Thyroidectomy and hypoparathyroidism in patients with pharyngoesophageal tumors

Abstract

Background. Total pharyngolaryngoesophagectomy and gastric transposition (TPLEGT) for pharyngoesophageal (PE) tumors may require thyroidectomy (with or without removal of the parathyroid glands) to obtain adequate margins around the tumor. As a result, a considerable number of patients may have hypoparathyroidism (HP) develop. The objective of this article is to report our experience with different types of thyroidectomy and to describe the relationship of thyroidectomy to HP in TPLETG. These results are compared with data in the literature.Methods. From 1985 to 2001, 40 patients underwent TPLEGT, with main index tumors in the esophagus (n = 17), hypopharynx (n = 17), and larynx (n = 6). All patients had advanced cTNM or pTNM stages (III or IV). Postoperative HP was diagnosed based primarily on the symptoms and calcium and phosphorus analysis but not on parathyroid hormone (PTH) levels.Results. Total thyroidectomy (TT) was done in 12 (30%) patients and 11 (91.6%) had permanent HP develop. In none of these patients was the parathyroid separated and implanted (fear of a tumor implant). Partial thyroidectomy (PT) (lobectomy and isthmus) was done in 25 (62.5%) patients, and permanent HP occurred in 11 (44%) patients. The thyroid was preserved in three patients, and none had HP develop. Of the 40 patients, 13 (32.5%) had no HP, five (12.5%) had temporary HP, and 22 (55%) had permanent HP. There was a correlation between the type of thyroidectomy, location of primary tumors, and development of HP. Only seven reports in the past 30 years have dealt with TPLEGT, thyroidectomy, and HP. HP occurred in 32.5% of the cases of TT and in 19.5% of the cases of PT.Conclusions. Permanent HP was very frequent (55%) in our series. In patients who underwent TPLEGT, HP was almost certain when TT was done (91.6%). PT was no guarantee that HP would not occur (44% permanent HP). The frequency of permanent HP based on primary index tumors was 47%, 59%, and 66.6% for esophageal, hypopharyngeal, and laryngeal cancer, respectively. A

Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism

“…However, the reported rates of transient and long-term hypocalcaemia were higher in patients who had total thyroidectomy (Table 3). Transient hypocalcaemia can occur in up to 100% of patients who had total laryngectomy with concomitant oesophagectomy and total thyroidectomy [8,18,25]; long-term hypocalcaemia is also higher in this group [25].…”

“…They found bilateral paratracheal lymph node dissection did not significantly increase the rates of transient PoSH compared to unilateral paratracheal lymph node dissection (50% versus 50%). Farlow et al examined the effects of paratracheal neck [8,25] dissection in 210 patients who underwent salvage laryngectomy [29]. They found no significant difference in rates of transient PoSH in patients who had bilateral PTLN, unilateral PTLN, and no PTLN (17% versus 6% versus 8%, respectively).…”

“…The reported rates (i.q.r.) of transient and long-term hypocalcaemia following bilateral thyroid surgery were 27% (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) and 1% (0-3) [1]. The estimated prevalence of PoSH in Europe and United States of America was 22 per 100,000 and 23 per 100,000, respectively [2].…”

Results after radical surgical treatment for advanced carcinoma of hypopharynx

“…One of the most common complications in patients that undergo PLE is hypoparathyroidism [26,27]. In the presence of advanced tumors of the hypopharynx and the cervical esophagus, invasion of the thyroid gland by the tumor is frequently seen and, in order to attain an R0, radical resection total or subtotal thyroidectomy is unavoidable.…”

Epileptic seizure as the first sign of hypoparathyroidism

“…U odrasloj populaciji, hipoparatireoidizam najčešće je posledica različitih hirurških intervencija u predelu vrata. Tako stečeni hipoparatireoidizam može se javiti nakon hirurške intervencije na samim paratiroidnim žlezdama, nakon operativnog rešavanja bolesti štita-ste žlezde ili kao posledica radikalnih hirurških intervencija zbog karcinoma larinksa ili jednjaka [2][3][4] .…”