Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia

Edafe, Ovie; Antakia, Ramez; Laskar, Nabila; Uttley, Lesley; Balasubramanian, Sabapathy P

doi:10.1002/bjs.9384

Cited by 557 publications

(639 citation statements)

References 111 publications

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“…According to a study of 100 cadaveric thyroid glands32, 38.2 per cent of the parathyroid vessels were considered at risk of damage during standard thyroidectomy; the authors reported that the four parathyroid glands were at risk in 5 per cent of the subjects. These results32 provide an anatomical explanation for the consistent reporting of a small proportion of patients with definitive hypoparathyroidism in most registry‐based or multicentre studies1, 33, 34. Hypothetically, ICG angiography could identify the vascular supply of parathyroid glands at risk of damage during dissection.…”

Section: Discussionsupporting

confidence: 57%

“…Postoperative hypoparathyroidism is currently the most common complication of total thyroidectomy1, and there is a need for a reliable tool that can accurately predict whether a patient will develop hypocalcaemia1, 14, 15. Currently available methods to evaluate parathyroid function are based on measurements of calcium16, 17 and PTH2, 6, 7, 18, 19, 20 levels at different time points after thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Transient hypocalcaemia is frequent and has been described in 15–30 per cent of patients, depending on the technical difficulty of the procedure and expertise of the surgeon. Permanent hypocalcaemia, defined as hypocalcaemia present for more than 6 months after thyroidectomy, has been reported in 1–3 per cent of patients1. Some authors have described rates of up to 10 per cent1, 2, which suggests a possible underestimation of the true prevalence of permanent hypocalcaemia after thyroid surgery.…”

Section: Introductionmentioning

confidence: 99%

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Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

Fortuny

Belfontali

Sadowski

et al. 2016

British Journal of Surgery

148

130

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BackgroundPostoperative hypoparathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative parathyroid gland angiography in predicting normal parathyroid gland function after thyroid surgery.MethodsAngiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified parathyroid glands.ResultsSome 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized parathyroid gland could be demonstrated developed transient hypoparathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoparathyroidism.Conclusion PTH levels on POD 1 were normal in all patients who had at least one well vascularized parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoparathyroidism.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

Fortuny

Belfontali

Sadowski

et al. 2016

British Journal of Surgery

148

130

View full text Add to dashboard Cite

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“…Its incidence depends on the technical difficulty of the procedure and expertise of the surgeon. Permanent hypocalcemia, defined as hypocalcemia for more than 6 months after thyroidectomy, is reported in 1-10% of patients (5,6). Reducing the rate of hypoparathyroidism is essential for improving the quality of life, as postoperative hypocalcemia can result in prolonged hospitalization and multiple clinic visits, neuromuscular symptoms, the need for life-long calcium and vitamin D supplementation, and long-term complications, such as cerebral, vascular, ocular, and renal damage (7)(8)(9)(10)(11).…”

Section: Vascular Anatomy Of the Parathyroid Glands (Pgs) And Its Impmentioning

confidence: 99%

A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques

Sadowski¹,

Fortuny²,

Triponez³

2017

Gland Surg.

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“…Recent systematic review indicated that perioperative parathyroid hormone (PTH) level, preoperative vitamin D, and postoperative changes of calcium were biochemical predictors of postoperative hypocalcemia (7). Of these factors, postoperative PTH was considered as the most useful predictor of hypocalcemia.…”

Section: Introductionmentioning

confidence: 99%

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

et al. 2017

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Purpose: Postoperative hypocalcemia is one of the most common complications after thyroid surgery. However, the predictive efficacy of parathyroid hormone (PTH) level was still controversial. We investigated the cut-off value of perioperative PTH level for postoperative hypocalcemia after total thyroidectomy. Methods: Four hundred eighty-two patients performed total thyroidectomy from January 2015 to December 2016 were enrolled. Demographics, operative variables and the development of symptomatic hypocalcemia were collected and evaluated. Results: Transient symptomatic hypocalcemia occurred in 83 (17.2%) patients and 5 (1.0%) patients have progressed to the permanent hypocalcemia. Patients with transient symptomatic hypocalcemia showed significantly lower postoperative day 1 PTH level than those without hypocalcemia (7.7±6.5 vs. 13.1±10.4 pg/mL; P<0.001), while correlation between postoperative PTH level and development of symptomatic hypocalcemia was not found in a multivariate analysis (P=0.122). Percentage decline of the preoperative PTH only showed significant association with transient hypocalcemia and the recommended cut-off value was 75.0%. When percentage decline of 75.0% was used, the incidence of transient hypoparathyroidism was 3.4 times (95% confidence interval, 2.1-5.6) higher in high percentage decline group (P<0.001). In regard to the permanent hypoparathyroidism, there were no significant differences in all factors. Conclusion: Percentage decline of PTH can be used as a predictive factor for postoperative hypocalcemia. Cautions against preventing injury of the parathyroid glands with careful surgical technique should be recommended.

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Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia

Abstract: Perioperative PTH, preoperative vitamin D and postoperative changes in calcium are biochemical predictors of post-thyroidectomy hypocalcaemia. Clinical predictors include female sex, Graves' disease, need for parathyroid autotransplantation and inadvertent excision of PTGs.

Cited by 557 publications

References 111 publications

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

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