Hypoparathyroidism following thyroidectomy: Predictive factors

Coimbra, Cristiana; Monteiro, Francisco; Oliveira, Pedro; Ribeiro, Leandro; Almeida, Mário Giesteira de; Condé, Artur

doi:10.1016/j.otoeng.2016.06.001

Cited by 4 publications

(5 citation statements)

References 20 publications

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“…In contrast, the surgeon’s experience had a protective role, suggesting that high-volume surgeons could safely perform more extensive central neck dissections with lower incidences of complications [ 30 ]. The extent of thyroid surgery is not necessarily associated with increased risk of incidental parathyroidectomy [ 26 , 27 , 29 , 30 , 31 , 32 , 33 ], as reported in our experience. Interestingly, incidental parathyroidectomy was associated with a higher risk of temporary hypoparathyroidism and with permanent hypocalcemia, although not statistically significant, but not with temporary hypocalcemia.…”

Section: Discussionsupporting

confidence: 61%

“…Many studies tried to find an explanation to female predisposition to post-thyroidectomy hypocalcemia [ 6 ] and, although the specific mechanism is not certain, the gender disparity may be related to effects of sexual steroids on PTH secretion [ 25 , 26 ]. Female patients were at higher risk of developing postoperative hypoparathyroidism (53/142, 37.3%) compared to male patients (6/47, 12.7%, p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Total thyroidectomy is seen to have an equivocal association with symptomatic hypocalcemia, with little evidence suggesting an association with either temporary or permanent hypocalcemia [ 10 ]. However, neck dissection demonstrates a significant association with hypoparathyroidism [ 5 , 16 , 23 , 26 ], but a recent meta-analysis demonstrated that the addition of neck dissection to total thyroidectomy shows an association only with symptomatic and permanent hypocalcemia, but not with temporary biochemical hypocalcemia [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…No significant correlation was found between histological type, cancer volume and thyroid volume and postoperative hypoparathyroidism, as reported in other studies [ 27 ]. In contrast, Mo et al [ 4 ], in their study investigating the risk for temporary hypocalcemia in 176 patients undergoing total thyroidectomy for papillary thyroid carcinoma, found that tumor diameter was a risk factor for temporary hypocalcemia in female patients, while histological diagnosis of papillary cancer may be related to an increased incidence of postoperative hypocalcemia [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this study, incidental parathyroidectomy was correlated with younger age (<40 years) and with neck dissection with higher lymph-node yield, while total thyroidectomy and histological findings did not increase the incidence of incidental parathyroidectomy. Malignancy and neck dissection, together with the surgeon’s experience have been identified as the strongest risk factors associated with incidental parathyroidectomy [ 26 , 27 , 29 , 30 , 31 , 32 , 33 ]. In their study, Barrios et al [ 30 ], among 1114 thyroidectomies and 396 concurrent central neck dissections performed across seven surgeons, found that central neck dissection, either prophylactic or therapeutic, but not the yield of lymphadenectomy, increased the risk of incidental parathyroidectomy (OR 2.68 and 4.44, respectively).…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Low Levels of Parathyroid Hormone after Surgery for Thyroid Cancer: A Single Center Study

Privitera

Gioco

Fazio

et al. 2021

JCM

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Background: Thyroidectomy is the definitive treatment for most patients with thyroid cancer. Hypoparathyroidism is the most frequent complication of thyroidectomy, and its pathogenesis is multifactorial. The aim of this study is to evaluate the patient- and surgical-related risk factors for hypoparathyroidism after surgery for thyroid cancer. Methods: In this retrospective study, patients referred to surgery for thyroid cancer from 2016 to 2019 were enrolled. Preoperative serum calcium and parathyroid hormone (PTH) and postoperative 24 h PTH and calcium levels were evaluated. Demographic data, type of surgery, incidence of hypoparathyroidism and hypocalcemia were recorded for all the patients. Patients were divided into two groups based on post-operative PTH levels (≤12 and >12 pg/mL). Results: A total of 189 patients were enrolled in this study. There were 146 women (87.3%) and 43 men (22.7%), with a mean age of 51.3 years. A total of 79 patients (41.7%) underwent a neck dissection. A total of 59 patients (31.1%) had a postoperative PTH level < 12 pg/mL. Female sex, neck dissection, the yield of lymph node dissection and incidental parathyroidectomy were significantly associated with postoperative hypoparathyroidism. Incidental parathyroidectomy was reported in 44 (23.2%) patients and was correlated with younger age (<40 years) and neck dissection. There was no difference in the rate of post-operative hypocalcemia between patients with incidental parathyroidectomy and those without. Conclusions: Young patients undergoing neck dissection and with incidental parathyroidectomy have the highest risk of postoperative hypoparathyroidism after surgery for thyroid cancer. However, a large proportion of patients without incidental parathyroidectomy may have temporary hypocalcemia, suggesting that impaired blood supply of parathyroid glands during their identification and dissection may play a relevant role.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Risk Factors for Low Levels of Parathyroid Hormone after Surgery for Thyroid Cancer: A Single Center Study

Privitera

Gioco

Fazio

et al. 2021

JCM

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Incidence and risk factors of hypoparathyroidism and hypocalcemia after hemithyroidectomy

Jeong,

Song,

et al. 2023

Langenbecks Arch Surg

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What are the real rates of temporary hypoparathyroidism following thyroidectomy? It is a matter of definition: a systematic review

et al. 2021

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Introduction Post-operative hypoparathyroidism is the most encountered complication of thyroid surgery and is classified as temporary or permanent. However, its incidence varies greatly in the literature ranging from 0.5% to 65%. This can be mainly attributed to the different definition of hypoparathyroidism used in each study and especially to the different time cutoff applied to distinguish temporary from permanent hypoparathyroidism. Methods We conducted a systematic literature search in PubMed, Scopus, Cochrane and GoogleScholar databases, as well as grey literature. Ultimately, 45 articles with 23,164 patients in total were included in this review. These articles used either the cutoff of six or twelve post-operative months to distinguish temporary from permanent hypoparathyroidism. Results The overall incidence of permanent hypoparathyroidism diagnosed at 6 months post-operatively was 4.11% and 4.08% at 12 months post-operatively. There was no statistically significant difference between the two groups (p = 0.92). Conclusions We suggest that adhering to the current guidelines that recommend diagnosing temporary hypoparathyroidism when recovery is made within 6 months after surgery is important when conducting future research in order to narrow the gap that exists currently in the literature, as well as when deciding to put patients on long-term calcium supplements.

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Hypoparathyroidism following thyroidectomy: Predictive factors

Cited by 4 publications

References 20 publications

Risk Factors for Low Levels of Parathyroid Hormone after Surgery for Thyroid Cancer: A Single Center Study

Risk Factors for Low Levels of Parathyroid Hormone after Surgery for Thyroid Cancer: A Single Center Study

Incidence and risk factors of hypoparathyroidism and hypocalcemia after hemithyroidectomy

What are the real rates of temporary hypoparathyroidism following thyroidectomy? It is a matter of definition: a systematic review

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