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Hypoparathyroidism After Total Thyroidectomy: Importance of the Intraoperative Management of the Parathyroid Glands

  • Guillermo Ponce de León-Ballesteros
  • David Velázquez-Fernández
  • F. Javier Hernández-Calderón
  • Carlos Bonilla-Ramírez
  • Rafael H. Pérez-Soto
  • Juan Pablo Pantoja
  • Mauricio Sierra
  • Miguel F. HerreraEmail author
Original Scientific Report
  • 72 Downloads

Abstract

Background

Total thyroidectomy is the most common surgical procedure for the treatment of thyroid diseases. Postoperative hypocalcemia/hypoparathyroidism is the most frequent complication after total thyroidectomy. The aim of this study was to evaluate the rate of postoperative hypocalcemia and permanent hypoparathyroidism after total thyroidectomy in order to identify potential risk factors and to evaluate the impact of parathyroid autotransplantation.

Patients and Methods

We performed a retrospective analysis of 1018 patients who underwent total thyroidectomy at our institution between 2000 and 2016. Medical records were reviewed to analyze patient features, clinical presentation, management and postoperative complications. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Statistical significance was set at p ≤ 0.05.

Results

Mean ± SD age was 46.79 ± 15.9 years; 112 (11.7%) were males and 844 (88.3%) females. A total of 642 (67.2%) patients underwent surgery for malignant disease. The rate of postoperative hypocalcemia, transient, protracted and permanent hypoparathyroidism was 32.8%, 14.43%, 18.4% and 3.9%, respectively. Permanent hypoparathyroidism was significantly associated with the number of parathyroid glands remaining in situ (4 glands: 2.5%, 3 glands: 3.8%, 1–2 glands: 13.3%; p ˂ 0.0001) [OR for 1–2 glands in situ = 5.32, CI 95% 2.61–10.82]. Other risk factors related to permanent hypoparathyroidism were obesity (OR 3.56, CI 95% 1.79–7.07), concomitant level VI lymph node dissection (OR 3.04, CI 95% 1.46–6.37) and incidental parathyroidectomy without autotransplantation (OR 3.6, CI 95% 1.85–7.02).

Conclusions

Identification and in situ preservation of at least three parathyroid glands were associated with a lower rate of postoperative hypocalcemia (30.4%) and permanent postoperative hypoparathyroidism (2.79%).

