LAUSR

Persistent hypoparathyroidism (PH) is a severe disease mostly occurring as a surgical complication of total thyroidectomy [1]. The primary goal of chronic management is to maintain serum calcium within an asymptomatic range avoiding significant hypoor hyper-calcemia; calcium and active vitamin D (calcitriol) are the most common and lowcost therapies used in this setting. However, choice of doses and strategies of follow-up are predominantly based on an empirical approach, which reflects huge variability among patients in the amount of calcium and calcitriol needed to correct biochemical and clinical profile. In fact, several patients do not achieve control of the disease under conventional therapy or need heavy up-titration, with high risk of poor compliance and side effects [2]. To overcome the current limitation, human recombinant PTH (rhPTH) (1–84) —identical in structure to full-length endogenous hormone —has been recently introduced in clinical practice and is currently indicated, due to its elevated cost, only in PH patients “resistant” to conventional therapy [3, 4]. Notably, so far there is no chance to predict resistance to conventional treatment, impairing the opportunity of personalized follow-up and adequate up-titration modalities.