Risk of Permanent Hypoparathyroidism After Total Thyroidectomy for Benign Disease

Annebäck, Matilda; Hedberg, Jakob; Almquist, Martin; Stålberg, Peter; Norlén, Olov

doi:10.1097/sla.0000000000003800

Cited by 53 publications

(61 citation statements)

References 30 publications

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“…Permanent hypocalcemia occurred in 20.7% of patients in this study which fits within the previously reported frequencies in other studies (0.6% - 21.7%) ( 1 , 10 , 11 , 23 – 25 ). In adults the incidence is lower compared to children (1.0% -12.5%) ( 26 – 28 ). In our cohort permanent hypocalcemia only occurred in patients who underwent a total thyroidectomy plus lymph node dissection because of thyroid cancer.…”

Section: Discussionmentioning

confidence: 98%

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

et al. 2021

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BackgroundThyroidectomy is a treatment option in some benign thyroid disorders and the definitive treatment option for thyroid cancer. As postoperative mortality is extremely rare data on postoperative complications and long-term health consequences are important.ObjectiveTo evaluate the frequencies of short- and long-term complications, and their risk factors in pediatric patients (0-18 years) who underwent a thyroidectomy in a tertiary children’s hospital.MethodsA retrospective single center study was performed including all pediatric patients who underwent a thyroidectomy between January 2013 and February 2020.ResultsForty-eight patients were included in this study (mean age 14.6 years). Twenty-nine total thyroidectomies and 19 hemithyroidectomies were conducted. Thyroid carcinoma was the indication to perform a thyroidectomy in 12 patients, 36 patients underwent a thyroidectomy because of a benign thyroid disorder. Postoperative hypocalcemia was evaluated in patients who underwent a total thyroidectomy. Rapidly resolved hypocalcemia was observed in three patients (10.3%), transient hypocalcemia in 10 patients (34.5%) and permanent hypocalcemia in six patients (20.7%). Permanent hypocalcemia was only seen in patients who underwent a thyroidectomy combined with additional lymph node dissection because of thyroid carcinoma [thyroid carcinoma: OR 43.73, 95% CI (2.11-904.95); lymph node dissection: OR 76.14, 95% CI (3.49-458.98)]. Transient and permanent recurrent laryngeal nerve injury was reported in four (8.3%) and one (2.1%) of all patients, respectively.ConclusionPermanent postoperative complications after thyroidectomy are rare in pediatric patients undergoing a thyroidectomy without lymph node dissection. However, in this age group permanent hypocalcemia occurs more frequently after thyroidectomy with additional lymph node dissection because of thyroid cancer. With respect to quality of life, especially of pediatric thyroid cancer patients, reducing this complication is an important goal.

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Section: Discussionmentioning

confidence: 98%

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

et al. 2021

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“…The risk of POSH after thyroid surgery is influenced by several operative factors. High surgical volume ( 3 , 4 ), routine parathyroid identification and in situ preservation of parathyroid glands ( 5 ) are all reducing the risk of POSH. In contrast, longer operations, reoperation for bleeding, the need for associated central compartment lymph node dissection and the routine use of parathyroid autotransplantation ( 6 ) increase the risk of POSH.…”

Section: Causes Of Postsurgical Hypoparathyroidism (Hypopt)mentioning

confidence: 99%

“…In a multivariable analysis, there was a higher risk of POSH among women, patients over the age of 60 years, patients who underwent parathyroid autotransplantation and those operated in centers with a volume of <100 thyroidectomies per year. Surgeons might not be aware of most of these cases as their self-reported data from the quality register only identified 178 of these 938 patients with POSH ( 4 ).…”

Section: Epidemiology Of Postsurgical Hypoptmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Postsurgical hypoparathyroidism: current treatments and future prospects for parathyroid allotransplantation

