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We have studied the serial changes in plasma endothelin (ET)-1, serum parathyroid hormone (PTH) and serum calcium concentrations during surgery in 20 patients undergoing a hemithyroidectomy for thyroid carcinoma. The plasma ET-1 concentrations increased within the first 24 h following surgery in 18 out of 20 cases with the peak concentration achieved between 1 and 12 h. Gel permeation chromatography showed only one major peak at the elution position of human ET-1 standard both in the pre- and postoperative plasma. Thirteen patients showed transient hypoPTHaemia and hypocalcaemia which clearly coincided with the peak plasma ET-1 concentration in 12. However, there was no significant association between the extent of the increase in the plasma ET-1 levels and the incidence of the transient hypoparathyroidism. When blood was sampled at multiple sites during surgery, the plasma ET-1 concentrations tended to be higher in the internal jugular vein on the side of the preserved thyroid lobe (4·92 ±2·21 pg/ml) as well as on the side of the lobectomy (4·36 ±1·95 compared with that in the antecubital vein (3·66± 1·44). Furthermore, tissue extracts from the parathyroid and thyroid contained considerably greater amounts of immunoreactive (ir-) ET-1 than most of the other tissues tested. In vivo experiments in animals revealed that a continuous infusion of ET-1 directly into the arterial bed supplying the preserved parathyroid glands can lead to a fall in serum PTH and Ca concentrations, whereas a bolus infusion into the artery or even a continuous infusion into the peripheral vein failed to do so, suggesting that the local increase in ET-1 may provoke this effect. All these results indicate that the transient increase in the plasma ET-1 level may be responsible for the transient hypoparathyroidism seen in patients after thyroid surgery despite successful preservation of the parathyroid glands. This effect may be mediated either through its vasoconstrictive activity or by its inhibitory effect on PTH secretion.

Journal of Endocrinology (1994) 143, 343–351