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The predictive factors for postoperative hypoparathyroidism and its severity on the first postoperative day after papillary thyroid carcinoma surgery

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Abstract

Purpose

The purpose of the study was to investigate the predictive factors for hypoparathyroidism and its severity on the first postoperative day (POD1) after total thyroidectomy (TT) with or without central neck dissection (CND) in patients with papillary thyroid carcinoma (PTC).

Methods

From February 2014 to February 2019, 2550 PTC patients were admitted to our department. PTC patients who underwent TT were enrolled in this study. A parathyroid hormone (PTH) level lower than 15 pg/mL on POD1 was defined as hypoparathyroidism, and the severity of hypoparathyroidism was classified into three categories according to the level of PTH on POD1: mild hypoparathyroidism (10 pg/mL ≤ PTH < 15 pg/mL), moderate hypoparathyroidism (5 g/mL ≤ PTH < 10 pg/mL), and severe hypoparathyroidism (PTH < 5 pg/mL). Multiple clinical, pathological and surgical parameters of these two different groups were compared and analyzed to demonstrate the possible causes of hypoparathyroidism. Furthermore, patients who developed postoperative hypoparathyroidism were also included in a subgroup analysis according to the severity of their hypoparathyroidism. The underlying factors affecting different severities of hypoparathyroidism were also illustrated with univariate and multivariate analyses.

Results

Ultimately, 690 patients who underwent TT were enrolled in this retrospective study. Through the univariate analysis, different surgeons (P < 0.001), extent of CND (P = 0.009), prophylactic calcium supplementation (PCS) (P < 0.001), preoperative (pre-op) PTH level (P < 0.001), and pre-op phosphorus concentration (P = 0.022) were found to be significantly correlated with postoperative hypoparathyroidism. According to the multivariate analysis, PCS was the only independent high-risk factor for hypoparathyroidism. In the univariate analysis of patient subgroups with different severities of hypoparathyroidism, we demonstrated that the tumor T stage (P = 0.021) and pre-op PTH level (P < 0.001) were associated with the severity of hypoparathyroidism. Furthermore, after the multivariate analysis, hypertension (P < 0.001) and pre-op PTH (P < 0.001) were the two independent predictive factors for the severity of hypoparathyroidism after surgery.

Conclusions

Postoperative PCS could increase the risk for PTC patients developing hypoparathyroidism after thyroid surgery. Patients with a history of hypertension and a relatively high pre-op PTH level may not develop severe hypoparathyroidism after TT with CND.

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Abbreviations

POD1:

First postoperative day

TT:

Total thyroidectomy

CND:

Central neck dissection

PTC:

Papillary thyroid carcinoma

PTH:

Parathyroid hormone

PCS:

Prophylactic calcium supplementation

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Author notes

  1. Renhong Huang, Qiang Wang and Wei Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery of Changzheng Hospital Affiliated to Naval Military Medical University, Fengyang Road, Shanghai, 200003, China

    Renhong Huang, Qiang Wang, Wei Zhang, Siluo Zha, Daozhen Jiang, Xinyun Xu, Xiangmin Zheng, Ming Qiu & Chengxiang Shan

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  1. Renhong Huang
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Correspondence to Chengxiang Shan.

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The authors all declare that no conflict of interest was involved in the study.

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All enrolled subjects provided written informed consent, and the study protocol was approved by the Ethics Committee of Shanghai Changzheng Hospital affiliated with the Naval Military Medical University.

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Huang, R., Wang, Q., Zhang, W. et al. The predictive factors for postoperative hypoparathyroidism and its severity on the first postoperative day after papillary thyroid carcinoma surgery. Eur Arch Otorhinolaryngol 278, 1189–1198 (2021). https://doi.org/10.1007/s00405-020-06211-4

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  • DOI: https://doi.org/10.1007/s00405-020-06211-4

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