Abstract
Background
Hypoparathyroidism is the most common complication after thyroidectomy and the main reason for frequent outpatient visits; however, there is a poor understanding of its outcomes and no clear follow-up strategies are available. We aimed to predict post-thyroidectomy hypoparathyroidism outcomes and identify relevant factors.
Methods
A multicenter, standardized prospective study was conducted. The parathyroid hormone level (PTH) was measured preoperatively and at the first hour after surgery, then at each outpatient follow-up visit after 1 week, 3 weeks, and 1 month, and then every 2 months, until it either reached normal values or up to 6 months. Cox proportional hazard modeling was used to determine the factors that affect PTH recovery. A Weibull distribution model was used to predict time to recovery. Both models were evaluated by goodness of fit.
Results
A total of 186 patients were enrolled in the study; 53 (28.5 %) developed hypoparathyroidism, 47 of them (88.6 %) females. Their mean age was 41.2 years, and 11.4 % were diabetic. Of these women, 33 (62.3 %) recovered within 1 month, 10 (18.9 %) recovered after 1 month but within 6 months, 7 (13.2 %) did not recover within 6 months, and 3 (5.6 %) missed follow-up. Factors that are found to affect and predict the speed of recovery were the preoperative PTH level, perioperative percent drop in PTH level, diabetes mellitus, and gender.
Conclusions
This study provides potentially useful information for early prediction of PTH recovery, and it highlights the factors that affect the course of hypoparathyroidism recovery, which in turn should be reflected in better patient management, improved patient satisfaction, and overall cost-effectiveness.
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References
Bhattacharyya N, Fried MP (2002) Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 128:389–392
Fahad Al-Dhahri S, Al-Ghonaim YA, Sulieman Terkawi A (2010) Accuracy of postthyroidectomy parathyroid hormone and corrected calcium levels as early predictors of clinical hypocalcemia. J Otolaryngol Head Neck Surg 39:342–348
Pfleiderer AG, Ahmad N, Draper MR et al (2009) The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. Ann R Coll Surg Engl 91:140–146
Jurecka-Lubieniecka B, Paliczka E, Czarniecka A et al (2006) Hypoparathyroidism after surgery on thyroid cancer: is there a delayed chance for recovery after a prolonged period of substitutive therapy? Endokrynol Pol 57:501–508
Pattou F, Combemale F, Fabre S et al (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724. doi:10.1007/s002689900459
Sitges-Serra A, Ruiz S, Girvent M et al (2010) Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg 97:1687–1695
Youngwirth L, Benavidez J, Sippel R et al (2010) Parathyroid hormone deficiency after total thyroidectomy: incidence and time. J Surg Res 163:69–71
Rich JT, Neely JG, Paniello RC et al (2010) A practical guide to understanding Kaplan-Meier curves. Otolaryngol Head Neck Surg 143:331–336
Smith T, Smith B (2013) Survival analysis and the application of Cox’s proportional hazards modeling using SAS 244-26. http://www2.sas.com/proceedings/sugi26/p244-26.pdf. Accessed 27 July 2013
Carroll KJ (2003) On the use and utility of the Weibull model in the analysis of survival data. Control Clin Trials 24:682–701
Kolluru GK, Bir SC, Kevil CG (2012) Endothelial dysfunction and diabetes: effects on angiogenesis, vascular remodeling, and wound healing. Int J Vasc Med 2012:918267
Glinoer D, Andry G, Chantrain G et al (2000) Clinical aspects of early and late hypocalcaemia after thyroid surgery. Eur J Surg Oncol 26:571–577
Fong J, Khan A (2012) Hypocalcemia: updates in diagnosis and management for primary care. Can Fam Physician 58:158–162
Schaffler A (2010) Hormone replacement after thyroid and parathyroid surgery. Dtsch Arztebl Int 107:827–834
Winer KK, Zhang B, Shrader JA et al (2012) Synthetic human parathyroid hormone 1–34 replacement therapy: a randomized crossover trial comparing pump versus injections in the treatment of chronic hypoparathyroidism. J Clin Endocrinol Metab 97:391–399
Acknowledgments
The authors are grateful to Dr. Marcel E. Durieux, Department of Anesthesiology, University of Virginia, Charlottesville, VA, for his review of the final manuscript.
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The authors declare no conflict of interest and received no external funding.
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Al-Dhahri, S.F., Mubasher, M., Mufarji, K. et al. Factors Predicting Post-thyroidectomy Hypoparathyroidism Recovery. World J Surg 38, 2304–2310 (2014). https://doi.org/10.1007/s00268-014-2571-6
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DOI: https://doi.org/10.1007/s00268-014-2571-6