Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

Chen, Zhimei; Zhao, Qiyuan; Du, Jinlei; Wang, Ya; Han, Rongrong; Xu, Caijuan; Chen, Xiaofang; Shu, Min

doi:10.1177/0300060521996911

Cited by 26 publications

(33 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Risk factors for total hypocalcemia were evaluated in recent meta-analyses and have been reported as TT (OR: 3.59), thyroid malignancy (OR:1.85), incidental parathyroidectomy (OR: 1.58), CND (OR: 1.54), female gender (R:1.49), hypoparathyroidism (OR: 5.58), hypomagnesemia (OR: 2.85), pre-operative vit D deficiency (OR: 2.32), and modified radical neck dissection (OR: 1.57). [ 24 ]…”

Section: Discussionmentioning

confidence: 99%

Effects of central neck dissection on complications in differentiated thyroid cancer

et al. 2021

View full text Add to dashboard Cite

Objective: It is still controversial whether performing central neck dissection (CND) in addition to total thyroidectomy (TT) increases the risk of complications. In the present study, we aimed to evaluate the effect of CND on the development of complications in differentiated thyroid cancer (DTC) compared to TT. Material and Methods: The data of 186 patients (136 females and 50 males) with a mean age of 48.73 ± 14.78 (range, 17–82) whom were operated for DTC were evaluated retrospectively. The patients were divided into two groups; TT (Group 1) and CND±TT/Completion thyroidectomy±lateral neck dissection (Group 2). Results: There were 117 (91 F, 26 M) patients in Group 1 and 69 (45 F, 24 M) patients in Group 2. Parathyroid auto transplantation (PA) was significantly higher in Group 2 compared to Group 1 (42% vs. 6%) ( p =0.000). Total (58% vs. 21.4%, respectively; p =0.000) and transient hypoparathyroidism (52.2% vs. 20.5%, respectively; p =0.000) were significantly higher in Group 2 than in Group 1, but permanent hypoparathyroidism rates were statistically not significant (5.8% vs. 0.9%, respectively; p =0.064). In the multinomial logistic regression analysis, CND alone was determined as an independent risk factor for increased both total and transient hypoparathyroidism. The relative risk (RR) of CND for total hypoparathyroidism was 5.2 times increased (odds ratio [OR]: 0.192) ( p =0.007), while the RR for transient hypoparathyroidism was 3.5 times increased (OR: 0.285) ( p =0.036). According to the number of nerves at risk, CND was performed in 119 neck side and only thyroidectomy was performed in 253 neck side. Total vocal cord paralysis (VCP) rate (9 [7.6%] vs. 6 [2.4%], respectively) ( p =0.017) and transient VCP rate (7 [6%] vs. 4 [1.6%], respectively) ( p =0.021) in patients who underwent CND were significantly higher compared to those who underwent only thyroidectomy. In multinomial logistic regression analysis performing only CND was an independent risk factor for total VCP, and increased the total VCP RR approximately 5.34 times (OR:0.184; p =0.007). Conclusion: Although CND can be applied without increasing the rates of permanent hypoparathyroidism and VCP compared to TT, it increases the risk of total and transient hypoparathyroidism, total, and transient VCP. Patients undergoing CND should be followed carefully in terms of transient hypoparathyroidism.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of central neck dissection on complications in differentiated thyroid cancer

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Although thyroidectomy is now considered a very safe surgery, known complications can seriously compromise patients’ quality of life [ 16 ]. Postoperative hemorrhage [ 17 , 18 ], recurrent laryngeal nerve injury (RLN) [ 19 ] and hypocalcemia [ 20 , 21 ] represent the most common adverse events after thyroidectomy. In this study, we focus on the risk of postoperative hypocalcemia.…”

