Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients

Díez, Juan J.; Anda, Emma; Sastre, Julia; Corral, Begoña Pérez; Álvarez-Escolá, Cristina; Manjón, Laura; Paja, Miguel; Sambo, Marcel; Fernández, Piedad Santiago; Carrera, Concepción Blanco; Galofré, Juan Carlos; Navarro, Elena; Zafón, Carles; Sanz, Eva; Oleaga, Laura; Bandrés, Orosia; Donnay, Sergio; Megía, Ana; Picallo, María; Sánchez-Ragnarsson, Cecilia; Baena-Nieto, Gloria; Fernández‐García, José Carlos; Lecumberri, Beatriz; Vega, Manel Sahún de la; Romero-Lluch, Ana R.; Iglesias, Pedro

doi:10.21037/gs-20-288

Cited by 5 publications

(5 citation statements)

References 31 publications

(38 reference statements)

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“…This was illustrated in a Swedish study showing hypoPT patients being overtreated because attempts to stop treatment were lacking 27 . Likewise, a Spanish study showed 15% of hypoPT patients had poor disease control which may indicate that the treatment can be optimised 28 . Finally, many different degrees of hypoPT exist including both symptomatic and asymptomatic cases, patients with normal, low or unmeasurable PTH, patients with normal and abnormal absorption from oral intake and patients with various combinations of other comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Hypoparathyroidism and mortality after total thyroidectomy: A nationwide matched cohort study

Reinke,

Udholm,

Christiansen

et al. 2024

Clinical Endocrinology

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ObjectiveTotal thyroidectomy (TT) carries a risk of hypoparathyroidism (hypoPT). Recently, hypoPT has been associated with higher overall mortality rates. We aimed to evaluate the frequency of hypoPT and mortality in patients undergoing TT in Denmark covering 20 years.DesignRetrospective Cohort study.Patients and measurementsUsing population‐based registries, we identified all Danish individuals who had undergone TT between January 1998 and December 2017. We included a comparison cohort by randomly selecting 10 citizens for each patient, matched on sex and birth year. HypoPT was defined as treatment with active vitamin D after 12 months postoperatively. We used cumulative incidence to calculate risks and Cox regression to compare the rate of mortality between patients and the comparison cohort. We evaluated patients in different comorbidity groups using the Charlson Comorbidity Index and by different indications for surgery.Results7912 patients underwent TT in the period. The prevalence of hypoPT in the study period was 16.6%, 12 months postoperatively. After adjusting for potential confounders the risk of death due to any causes (hazard ratio; 95% confidence intervals) following TT was significantly increased (1.34; 1.15‐1.56) for patients who developed hypoPT. However, subgroup analysis revealed mortality was only increased in malignancy cases (2.48; 1.99‐3.10) whereas mortality was not increased when surgery was due to benign indications such as goitre (0.88; 0.68‐1.15) or thyrotoxicosis (0.86; 0.57‐1.28).ConclusionsThe use of active vitamin D for hypoPT was prevalent one year after TT. Patients with hypoPT did not have an increased risk of mortality following TT unless the indication was due to malignancy.

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Section: Discussionmentioning

confidence: 99%

Hypoparathyroidism and mortality after total thyroidectomy: A nationwide matched cohort study

Reinke,

Udholm,

Christiansen

et al. 2024

Clinical Endocrinology

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“…and permanent HypoPT represents the most common long-term complication following this procedure [1][2][3][4][5][6][7][8][9][10].…”

Section: Original Papermentioning

confidence: 99%

“…Regarding postoperative stay, as widely described in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13]41], patients with lower postoperative PTH values and therefore lower postoperative serum calcium levels cannot, for safety reasons, be discharged early and therefore have a longer hospital stay.…”

Section: Original Papermentioning

confidence: 99%

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Intact parathyroid hormone value on the first postoperative day following total thyroidectomy as a predictor of permanent hypoparathyroidism: a retrospective analysis on 426 consecutive patients

Canu

Medas

Cappellacci

et al. 2022

Endokrynologia Polska

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stones, nephrocalcinosis, chronic kidney disease, basal ganglia calcifications, myocardial dysfunction, dental abnormalities, and cataracts [9,[14][15][16][17][18].In the case of permanent HypoPT, to avoid subtle but potentially lethal complications, long-term treatment, which consists of administration of calcium and vitamin D, and careful follow-up are mandatory. However, it is important to underline that long-term calcium supplementation may cause side effects, such as myocardial infarction, gastrointestinal reactions, and urinary calculi [9,19,20].Costs to society due to this complication, in terms of medical treatments and surveillance, are considerable [1-10]. Moreover, permanent HypoPT is an important cause of medical litigation [21].To date, there is still no reliable and immediate postoperative parameter to establish which patients with postsurgical HypoPT will develop permanent HypoPT [1,

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Predictive value of parathyroid hormone levels for permanent hypoparathyroidism at different time points after papillary thyroid cancer surgery

Gao

Zhang

Wang

et al. 2023

Preprint

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Purpose To investigate the relationship between parathyroid hormone (PTH) levels on day 1 after radical thyroid surgery for papillary carcinoma and permanent hypoparathyroidism (PHPP) and the predictive value of the relationship between them. Methods Eighty patients with papillary thyroid cancer who underwent total thyroidectomy and lymph node dissection in the central area admitted to the General Surgery Department of Gansu Provincial People’s Hospital from January 2021 to January 2022 were collected and analyzed. Patients were divided into hypoparathyroidism and normal parathyroid groups according to whether PHPP occurred after surgery, and the correlation between parathyroid hormone (PTH) and serum calcium levels and permanent hypoparathyroidism (PHPP) on postoperative day 1 in both groups was analyzed using univariate and binary logistics regression. The area under the subject operating curve (ROC) was used to assess the predictive validity of PTH for the occurrence of PHPP in the postoperative period. Results PHPP occurred in 10 of the 80 patients with papillary thyroid cancer included, with an incidence of 12.5%; binary logistic regression analysis showed that PTH on a postoperative day 1 (OR = 14.534, 95% CI: 2.377 to 88.858, P = 0.004), was an independent predictive risk factor for the development of PHPP after surgery. The area under the curve (AUC) was 0.874 (95% CI: 0.79–0.958, P = 0.000) with a sensitivity of 71.4%, specificity of 100%, and Jorden index of 0.714, using PTH = 8.75ng/L on postoperative day 1 as the threshold value. Conclusions PTH levels on day 1 after total thyroid papillary carcinoma are strongly associated with permanent hypoparathyroidism and are an independent predictor of the development of PHPP.

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Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients

Cited by 5 publications

References 31 publications

Hypoparathyroidism and mortality after total thyroidectomy: A nationwide matched cohort study

Hypoparathyroidism and mortality after total thyroidectomy: A nationwide matched cohort study

Intact parathyroid hormone value on the first postoperative day following total thyroidectomy as a predictor of permanent hypoparathyroidism: a retrospective analysis on 426 consecutive patients

Predictive value of parathyroid hormone levels for permanent hypoparathyroidism at different time points after papillary thyroid cancer surgery

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