The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single center study

Akgün, İsmail; Unlu, Mehmet Taner; Aygün, Nurcihan; Kostek, Mehmet; Tufan, Aydın Eray; Yanar, Ceylan; Yüksel, Ali; Baran, Elif; Cakir, Yasin; Uludağ, Mehmet

doi:10.14744/semb.2022.24356

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…This result was expected, since by performing a lobectomy, a minimum of two parathyroid glands remain intact, and this is sufficient for proper maintenance of PTH levels. The results obtained are in line with many publications in which the extent of surgery is the primary risk factor for hypoparathyroidism [ 5 , 9 , 10 , 11 , 16 ]. It seems advisable to limit the extent of thyroid surgery to one lobe with the parathyroid gland whenever possible in the absence of significant changes in the second lobe of the thyroid gland, especially in the case of thyroid microcarcinoma, which is in line with the recent trend in the treatment of thyroid cancer [ 5 , 25 , 26 , 27 ].…”

Section: Discussionsupporting

confidence: 90%

“…Disorders in calcium and phosphate metabolism following thyroidectomy significantly affect patients’ quality of life. While hypoparathyroidism almost always results in a decrease in calcium concentration, postoperative hypocalcemia is more common [ 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. There are different thresholds for Ca and PTH concentrations, as well as different timing of calcium, phosphorus and PTH determinations after thyroid surgery for the diagnosis and monitoring of these complications [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Transient hypoparathyroidism ranges from 7% to 51% [ 5 , 6 , 7 , 10 , 21 , 22 , 23 ], of which permanent affects 0–5% of those operated on [ 5 , 8 , 24 ]. Among the risk factors for hypoparathyroidism are bilateral thyroid gland surgery, concomitant autoimmune diseases, thyroid surgery with lymphadenectomy, little surgical experience, secondary surgery, and retrosternal goiter [ 5 , 9 , 10 , 11 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…If the parathyroid glands could not be safely dissected, the technique of excising the parathyroid gland “on a patch” formed from a fragment of the thyroid gland was used. Surgeon experience as an important risk factor for hypoparathyroidism has been discussed in many publications [ 10 , 11 , 16 ]. Cocchiara et al [ 34 ] showed that surgical experience is the most significant risk factor for a decrease in PTH levels.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Calcium-Phosphate Disorders after Thyroid Surgery

Sępek,

Marciniak,

Głód

et al. 2023

Biomedicines

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Introduction: Iatrogenic hypoparathyroidism following thyroidectomy is one of the most common complications significantly reducing patients’ quality of life. Objectives: This study aimed to analyze the risk factors for calcium-phosphate disorders following thyroidectomy. Patients and methods: The study group consisted of 211 patients who underwent thyroidectomy for different conditions in 2018–2020. Demographic, clinical and surgical risk factors were analyzed against hypoparathyroidism and hypocalcemia. Results: Hypoparathyroidism occurred in 15.63% of patients, and hypocalcemia occurred in 45% of those operated on. There was statistical significance between hypoparathyroidism and the extent of thyroid surgery: thyroidectomy vs. lobectomy (p = 0.02, OR = 4.5) and surgeon experience (p = 0.016, OR = 6.9). Low preoperative PTH levels were associated with a higher incidence of hypoparathyroidism (p = 0.055, OR = 0.9). There was a statistically significant correlation between the occurrence of hypocalcemia and preoperative vitamin D deficiency (p = 0.04, OR = 3.5). Low calcium levels before surgery were associated with a higher incidence of hypocalcemia (p = 0.051, OR = 0.5). Meta-analyses of selected risk factors confirmed that the most significant factor in the incidence of hypocalcemia was a decrease in PTH levels (p < 0.001). Conclusions: The extent of thyroid surgery and the experience of the surgeon are the most significant risk factors for hypoparathyroidism. Hypocalcemia is much more common than hypoparathyroidism. Among the risk factors for hypocalcemia, in addition to the decrease in parathormone levels due to iatrogenic parathyroid damage, we should mention vitamin D deficiency in the preoperative period.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Calcium-Phosphate Disorders after Thyroid Surgery

Sępek,

Marciniak,

Głód

et al. 2023

Biomedicines

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“…[ 2 , 3 ] Decreased plasma concentrations of parathyroid hormone (PTH) may lead to the development of hypocalcemia. [ 4 ] The incidence of transient hypoparathyroidism has been reported as 6-49%. [ 1 , 5 ] However, in some patients, permanent hypoparathyroidism may develop.…”

mentioning

confidence: 99%

Assessing Parathyroid Gland Viability and Predicting Postoperative Hypoparathyroidism in Thyroid Surgery: The Utility of Indocyanine Green Angiography

