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Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients

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Abstract

Postoperative hypocalcemia is the most frequent complication of total thyroidectomy. It may have a delayed onset, and therefore delays the discharge from the hospital, requiring calcium replacement therapy to alleviate clinical symptoms. During a 7-month period, 2,631 consecutive patients undergoing primary or completion thyroidectomy were prospectively followed up and underwent analysis regarding postoperative hypoparathyroidism. Data were prospectively collected by questionnaires from 39 Italian endocrine surgery units affiliated to the Italian Endocrine Surgery Units Association (Club delle Unità di EndocrinoChirurgia—UEC), where thyroid surgery is routinely performed. The incidence of hypoparathyroidism was 28.8 % (757 patients), including transient hypocalcemia (27.9 %—734 patients) and permanent hypocalcemia (0.9 %—23 patients). The rate of asymptomatic hypocalcemia was 70.80 %. The incidence of permanent hypocalcemia was higher in the symptomatic hypocalcemia group (7.5 %) than in asymptomatic one (1.5 %). Female patients experienced a transient postoperative hypocalcemia more frequently than male patients (29.7 and 21.2 %, respectively; p < 0.0001). The percentage developing hypocalcemia in patients in which parathyroid glands were intraoperatively identified and preserved was higher than in the patients in which the identification of parathyroid glands was not achieved (29.2 vs. 18.7 %, p < 0.01). This prospective study confirmed the main risk factors for postoperative hypocalcemia: thyroid cancer, nodal dissection, and female gender. It farther showed that identifying parathyroids has an important role to prevent permanent hypocalcemia though with a higher risk of transient hypocalcemia. A suitable informed consent should especially emphasize the importance of some primary factors in increasing the risk of hypocalcemia after thyroid surgery.

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References

  1. F. Pattou, F. Combemale, S. Fabre, B. Carnaille, M. Decoulx, J.L. Wemeau, A. Racadot, C. Proye, Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J. Surg. 22, 718–724 (1998)

    Article  PubMed  CAS  Google Scholar 

  2. M. Costanzo, A. Marziani, F. Condorelli, M. Migliore, M.A. Cannizzaro, Post-thyroidectomy hypocalcemic syndrome: predictive value of early PTH. Preliminary results. Ann. Ital. Chir. 81, 301–305 (2010)

    PubMed  Google Scholar 

  3. T. Reeve, N.W. Thompson, Complications in thyroid surgery: how to avoid them, how to manage them and observations on their possible efficacy on the whole patient. World J. Surg. 24, 971–975 (2000)

    Article  PubMed  CAS  Google Scholar 

  4. R.D. Bliss, P.G. Gauger, L.W. Delbridge, Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J. Surg. 24, 891–897 (2000)

    Article  PubMed  CAS  Google Scholar 

  5. A.R. Shaha, B.M. Jaffe, Parathyroid preservation during thyroid surgery. Am. J. Otolaryngol. 19, 113–117 (1998)

    Article  PubMed  CAS  Google Scholar 

  6. A. Trupka, W. Sienel, Autotransplantation of at least one parathyroid gland during thyroidectomy in benign thyroid disease minimized the risk of permanent hypoparathyroidism. Zentrabl. Chir. 127, 439–442 (2002)

    Article  CAS  Google Scholar 

  7. R. Gervasi, G. Orlando, M.A. Lerose, B. Amato, G. Docimo, P. Zeppa, A. Puzziello, Thyroid surgery in geriatric patients: a literature review. BMC Surg. 12(Suppl 1), S16 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  8. A.R. Zambudio, J. Rodríguez, J. Riquelme, T. Soria, M. Canteras, P. Parrilla, Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann. Surg. 24, 18–25 (2004)

    Article  Google Scholar 

  9. L. Rosato, N. Avenia, P. Bernante, M. De Palma, G. Gulino, P.G. Nasi, M.R. Pelizzo, L. Pezzullo, Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J. Surg. 28, 271–276 (2004)

    Article  PubMed  Google Scholar 

  10. O. Cavicchi, O. Piccin, U. Caliceti, A. De Cataldis, R. Pasquali, A.R. Ceroni, Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol. Head Neck Surg. 137, 654–658 (2007)

