Influence of gender and women’s age on the prevalence of parathyroid failure after total thyroidectomy for multinodular goiter

Abstract

Background: Female gender, particularly of a young age, has been reported as a risk factor for hypocalcemia after total thyroidectomy. There are no studies, however, addressing specifically the influence of women's age and menstrual status on postoperative parathyroid function.Methods: Cohort study of consecutive patients undergoing total thyroidectomy for benign goiter between 2000-2017, excluding those with associated hyperparathyroidism, reoperation or conservative procedures.Prevalence of postoperative hypocalcemia (s-Ca <8 mg/dL at 24 hours), protracted (1-month) and permanent hypoparathyroidism (>1 year) were the main variables studied. Complete >1-year follow-up was achieved for all patients developing post-thyroidectomy hypocalcemia. Demographic, disease-related, number of parathyroid glands remaining in situ (PGRIS), biochemical and surgical variables were recorded. The impact of menstrual status on parathyroid function was analyzed by comparing two groups of women using a cut-off age of 45 years.Results: A total of 811 patients were included: 14 percent were males and 86 percent females with a mean age of 53.2 years. The prevalence of postoperative hypocalcemia was ten points higher in women than in men (23.7% vs. 36.4%; P=0.008). Permanent hypoparathyroidism was more common in women than in men (5% vs. 0.9%; P=0.048). Compared to females ≥45 years, young women presented higher rates of all three parathyroid failure syndromes despite similar PGRIS scores. Age <45 years and low PGRIS scores were the only independent variables predicting postoperative hypocalcemia in females.Conclusions: Premenopausal patients presented a higher prevalence of parathyroid failure and permanent hypoparathyroidism with similar PGRIS scores suggesting the presence of a sex-hormone factor influencing post-thyroidectomy parathyroid function.

The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single center study

“…Villarroya-Marquina et al described female patients younger than 45 years of age and low PGRIS score as independent variables in predicting post-operative hypocalcemia in patients with MNG. [ 39 ]…”

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

“…In one way or another, these result in some kind of injury to the parathyroid glands (fragmentation, thermal injury, devascularization, inadvertent resection, autotransplantation into the sternocleidomastoid muscle). The only exception might be the higher prevalence of hypoparathyroidism syndromes in young women in whom, besides an iPTH drop, other endocrine regulators such as the estrogens may play a role, particularly in total thyroidectomy for benign disease [ 5 ].…”

Epidemiology and Financial Burden of Adult Chronic Hypoparathyroidism

“…Villaroya‐Marquina and colleagues ( 26 ) evaluated 811 patients undergoing total thyroidectomy for benign goiter and reported that premenopausal women developed a higher prevalence of chronic hypoparathyroidism than men despite similar number of parathyroid glands remaining in situ at the end of surgery.…”

“…Published studies have reported the prevalence of chronic hypoPT to range from 6.4–37/100,000 population in different countries. ( 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ) Incidence has been more difficult to estimate, with only two studies reporting this to be between 0.8/100,000/year in hospitalized patients in Denmark and 2.6/100,000/year in India in patients with idiopathic hypoPT. ( 17 , 27 ) Mortality was not reported to be increased in Denmark or South Korea, despite the increased morbidity these patients experience from recognized complications, but was increased in Scotland and Sweden.…”