dL)	2.91 ± 0.34	3.25 ± 1.00	3.08 ± 0.48	0.482
Alkaline phosphatase (U/L)	72.58 ± 12.2	74 ± 15.8	71.33 ± 12.7	0.840
25-hydroxyvitamin D (ng/mL)	32.19 ± 10.2	33.36 ± 11.6	32.87 ± 9.56	0.964
PTH (pg/mL)	12.36 ± 8.66	14.01 ± 9.63	12.46 ± 8.04	0.876
TSH (µLU/mL)^a a Adjustment in distribution range (asymmetric data); significance, p < 0.05. CaCO3, calcium carbonate; FT4, free thyroxine; TSH, thyrotropin; PTH, parathyroid hormone. Reference values: calcium 8.4-10.2 mg/dL; phosphorus 2.5-4.5 mg/dL; magnesium 1.6-2.3 mg/dL; total protein 6.3-8.2 g/dL; albumin 3.5-5 g/dL; globulin 1.4-3.2 g/dL; alkaline phosphatase 35-104 U/L; 25-hydroxyvitamin D 30-60 ng/mL; PTH 11-65 pg/mL; TSH 0.4-4 µLU/mL; FT4 0.8-1.8 ng/mL.	1.21 ± 2.88	0.92 ± 2.01	0.9 ± 2.36	0.896
FT4 (ng/mL)	1.34 ± 0.28	1.35 ± 0.31	1.33 ± 0.38	0.990

Serum		CaCO₃ supplementation			p-value
		Water	Juice	Breakfast
Calcium	Maximum peak (mg/dL)	8.63 ± 0.87	8.77 ± 0.55	8.95 ± 0.38	0.477
	Time to peak (min)	202.5 ± 85.9	182.5 ± 57.8	152.5 ± 94.5	0.326
	AUC (mg/dL min)	2433 ± 239	2577 ± 214	2506 ± 121	0.226
	Maximum peak (mg/dL)	4.04 ± 0.76	4.03 ± 0.69	4.12 ± 0.66	0.945
Phosphorus	Time to peak (min)	142 ± 92.1	135 ± 99.0	167 ± 107	0.706
Phosphorus	AUC (mg/dL min)	1203 ± 173	1052 ± 119	1128 ± 320	0.981
Ca × P product	Maximum peak (mg²/dL²)	34.3 ± 6.55	35.8 ± 7.34	34.5 ± 6.41	0.827
	Time to peak (min)	180 ± 85.9	187 ± 85.9	192 ± 100	0.944
	AUC (mg²/dL min²)	9038 ± 1645	8846 ± 1365	9094 ± 1095	0.900

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:gmazeto@fmb.unesp.br (G.M. Mazeto).