Severe Graves' Ophthalmopathy may be a Risk Factor for the Development of Postthyroidectomy Hypocalcaemia

Hassan, I.; Dănilă, Radu; Maurer, Elisabeth; Osei-Agymang, Thomas; Zielke, A.

doi:10.1055/s-2008-1065333

Cited by 5 publications

(8 citation statements)

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“…[27] High incidence of hypocalcaemia in both subsets may be related to the autoimmunity associated with both conditions. The observation that concurrent active orbitopathy was found to potentiate the chance of post-operative hypocalcaemia in Grave's disease[28] underlines the above postulation.…”

Section: Discussionmentioning

confidence: 99%

Hypocalcaemia following total thyroidectomy: An analysis of 806 patients

Nair

Babu

Ramachandran

et al. 2013

Indian J Endocr Metab

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Background:Permanent hypocalcaemia following thyroidectomy causes considerable morbidity. This prospective observational study aims to define the factors likely to predict hypocalcaemia following total thyroidectomy.Materials and Methods:Patients who were subjected to total thyroidectomy during January 2005 to December 2009 were followed up for a minimum period of 1 year. Efficacy of an intraoperative parathyroid hormone assay to predict hypocalcaemia was validated.Results:Overall incidence of hypocalcaemia was 23.6% (n = 190) and that of permanent hypocalcaemia was 1.61% (n = 13). Onset was delayed up to 3rd postoperative day in 13 patients. Hypocalcaemia was significantly associated with thyroidectomy for Grave's Disease (P = 0.001), Hashimoto's thyroiditis (P = 0.003), and with incidental parathyroidectomy (P = 0.006). The intraoperative assay of parathyroid hormone showed low sensitivity (0.5) and satisfactory specificity (0.9) in predicting hypocalcemia.Conclusion:Hypocalcemia could manifest late in the immediate postoperative period and this may explain latent hypocalcemia. High incidence of hypocalcaemia noted in Grave's Disease could be due to the autoimmunity since same feature was noted associated with Hashimoto's thyroiditis and the incidence of hypocalcaemia was not high in the subgroup with toxic nodular goiter. The incidence of hypocalcemia was not affected by age or sex.

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Section: Discussionmentioning

confidence: 99%

Hypocalcaemia following total thyroidectomy: An analysis of 806 patients

Nair

Babu

Ramachandran

et al. 2013

Indian J Endocr Metab

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“…In contrast to previous studies that evaluated the effect of thyroidectomy on GO, the aim of the present study was to evaluate whether GO, which remains a relative surgical indication, would affect surgical outcomes in GD. We postulated that GO as an indication might adversely affect outcomes as the disease is generally more active and severe, making the surgery more technically demanding [12, 13]. Furthermore, a study has found that patients with severe GO are more likely to suffer from hypoparathyroidism after thyroidectomy [13].…”

Section: Discussionmentioning

confidence: 99%

“…We postulated that GO as an indication might adversely affect outcomes as the disease is generally more active and severe, making the surgery more technically demanding [12, 13]. Furthermore, a study has found that patients with severe GO are more likely to suffer from hypoparathyroidism after thyroidectomy [13]. Since GO is common and is present in about a third of patients with GD [15], the present analysis regarded only patients with active or unstable GO requiring ophthalmic treatment or follow-up as having a genuine indication for thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Most would presume that surgical outcomes are similar to other non-GO indications as the same procedure is performed. However, there is emerging evidence that patients with GO tend to have more active glandular disease and are more likely to relapse [12, 13]. Furthermore, one study has found that patients with severe GO are significantly more likely to suffer from both temporary and permanent hypoparathyroidism after bilateral thyroidectomy than those without GO ( P = 0.004), although the exact mechanism remains unexplained [13].…”

Section: Introductionmentioning

confidence: 99%

“…However, there is emerging evidence that patients with GO tend to have more active glandular disease and are more likely to relapse [12, 13]. Furthermore, one study has found that patients with severe GO are significantly more likely to suffer from both temporary and permanent hypoparathyroidism after bilateral thyroidectomy than those without GO ( P = 0.004), although the exact mechanism remains unexplained [13]. The aim of this study was to evaluate the impact of GO as an indication relative to other accepted indications on the surgical outcomes of thyroidectomy for GD.…”

Section: Introductionmentioning

confidence: 99%

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Graves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomy

Wong

Lang

2011

World j. surg.

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BackgroundStudies have evaluated the effect of thyroidectomy on the course of Graves’ ophthalmopathy (GO) but it is unclear how GO as an indication might affect surgical outcomes. We aimed to evaluate the impact of this indication on surgical outcomes in Graves’ disease (GD).MethodsFrom 1995 to 2008, 329 patients with GD underwent thyroidectomy. Patients were stratified into two groups, namely, those with GO as indication (GO) and those with non-GO indication (non-GO). Outcomes were compared between the groups and outcomes with significance were further analyzed by multivariate analyses to determine independent factors.ResultsThe GO group was significantly older (P < 0.001), had more males (P < 0.001), and fewer relapses (P < 0.001) than the non-GO group. It also had a higher proportion of total/near-total thyroidectomy (P < 0.001), despite a shorter operating time (P = 0.024) and less blood loss (P = 0.010). When only total/near-total thyroidectomy was considered, the GO group had significantly more permanent hypoparathyroidism than the non-GO group (9.2 vs. 1.6%, P = 0.038), but the rate of permanent hypoparathyroidism was similar in the two groups when only those with parathyroid autotransplantation were considered. Other complications were similar between the two groups. By multivariate analysis, GO as indication was an independent risk factor for temporary (OR 1.97, P = 0.033) and permanent hypoparathyroidism (OR 4.76, P = 0.007).ConclusionGO as a surgical indication (i.e., unstable or active GO requiring ophthalmic treatment or follow-up) was associated with increased risk of temporary and permanent hypoparathyroidism after bilateral thyroidectomy. Routine parathyroid autotransplantation may reduce the risk of permanent hypoparathyroidism in this select patient group.

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