Determination of risk factors causing hypocalcaemia after thyroid surgery

Lale, Azmi; Öz, Bahadır; Akçan, Alper; Sözüer, Erdoğan; Arıkan, Tamer; Gök, Mustafa

doi:10.1016/j.asjsur.2018.12.009

Cited by 10 publications

(20 citation statements)

References 24 publications

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“…In our study, 28.98% (51/176) of patients displaying transient hypocalcemia on postoperative day 1 and 2 patients (1.14%) developed permanent hypoparathyroidism at the 1-year follow-up. All of these incidences were within the range of the incidence of transient and permanent hypocalcemia as previously reported [ 1 – 3 , 13 , 17 , 18 ]. The differences in hypoparathyroidism incidence were attributed to the various thresholds used by the surgeons.…”

Section: Discussionsupporting

confidence: 86%

“…As documented in selected literature, total thyroidectomy without CLND induced lower rates of postoperative hypocalcemia [ 13 , 18 , 23 ]. Various surgeons confirmed that bilateral CLND was an independent risk factor for the development of transient hypoparathyroidism [ 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical and demographic parameters including diabetes, thyrotoxicosis, malignant pathology, age, female gender, and parathyroid gland number are all indicated as risk factors for asymptomatic and transient hypocalcemia [ 8 , 9 , 23 ]. The probability of age as a risk factor for postoperative hypocalcemia has been controversial until now [ 8 , 15 , 18 , 25 ]. The mechanism for the association of age and female gender with postoperative hypoparathyroidism has not been investigated.…”

Section: Discussionmentioning

confidence: 99%

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Parathyroid Hormone Reduction Predicts Transient Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective Study

Shang

Wang

et al. 2020

International Journal of Endocrinology

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Objective. We performed this study to investigate the risk factors for postoperative hypocalcemia after total thyroidectomy with central lymph node dissection (CLND). Study Design. This was a single-center prospective study based on 176 consecutive patients who underwent total thyroidectomy for papillary thyroid carcinoma. Setting. Patients were recruited between January 2016 and June 2018. Subjects and Methods. Patients who underwent bilateral (n = 155, bilateral group) and ipsilateral CLND (n = 21) after total thyroidectomy were included. The preoperative and postoperative parathyroid hormone (PTH) and calcium levels were detected. The risk factors for transient hypocalcemia were identified using logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results. Fifty-one (28.98%) patients developed transient hypocalcemia, and 2 patients (1.14%) developed permanent hypoparathyroidism. There was no difference in the gender ratio or the morbidity of hypocalcemia between the patients who underwent bilateral and ipsilateral CLND. On postoperative day 1, PTH decrease was a risk factor for transient hypocalcemia in the whole cohort (β = 0.043, OR = 1.044, 95% CI 1.023–1.065, p<0.001), bilateral group (β = 0.042, OR = 1.043, 95% CI 1.022–1.064, p<0.001), and female patients (β = 0.049, OR = 1.050, 95% CI 1.026–1.075, p<0.001). Tumor diameter was a risk factor for transient hypocalcemia in female patients (β = 0.499, OR = 1.647, 95% CI 1.003–2.704, p=0.049). The ROC curve analysis illustrated that 65.58%, 71.00%, and 71.00% PTH level reduction had high accuracy in predicting transient hypocalcemia in the whole cohort, bilateral group, and female patients, respectively (AUC = 0.986, 0.987, and 0.987). Conclusion. Asymptomatic female patients with bilateral CLND and a 71.00% PTH level reduction were at a high risk of transient hypocalcemia.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Parathyroid Hormone Reduction Predicts Transient Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective Study

Shang

Wang

et al. 2020

International Journal of Endocrinology

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“…15,32,49 In addition, accidental parathyroid gland removal can easily occur during surgery owing to the high proportion of female parathyroid glands that are located in the thyroid parenchyma, contributing to a significantly higher incidence of postoperative hypocalcaemia in patients with thyroidectomy. 50,51 Although numerous studies have indicated that women are an independent risk factor after thyroidectomy, 3,15,16,19,20,22,23,25,27,29,34 the incidence of hypocalcaemia in premenopausal and postmenopausal women needs to be further investigated.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

Chen

Zhao

et al. 2021

J Int Med Res

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Objective A meta-analysis to investigate the risk factors for postoperative hypocalcaemia after thyroidectomy in adult patients. Methods A systematic search of publications in the electronic databases (PubMed®, The Cochrane Library, Web of Science, OVID and Embase®) from inception to June 2020 was conducted. Screening of titles, abstracts and full texts and data extraction were independently performed by two authors. The OR was selected as the pooled estimate. Results The analysis included 23 studies. Twelve significant risk factors for postoperative hypocalcaemia were identified: hypoparathyroidism, OR 5.58; total thyroidectomy, OR 3.59; hypomagnesaemia, OR 2.85; preoperative vitamin D deficiency, OR 2.32; female sex, OR 1.49; thyroid malignancy, OR 1.85; thyroiditis, OR 1.48; substernal multinodular goitres, OR 1.70; parathyroidectomy, OR 1.58; central compartment neck dissection, OR 1.17; modified radical neck dissection, OR 1.57; and central neck dissection, OR 1.54. Conclusions This meta-analysis provides moderate-to-high quality evidence that the 12 risk factors were predictive of postoperative hypocalcaemia, which should be monitored closely before thyroidectomy.

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“…Among them, female gender, older age, hyperthyroidism, thyroid malignancy, undergoing a follow-up surgical procedure, sub-sternal localization of thyroid tissue, undergoing cervical lymph node dissection, and having an enlarged thyroid gland have been suggested as factors associated with increase in risk of hypocalcemia. 6 Finally, the risk of PoSH has been reported to increase with age, which is associated with vitamin D deficiency. 7 A previous study that examined the predictors of PoSH in patients undergoing TT has reported that 64.2% of patients had become hypocalcemic.…”

mentioning

confidence: 99%

The prevalence of hypocalcemia following total thyroidectomy

Althoubaity

Almusallam

Alghorair

et al. 2020

SMJ

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Objectives: To estimate the prevalence of hypocalcemia following total thyroidectomy (TT) at a tertiary center. Methods: This retrospective study was conducted between 2014 and 2019 at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The study was based at the Department of General Surgery and was approved by the Research Ethics Committee of KAUH. Medical records of 154 patients who had undergone TT were reviewed. Data such as age, gender, level of postoperative calcium at 24 and 48 hours after surgery, parathyroid hormone (PTH) levels, central neck dissection (CCND), histological diagnosis were entered into Microsoft Excel sheets. Results: Hypocalcemia occurred more on the second day after surgery in 67.4% of patients. Among them, 83.9% were female and 16.1% were male. The majority of patients were asymptomatic and benign thyroid disease was the most common. There was a significant association between hypocalcemia and the PTH level (p<0.001). Conclusion: There was a high prevalence of hypocalcemia on the second day after surgery. Presence of hypocalcemia association with the PTH level. Meticulous surgical technique and preservation of parathyroid vascularity are important in preventing postoperative hypocalcemia.

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Determination of risk factors causing hypocalcaemia after thyroid surgery

Cited by 10 publications

References 24 publications

Parathyroid Hormone Reduction Predicts Transient Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective Study

Parathyroid Hormone Reduction Predicts Transient Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective Study

Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

The prevalence of hypocalcemia following total thyroidectomy

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