Predictors and risk factors of hypoparathyroidism after total thyroidectomy

Cho, Jeong Nam; Park, Won Seo; Min, Sun Young

doi:10.1016/j.ijsu.2016.08.019

Cited by 77 publications

(64 citation statements)

References 23 publications

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“…As expected, these patients have low serum PTH level in the postoperative period. Lymph node dissection and malignancy have been reported as risk factors for developing HPP [13]. It has been reported by various studies that central lymph node dissection impairs blood supply of the parathyroid glands or inadvertently causes the performance of parathyroidectomy or autotransplantation during surgery [14].…”

Section: Discussionmentioning

confidence: 99%

Risk factors of hypoparathyroidism after bilateral total thyroidectomy

Aydın¹

2019

Ann Clin Anal Med

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Aim: Hypoparathyroidism (HPP) is a complication after thyroid surgery that is difficult-to-treat in the long term. Our aim was to assess the outcomes of patients undergoing bilateral total thyroidectomy for thyroid disorders and to determine the incidence and risk factors of transient or permanent HPP. Material and Method: The outcomes of patients who underwent bilateral total thyroidectomy were evaluated. The patients were divided into three groups, namely those that did not develop hypocalcemia (Group 1), those that developed transient hypocalcemia (Group 2), and those that developed permanent hypocalcemia (Group 3). Results: The mean postoperative Ca and iPTH levels were 8.1±0.6 mg/dL and 37.1±17.8 pg/mL, respectively in Group 1; 7.6±0.5 mg/dL and 10.9±10.7 pg/mL, respectively in Group 2; and 7.4±0.7 mg/dL and 8.2±9.6 pg/mL, respectively in Group 3. Postoperative Ca and iPTH levels were significantly lower in Group 2 and Group 3 compared to Group 1 (p<0.01). An inter-group analysis with respect to mean excised nodule size revealed a mean nodule size of 20.1±14.3 mm in Group 1; 21.5±14.5 mm in Group 2; and 35.6±11.5 mm in Group 3. The mean excised nodule size of Group 3 was significantly greater than those of the other groups (p<0.05). Discussion: Female gender, low preoperative calcium level, the number of incidentally excised parathyroid glands, and nodule size were considered risk factors for developing postoperative HPP; thus, it is recommended to follow such patients closely in the postoperative period.

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Section: Discussionmentioning

confidence: 99%

Risk factors of hypoparathyroidism after bilateral total thyroidectomy

Aydın¹

2019

Ann Clin Anal Med

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“…Similarly, those who undergo peripheral ligation of the inferior thyroid artery at the thyroid capsule are more prone to develop hypoparathyroidism than those who undergo subcapsular dissection (10). Parathyroid auto-transplantation, inadvertent excision of PGs and presence of PGs in the thyroid specimen have also been shown to increase the risk of post-operative hypoparathyroidism (1,(11)(12)(13)(14)(15)(16)(17). This is because they all lower the number of in situ PGs and therefore, the residual parathyroid function is immediately compromised.…”

Section: Risk Factors Leading To Postoperative Hypoparathyroidismmentioning

confidence: 99%

“…Some suggested that an early postoperative decrease in serum iPTH concentrations (8,10), combining with serum Ca concentration may predict hypoparathyroidism and guide the administration of Ca or vitamin D supplements (18,19). Post-operative hypoparathyroidism results from a reduction of functioning parathyroid parenchyma, which could be secondary to intraoperative damages caused by mechanical or thermal trauma, gland devascularization, obstruction of venous outflow, and inadvertent parathyroid excision (14,15,17). Therefore, the question has been whether there are strategies or approaches a surgeon could follow intra-operatively to minimize PG injuries and hypoparathyroidism.…”

Section: Risk Factors Leading To Postoperative Hypoparathyroidismmentioning

confidence: 99%

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To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

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Hypoparathyroidism is one of the most common complications after total thyroidectomy and may impose a significant burden to both the patient and clinician. The extent of thyroid resection, surgical techniques, concomitant central neck dissection, parathyroid gland (PG) autotransplantation and inadvertent parathyroidectomy have long been some of the risk factors for postoperative hypoparathyroidism. Although routine identification of PGs has traditionally been advocated by surgeons, recent evidence has suggested that perhaps identifying fewer number of in situ PGs during surgery (i.e., selective identification) may further lower the risk of hypoparathyroidism. One explanation is that visual identification may often lead to subtle damages to the nearby blood supply of the in situ PGs and that may increase the risk of hypoparathyroidism.However, it is worth highlighting the current literature supporting either approach (i.e., routine vs. selective) remains scarce and because of the significant differences in study design, inclusions, definitions and management protocol between studies, a pooled analysis on this important but controversial topic remains an impossible task. Furthermore, it is worth nothing that identification of PGs does not equal safe preservation, as some studies demonstrated that it is not the number of PGs identified, but the number of PG preserved in situ that matters. Therefore a non-invasive, objective and reliable way to localize PGs and assess their viability intra-operatively is warranted. In this aspect, modern technology such as the indocyanine green (ICG) as near-infrared fluorescent dye for real-time in situ PG perfusion monitoring may have a potential role in the future.

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“…Other studies include phosphorus and magnesium as predictors of hypocalcemia; however, their predictive value is significant since the second postoperative day. (15)(16)(17).…”

mentioning

confidence: 99%