Sobutay

2023

Sisli Etfal

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Objectives Postoperative hypoparathyroidism is a common complication following thyroidectomy, with the potential for significant morbidity and cost. While various techniques have been proposed for intraoperative parathyroid gland (PG) identification and preservation, indocyanine green (ICG) angiography has emerged as a promising method. In this retrospective study, patients who underwent total thyroidectomy with or without central neck dissection were evaluated for the utility of ICG angiography in identifying PGs and the correlation of ICG scores with postoperative parathyroid function. Methods ICG angiography was performed using a standardized protocol, and the degree of PG vascularization was assessed visually. A scoring system was employed based on ICG uptake intensity in PGs, as described in the literature. Pearson's correlation test examined the relationship between the total ICG score and percentage parathyroid hormone (PTH) gradient, postoperative calcium, and PTH levels. In addition, patients with at least one well-vascularized PG were also evaluated. Results Twenty-two patients were included in the study. Significant positive correlations were found between the total ICG score and postoperative PTH levels (r=0.549, p=0.008), and a negative correlation with the percentage of PTH gradient (r=-0.504, p=0.01). However, six patients with well-vascularized PGs on ICG angiography still developed postoperative hypoparathyroidism. Conclusion ICG angiography offers a potential tool for evaluating PG vascularization during thyroidectomy and predicting the risk of postoperative hypoparathyroidism. However, its application should be used judiciously, and the technique should be improved for PG preservation. Further studies are warranted to better understand its benefits and limitations in thyroid surgery.

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Predictive factors affecting the development of central lymph node metastasis in papillary thyroid cancer

Caliskan¹

2022

Sisli Etfal

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Objectives The most common subtype of thyroid cancer is papillary thyroid cancer (PTC); lymph node metastases are common in this disease. Factors affecting the development of central lymph metastasis of PTC determine the treatment modality and prognosis of the disease. In this study, we aimed to evaluate the clinicopathologic features affecting the development of central lymph node metastasis. Methods The data of a total of 346 PTC patients who were operated between May 2012 and September 2020 in our clinic and whose follow-up could be reached were evaluated retrospectively. Demographic data, surgical treatment modalities, and histopathological data of all patients were evaluated as a result of at least 6 months of follow-up. Patients age, sex, body mass index, pre-operative TSH levels, anti-TPO, and anti-Tg values at the time of diagnosis, whether lymph node dissection is performed, presence of lymph node metastasis, presence of distant metastasis, stage at the time of diagnosis (TNM 8th edition), ATA risk group at the time of diagnosis, multifocal and/or multicentric (bilaterality), largest tumor size, aggressive histological subtype, lymphovascular invasion of the tumor, extrathyroidal invasion, presence of lymphocytic thyroiditis, and surgical margin positivity were evaluated retrospectively. Results In the development of PTC central metastasis, distant metastasis, tumor size, multifocality, multicentricity, presence of lymphovascular invasion, aggressive tumor subtype, presence of lateral metastasis, nodular goiter, and extrathyroidal spread were found to be effective. Among these factors, T stage, presence of lymphovascular invasion, and multicentricity were identified as independent risk factors for the development of central metastasis. Conclusion Today, the investigation of predictive factors for the development of nodal metastasis in PTC does not seem to be out of date anytime soon. In our study, T stage, presence of lymphovascular invasion, and multicentricity were identified as independent risk factors for the development of central metastasis from the histopathological features of the tumor in PTC and of these features, T stage and multicentricity can be predicted by pre-operative imaging in many patients and can be used to decide whether to perform prophylactic SLN dissection in patients. However, new studies are still needed on this issue, in the literature.

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The reality of hypoparathyroidism after thyroidectomy: which risk factors are effective? Single center study

Cited by 6 publications

References 40 publications

Risk Factors for Calcium-Phosphate Disorders after Thyroid Surgery

Risk Factors for Calcium-Phosphate Disorders after Thyroid Surgery

Assessing Parathyroid Gland Viability and Predicting Postoperative Hypoparathyroidism in Thyroid Surgery: The Utility of Indocyanine Green Angiography

Predictive factors affecting the development of central lymph node metastasis in papillary thyroid cancer

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