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Is Partial or Total Thyroidectomy Associated with Risk of Long-Term Osteoporosis: A Nationwide Population-Based Study

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Abstract

Background

Whether thyroidectomy contributes to osteoporosis (OP) and osteoporotic fracture (OF) is a subject of debate. This study aimed to determine the effect of thyroidectomy on the risk of OP and OF.

Methods

This retrospective cohort study is based on patient data between January 2000 to December 2005 from the National Health Insurance Research Database. Patients who underwent thyroidectomy were enrolled in the thyroidectomy cohort, and the control cohort was selected by propensity score matching at a ratio of 1:4. Incident OP and OF cases were identified until the end of 2013. The thyroidectomy cohort to control cohort adjusted hazard ratio (aHR) for OP/OF was assessed through multivariable Cox proportional hazard regression analysis.

Results

Totals of 1426 and 5704 patients were included in the thyroidectomy and control cohorts, respectively. The incidence density of OP was higher in the thyroidectomy cohort (7.91/1000 person-years) than in the control cohort (5.98/1000 person-years), with an aHR of 1.43 (95% CI 1.16–1.77, p < 0.05). Younger patients, women, and patients with comorbidities were at a higher risk. The risks of postoperative OP/OF were significantly increased in patients who received thyroxine treatment for more than 1 year, both in the partial thyroidectomy group and in the total and subtotal thyroidectomy group (aHR: 2.47, 95% CI: 1.42–2.31 vs. aHR: 1.84, 95% CI: 1.22–2.76).

Conclusion

Thyroidectomy significantly increased the long-term risk of OP. Younger patients, women, patients with comorbidities, and patients receiving chronic thyroxin treatment should be monitored for changes in postoperative bone density.

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Abbreviations

BNHI:

Bureau of National Health Insurance

CI:

Confidence interval

HR:

Hazard ratio

NHI:

National Health Insurance

NHIRD:

National Health Insurance Research Database

NHRI:

National Health Research Institute

OF:

Osteoporotic fracture

OP:

Osteoporosis

TSH:

Thyroid-stimulating hormone

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Funding

This study was supported by grants from Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDU-B-212-113004) and Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037).

Author information

Authors and Affiliations

  1. Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Chien-Ling Hung & Chung-Jye Hung

  2. School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Chih-Ching Yeh

  3. Department of Public Health, China Medical University, Taichung, Taiwan

    Chih-Ching Yeh

  4. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan

    Pi-Shan Sung & Kuen-Jer Tsai

  5. Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Pi-Shan Sung

  6. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Chih-Hsin Muo & Fung-Chang Sung

  7. Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Fung-Chang Sung

  8. Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

    I-Ming Jou

  9. Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Kuen-Jer Tsai

Authors
  1. Chien-Ling Hung
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  2. Chih-Ching Yeh
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  3. Pi-Shan Sung
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  4. Chung-Jye Hung
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  6. Fung-Chang Sung
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  7. I-Ming Jou
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  8. Kuen-Jer Tsai
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Corresponding author

Correspondence to Kuen-Jer Tsai.

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Hung, CL., Yeh, CC., Sung, PS. et al. Is Partial or Total Thyroidectomy Associated with Risk of Long-Term Osteoporosis: A Nationwide Population-Based Study. World J Surg 42, 2864–2871 (2018). https://doi.org/10.1007/s00268-018-4573-2

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  • DOI: https://doi.org/10.1007/s00268-018-4573-2

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