Factors in the occurrence and restoration of hypoparathyroidism after total thyroidectomy for thyroid cancer patients with intraoperative parathyroid autotransplantation

Abstract

IntroductionPostoperative hypoparathyroidism (POH) is the most common and important complication for thyroid cancer patients who undergo total thyroidectomy. Intraoperative parathyroid autotransplantation has been demonstrated to be essential in maintaining functional parathyroid tissue, and it has clinical significance in identifying essential factors of serum parathyroid hormone (PTH) levels for patients with parathyroid autotransplantation. This retrospective cohort study aimed to comprehensively investigate influential factors in the occurrence and restoration of POH for patients who underwent total thyroidectomy with intraoperative parathyroid autotransplantation (TTIPA).MethodThis study was conducted in a tertiary referral hospital, with a total of 525 patients who underwent TTIPA. The postoperative serum PTH levels were collected after six months, and demographic characteristics, clinical features and associated operative information were analyzed.ResultsA total of 66.48% (349/525) of patients who underwent TTIPA were diagnosed with POH. Multivariate logistic regression indicated that Hashimoto’s thyroiditis (OR=1.93, 95% CI: 1.09-3.42), P=0.024), the number of transplanted parathyroid glands (OR=2.70, 95% CI: 1.91-3.83, P<0.001) and postoperative blood glucose levels (OR=1.36, 95% CI: 1.06-1.74, P=0.016) were risk factors for POH, and endoscopic surgery (OR=0.39, 95% CI: 0.22-0.68, P=0.001) was a protective factor for POH. Multivariate Cox regression indicated that PTG autotransplantation patients with same-side central lymph node dissection (CLND) (HR=0.50; 95% CI: 0.34-0.73, P<0.001) demonstrated a longer time for increases PTH, and female patients (HR=1.35, 95% CI: 1.00-1.81, P=0.047) were more prone to PTH increases. Additionally, PTG autotransplantation with same-side CLND (HR=0.56, 95% CI: 0.38-0.82, P=0.003) patients had a longer time to PTH restoration, and patients with endoscopic surgery (HR=1.54, 95% CI: 1.04-2.28, P=0.029) were more likely to recover within six months.ConclusionHigh postoperative fasting blood glucose levels, a large number of transplanted PTGs, open surgery and Hashimoto’s thyroiditis are risk factors for postoperative POH in TTIPA patients. Elevated PTH levels occur earlier in female patients and patients without CLND on the transplant side. PTH returns to normal earlier in patients without CLND and endoscopic surgery on the transplant side.

Prospective cohort study of parathyroid function and quality of life after total thyroidectomy for thyroid cancer: robotic surgery vs. open surgery

“…Some guidelines have suggested that strategic transplantation of one PG can reduce (or even avoid) the occurrence of severe permanent hypoparathyroidism 9 , 28 . However, use of univariate and multivariate analysis after the Cox proportional hazards test identified PG transplantation to be a risk factor for permanent hypoparathyroidism in RT and OT, a conclusion that is consistent with that in previous reports 29 .…”

The safety, benefits and future development of overnight and outpatient thyroidectomy

“…The incidence of hypoparathyroidism in outpatient surgery was not statistically different from inpatients ( 9 , 10 , 34 ). The symptoms of hypoparathyroidism may not usually appear at once after surgery and may even appear on the 2nd or 3rd postoperative day.…”

“…The meticulous anatomy of the parathyroid glands and the protection of the blood supply of the parathyroid glands during surgery are effective measures to prevent postoperative hypoparathyroidism. In addition, intraoperative parathyroid autotransplantation can effectively prevent most permanent hypoparathyroidism, so each parathyroid gland should be protected as the last parathyroid gland during surgery ( 34 ). At present, many studies have predicted postoperative hypoparathyroidism and recovery by measuring the results of PTH or serum ions at different time points.…”

“…The proper extent of surgery is also important for the patient who will undergo outpatient thyroidectomy. At present, the surgical scope of outpatient thyroidectomy is mainly unilateral thyroidectomy, but bilateral thyroidectomy still accounts for a small proportion ( 9 , 10 , 34 ). Patients with malignancies will additionally undergo cervical neck dissection.…”