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World Journal of Surgery

, Volume 38, Issue 10, pp 2613–2620 | Cite as

Prediction of Permanent Hypoparathyroidism after Total Thyroidectomy

  • M. AlmquistEmail author
  • P. Hallgrimsson
  • E. Nordenström
  • A. Bergenfelz
Article

Abstract

Background

Hypoparathyroidism is a common complication with thyroid surgery. The ability to predict a high risk of permanent hypoparathyroidism is important for individual prognosis and follow-up.

Methods

Permanent hypoparathyroidism, defined as continuing need for vitamin D medication at 1-year post-operatively, was investigated in patients after total thyroidectomy. Blood levels of calcium and parathyroid hormone (PTH) were measured intra-operatively, the day after surgery and at 1 month post-operatively. Logistic regression analysis was performed to investigate the risk of vitamin D treatment at last follow-up, calculated as odds ratios (ORs) with 95 % confidence intervals (CIs). Patients were followed until cessation of vitamin D and/or calcium medication, until death, loss to follow-up, or end of follow-up, whichever came first.

Results

A total of 519 patients were included. The median (range) follow-up in patients unable to cease vitamin D was 2.7 (1.2–10.3) years. The rate of permanent hypoparathyroidism was 10/519, 1.9 %. Parathyroid auto-transplantation was performed in 90/519 (17.3 %) patients. None of these developed permanent hypoparathyroidism, nor did any patient with normal PTH day 1 (>1.6 pmol/l or 15 pg/ml). The adjusted risk (OR, 95 % CI) for permanent hypoparathyroidism for log PTH on day 1 was 0.25 (0.13–0.50). In patients not auto-transplanted and with unmeasurable PTH day 1 (<0.7 pmol/l or 6.6 pg/ml), 8/42 (19.2 %) developed permanent hypoparathyroidism.

Conclusions

Auto-transplantation protects against permanent hypoparathyroidism, whereas low PTH day 1 is associated with high risk.

Keywords

Goiter Parathyroid Gland Total Thyroidectomy Hypoparathyroidism Nodular Goiter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • M. Almquist
    • 1
    • 2
    Email author
  • P. Hallgrimsson
    • 1
    • 2
  • E. Nordenström
    • 1
    • 2
  • A. Bergenfelz
    • 1
    • 2
  1. 1.Department of SurgerySkane University HospitalLundSweden
  2. 2.Lund UniversityLundSweden

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