Section: Discussionmentioning

confidence: 99%

PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia

Metere¹,

Biancucci

Natili³

et al. 2021

Diagnostics

View full text Add to dashboard Cite

Post-thyroidectomy hypocalcemia is a frequent complication with significant morbidity, and has been shown to increase hospital stay and readmission rates. The evaluation of serum parathyroid hormone (PTH) levels after thyroidectomy represents a reliable method to predict post-thyroidectomy hypocalcemia, but it remains infrequently used. This retrospective study investigates serum PTH values 3 h after thyroidectomy as a predictor of hypocalcemia. In this study, we enrolled 141 patients aged between 27 and 71 years eligible for total thyroidectomy who presented with multinodular goiter, suspicious nodule on cytological examination, Graves’ disease, or toxic multinodular goiter. Three hours after total thyroidectomy, 53 patients (37.6%) showed a reduction in serum PTH. Of these patients 75.5% developed hypocalcemia by 24 h after surgery and 100% were hypocalcemic after 48 h (p < 0.001). There was no significant difference attributable to the different thyroid diseases, nor to the age of the patients. PTH at 3 h after total thyroidectomy accurately predicts post-operative hypocalcemia. The early detection of patients at risk of developing post-operative hypocalcemia allows for prompt supplementation of calcium and Vitamin D in order to prevent symptoms and allows for a safe and timely discharge.

show abstract

“…The hypocalcemia in the postoperative period has many reasons. A meta-analysis of 23 studies with a total of 877356 patients indicates 12 risk factors for the development of postoperative hypocalcemia, such as hypoparathyroidism, thyroidectomy, hypomagnesemia, vitamin D deficiency, female, thyroid cancer, thyroiditis, retrosternal goiter, parathyroid attachment, central lymph node dissection, lateral lymph node dissection, dissection of surrounding thyroid gland tissues ( 38 ).…”

Section: Disadvantages Of Central Lymph Node Dissectionmentioning

confidence: 99%

A Narrative Review of Preventive Central Lymph Node Dissection in Patients With Papillary Thyroid Cancer - A Necessity or an Excess

et al. 2022

View full text Add to dashboard Cite

ObjectiveThis review article summarises the latest evidence for preventive central lymph node dissection in patients with papillary thyroid cancer taking into account the possible complications and risk of recurrence.BackgroundPapillary thyroid cancer is the most frequent histological variant of malignant neoplasms of the thyroid gland. It accounts for about 80-85% of all cases of thyroid cancer. Despite good postoperative results and an excellent survival rate in comparison with many other malignant diseases, tumor metastases to the cervical lymph nodes are frequent. Most researchers agree that the presence of obvious metastases in the lymph nodes requires careful lymph node dissection. It was suggested to perform preventive routine lymphadenectomy in all patients with malignant thyroid diseases referred to surgery.MethodsIt was performed the literature review using the “papillary thyroid cancer”, “central lymph node dissection”, “hypocalcemia”, “recurrent laryngeal nerve paresis”, “metastasis”, “cancer recurrence” along with the MESH terms. The reference list of the articles was carefully reviewed as a potential source of information. The search was based on Medline, Scopus, Google Scholar, eLibrary engines. Selected publications were analyzed and their synthesis was used to write the review and analyse the role of preventive central lymph node dissection in patients with papillary thyroid cancer.ConclusionsThe necessity of preventive central lymph node dissection in patients with differentiated papillary thyroid carcinoma is still controversial. There is much evidence that it increases the frequency of transient hypocalcemia. Due to the fact that this complication is temporary, its significance in clinical practice is debatable. It can also be assumed that an extant of surgery in the neck area is associated with an increased risk of recurrent laryngeal nerve injury. However, most studies indicate that this injury is associated more with thyroidectomy itself than with lymph node dissection. Recurrent laryngeal nerve dysfunction is also a temporary complication in the vast majority of cases. At the same time, a large amount of data shows that central lymph node dissection reduces the risk of thyroid cancer recurrence in two times.

show abstract

Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

Cited by 26 publications

References 53 publications

Effects of central neck dissection on complications in differentiated thyroid cancer

Effects of central neck dissection on complications in differentiated thyroid cancer

PTH after Thyroidectomy as a Predictor of Post-Operative Hypocalcemia

A Narrative Review of Preventive Central Lymph Node Dissection in Patients With Papillary Thyroid Cancer - A Necessity or an Excess

Contact Info

Product

Resources

About