Notes

References

  1. 1.
    Zhou HY, He JC, McHenry CR (2016) Inadvertent parathyroidectomy: incidence, risk factors, and outcomes. J Surg Res 205:70–75CrossRefGoogle Scholar
  2. 2.
    Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 101:307–320CrossRefGoogle Scholar
  3. 3.
    Fama F, Cicciu M, Polito F, Cascio A, Gioffre-Florio M et al (2017) Parathyroid autotransplantation during thyroid surgery: a novel technique using a cell culture nutrient solution. World J Surg 41:457–463CrossRefGoogle Scholar
  4. 4.
    Chadwick DR (2017) Hypocalcaemia and permanent hypoparathyroidism after total/bilateral thyroidectomy in the BAETS Registry. Gland Surg 6:S69–S74CrossRefGoogle Scholar
  5. 5.
    Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B (2008) Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg 143:132–137 (Discussion 8) CrossRefGoogle Scholar
  6. 6.
    Lorente-Poch L, Sancho J, Munoz JL, Gallego-Otaegui L, Martinez-Ruiz C, Sitges-Serra A (2017) Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy. Langenbeck’s Arch Surg 402:281–287CrossRefGoogle Scholar
  7. 7.
    Shaha AR, Jaffe BM (1998) Parathyroid preservation during thyroid surgery. Am J Otolaryngol 19:113–117CrossRefGoogle Scholar
  8. 8.
    Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A (2015) Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg 102:359–367CrossRefGoogle Scholar
  9. 9.
    Herrera M, Grant C, van Heerden JA, Fitzpatrick LA (1992) Parathyroid autotransplantation. Arch Surg 127:825–829 (Discussion 9–30) CrossRefGoogle Scholar
  10. 10.
    Sierra M, Herrera MF, Herrero B, Jimenez F, Sepulveda J et al (1998) Prospective biochemical and scintigraphic evaluation of autografted normal parathyroid glands in patients undergoing thyroid operations. Surgery 124:1005–1010CrossRefGoogle Scholar
  11. 11.
    Wells SA Jr, Gunnells JC, Shelburne JD, Schneider AB, Sherwood LM (1975) Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78:34–44Google Scholar
  12. 12.
    Su A, Gong Y, Wu W, Gong R, Li Z, Zhu J (2018) Does the number of parathyroid glands autotransplanted affect the incidence of hypoparathyroidism and recovery of parathyroid function? Surgery 164:124–129CrossRefGoogle Scholar
  13. 13.
    Sitges-Serra A, Ruiz S, Girvent M, Manjon H, Duenas JP, Sancho JJ (2010) Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg 97:1687–1695CrossRefGoogle Scholar
  14. 14.
    Lo CY, Lam KY (2001) Routine parathyroid autotransplantation during thyroidectomy. Surgery 129:318–323CrossRefGoogle Scholar
  15. 15.
    Tartaglia F, Blasi S, Giuliani A, Merola R, Livadoti G et al (2016) Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study. Int J Surg 28(Suppl 1):79–83CrossRefGoogle Scholar
  16. 16.
    Lorente-Poch L, Sancho JJ, Munoz-Nova JL, Sanchez-Velazquez P, Sitges-Serra A (2015) Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg 4:82–90Google Scholar
  17. 17.
    Stack BC Jr, Bimston DN, Bodenner DL, Brett EM, Dralle H et al (2015) American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: postoperative hypoparathyroidism-definitions and management. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol 21:674–685Google Scholar
  18. 18.
    Underbjerg L, Sikjaer T, Rejnmark L (2018) Long-term complications in patients with hypoparathyroidism evaluated by biochemical findings: a case-control study. J Bone Miner Res Off J Am Soc Bone Miner Res 33:822–831CrossRefGoogle Scholar
  19. 19.
    Lorente-Poch L, Sancho JJ, Carballo L, Sitges-Serra A (2017) Clinical profile and long-term follow-up of 32 patients with postoperative permanent hypoparathyroidism. Gland Surg 6:S3–S10CrossRefGoogle Scholar
  20. 20.
    Wells SA Jr, Burdick JF, Hattler BG, Christiansen C, Pettigrew HM et al (1974) The allografted parathyroid gland: evaluation of function in the immunosuppressed host. Ann Surg 180:805–813CrossRefGoogle Scholar
  21. 21.
    Pata G, Casella C, Mittempergher F, Cirillo L, Salerni B (2010) Loupe magnification reduces postoperative hypocalcemia after total thyroidectomy. Am Surg 76:1345–1350Google Scholar
  22. 22.
    Chang YK, Lang BHH (2017) To identify or not to identify parathyroid glands during total thyroidectomy. Gland Surg 6:S20–S29CrossRefGoogle Scholar
  23. 23.
    Song CM, Jung JH, Ji YB, Min HJ, Ahn YH, Tae K (2014) Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol 12:200CrossRefGoogle Scholar
  24. 24.
    Wells SA Jr, Burdick JF, Christiansen CL, Abe M, Sherwood LM et al (1973) Long-term survival of dogs transplanted with parathyroid glands as autografts and as allografts in immunosuppressed hosts. Transpl Proc 5:769–771Google Scholar
  25. 25.
    Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F (2007) Reoperative surgery for thyroid disease. Langenbeck’s Arch Surg 392:685–691CrossRefGoogle Scholar
  26. 26.
    Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133:180–185CrossRefGoogle Scholar
  27. 27.
    Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB (2015) Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev Off J Int Assoc Study Obes 16:341–349CrossRefGoogle Scholar
  28. 28.
    Orloff LA, Wiseman SM, Bernet VJ, Fahey TJ 3rd, Shaha AR et al (2018) American Thyroid Association Statement on Postoperative Hypoparathyroidism: diagnosis, prevention, and management in adults. Thyr Off J Am Thyr Assoc 28:830–841CrossRefGoogle Scholar
  29. 29.
    Promberger R, Ott J, Kober F, Mikola B, Karik M et al (2010) Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy. Thyr Off J Am Thyr Assoc 20:1371–1375CrossRefGoogle Scholar
  30. 30.
    Kirdak T, Dundar HZ, Uysal E, Ocakoglu G, Korun N (2017) Outcomes of parathyroid autotransplantation during total thyroidectomy: a comparison with age- and sex-matched controls. J Invest Surg 30:201–209CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019
corrected publication 2019

Authors and Affiliations

  • Guillermo Ponce de León-Ballesteros
    • 1
  • David Velázquez-Fernández
    • 1
  • F. Javier Hernández-Calderón
    • 1
  • Carlos Bonilla-Ramírez
    • 1
  • Rafael H. Pérez-Soto
    • 1
  • Juan Pablo Pantoja
    • 1
  • Mauricio Sierra
    • 1
  • Miguel F. Herrera
    • 1
    Email author
  1. 1.Service of Endocrine and Advanced Laparoscopic Surgery/Department of SurgeryInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiranMexico CityMexico

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