Mihai

Thakker

2021

European Journal of Endocrinology

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Background. Permanent post-surgical hypoparathyroidism (POSH) is a major complication of anterior neck surgery in general and of thyroid surgery in particular. Depending of diagnostic criteria, up to 10% of patients undergoing bilateral thyroid surgery develop POSH. This leads to a multitude of symptoms that decrease the quality of life and burden the healthcare provision through complex needs for medication and treatment of specific complications, such as seizures and laryngospasm. Methods. Narrative review of current medical treatments for POSH and of the experience accumulated with parathyroid allotransplantation. Results. In most patients, POSH is controlled with regular use of calcium supplements and active vitamin D analogues but a significant proportion of patients continue to experience severe symptoms requiring repeated emergency admissions. Replacement therapy with synthetic PTH compounds (PTH1-34, Natpara® and PTH1-84, teriparatide, Forsteo®) has been assessed in multicentre trials, but the use of this medication is restricted by costs and concerns related to the risk of development of osteosarcoma. Based on recent case reports of successful allotransplantation of parathyroid tissue between siblings, there is renewed interest in this technique. Data on selection of donors, parathyroid cell preparation before allotransplantation, site and timing of transplantation, need for immunosuppression and long-term outcomes are reviewed. Conclusion. A prospective trial to assess the efficacy of parathyroid allotransplantation in patients with severely symptomatic protracted post-surgical hypoparathyroidism is warranted.

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“…Hypocalcemia after thyroidectomy is an effect of hypoparathyroidism occurring due to direct injury, devascularization, inadvertent excision of parathyroid glands, or mineral depletion of the bone caused by an increased metabolism [ 8 , 9 ]. Besides female sex, higher age, Graves’ disease and parathyroid gland reimplantation, vitamin D deficiency has been found to be an independent indicator of transient post-operative hypocalcemia following thyroid surgery [ 4 , 8 , 10 – 12 ]. However, there is no clear cut-off value for vitamin D, and opinions diverge on to what extent vitamin D levels may predict post-operative hypocalcemia [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Seasonal variation in calcium treatment after thyroidectomy as surrogate for post-operative hypocalcemia: a retrospective register-based national cohort study

et al. 2022

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Background Hypocalcemia is one of the most common complications of thyroidectomy, and vitamin D deficiency has been found to be an independent risk factor. Sweden is located north of the 55th latitude, resulting in a significant seasonal variation in sun exposure, thereby large variation in the naturally occurring levels of vitamin D. This study aimed to determine if there is a correlation between season of surgery and post-thyroidectomy hypocalcemia. Methods We conducted a retrospective register-based observation study on patients who had undergone total thyroidectomy during 2008–2015. In total, 7125 patients operated in Swedish facilities were identified via the Scandinavian Quality Register for Thyroid, Parathyroid, and Adrenal Surgery (SQRTPA). Patients operated during February–April were included in the dark group and patients operated during August–October were included in the bright group. Further stratification was made on the indication for surgery. The primary outcome was post-operative calcium treatment due to hypocalcemia, defined as having received calcium orally or intravenously before discharge. Results The risk of receiving post-operative calcium treatment was significantly lower in the bright group (29.7%) compared to the dark group (35.1%), with a relative risk of 0.846 (P < 0.001). This correlation held true if the indication for surgery was goiter or thyrotoxicosis. For malignancy, there was no significant difference between the groups. Conclusion In this cohort, total thyroidectomy performed during August–October was associated with a lower rate of calcium treatment given post-operatively when compared to total thyroidectomy performed during February–April. This would indicate a decreased risk of post-operative hypocalcemia if surgery was carried out after the brighter season.

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Risk of Permanent Hypoparathyroidism After Total Thyroidectomy for Benign Disease

Abstract: Supplemental Digital Content is available in the text

Cited by 53 publications

References 30 publications

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia

MANAGEMENT OF ENDOCRINE DISEASE: Postsurgical hypoparathyroidism: current treatments and future prospects for parathyroid allotransplantation

Seasonal variation in calcium treatment after thyroidectomy as surrogate for post-operative hypocalcemia: a retrospective register-based national cohort study

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