    Article  PubMed  Google Scholar 

  11. N.E. Cusano, M.R. Rubin, J. Sliney Jr, J.P. Bilezikian, Mini-review: new therapeutic options in hypoparathyroidism. Endocrine 41, 410–414 (2012)

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. J.L. Roh, C.I. Park, Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am. J. Surg. 192, 675–678 (2006)

    Article  PubMed  CAS  Google Scholar 

  13. A. Duclos, J.L. Peix, C. Colin, J.L. Kraimps, F. Menegaux, F. Pattou, F. Sebag, S. Touzet, S. Bourdy, N. Voirin, J.C. Lifante, CATHY Study Group, Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study. BMJ 344, 8041 (2012)

    Article  Google Scholar 

  14. K.M. Higgins, D.L. Mandell, S. Govindaraj, E.M. Genden, J.I. Mechanick, D.A. Bergman, E.J. Diamond, M.L. Urken, The role of Intraoperative rapid parathyroid hormone monitoring for predicting thyroidectomy related hypocalcemia. Arch. Otoryngol. Head Neck Surg. 130, 63–67 (2004)

    Article  Google Scholar 

  15. G. Conzo, D. Pasquali, G. Bellastella, K. Esposito, C. Carella, A. De Bellis, G. Docimo, M. Klain, S. Iorio, S. Napolitano, A. Palazzo, A. Pizza, A.A. Sinisi, E. Zampella, A. Bellastella, L. Santini, Total thyroidectomy, without prophylactic central lymph node dissection, in the treatment of differentiated thyroid cancer. Clinical retrospective study on 221 cases. Endocrine 44, 419–425 (2013)

    Article  PubMed  CAS  Google Scholar 

  16. P. Aluffi, E. Aina, T. Bagnati, A. Toso, F. Pia, Prognostic factors for definitive hypoparathyroidism following total thyroidectomy. Acta Otorinolaringol Esp. 59, 321–324 (2008)

    Article  Google Scholar 

  17. M. Testini, L. Rosato, N. Avenia, F. Basile, P. Portincasa, G. Piccinni, G. Lissidini, A. Biondi, A. Gurrado, M. Nacchiero, The impact of single parathyroid autotransplantation during thyroid surgery on postoperative hypoparathyroidism: a multicenter study. Transp. Proc. 39, 225–230 (2007)

    Article  CAS  Google Scholar 

  18. L. Rosato, G. De Toma, R. Bellantone, N. Avenia, G. Cavallaro, C. Dobrinja, M.G. Chiofalo, C. De Crea, M. De Palma, G. Gasparri, A. Gurrado, C. Lombardi, P. Miccoli, B. Mullineris, P.G. Nasi, M.R. Pelizzo, L. Pezzullo, G. Perigli, M. Testini, Associazione delle Unità di Endocrinochirurgia Italiana, Diagnostic, therapeutic and healthcare management protocols in thyroid surgery: 3rd Consensus Conference of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB). Minerva Chir. 67, 365–379 (2012)

    PubMed  CAS  Google Scholar 

  19. R.D. Bliss, P.G. Gauger, L.W. Delbridge, Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J. Surg. 24, 891–897 (2000)

    Article  PubMed  CAS  Google Scholar 

  20. G. Cocchiara, M. Cajozzo, G. Amato, A. Mularo, A. Agrusa, G. Romano, Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels. J. Visc. Surg. 147, e329–e332 (2010)

    Article  PubMed  CAS  Google Scholar 

  21. N.B. Sands, R.J. Payne, V. Côté, M.P. Hier, M.J. Black, M. Tamilia, Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngol. Head Neck Surg. 145, 561–564 (2011)

    Article  PubMed  Google Scholar 

  22. G. Docimo, S. Tolone, D. Pasquali, G. Conzo, A. D’Alessandro, G. Casalino, S. Gili, L. Brusciano, A. Gubitosi, G. Del Genio, R. Ruggiero, L. Docimo, Role of pre and post-operative oral calcium and vitamin D supplements in prevention of hypocalcemia after total thyroidectomy. G. Chir. 33, 374–378 (2012)

    PubMed  CAS  Google Scholar 

  23. G. Docimo, S. Tolone, R. Ruggiero, A. Gubitosi, D. Pasquali, A. De Bellis, P. Limongelli, G. Del Genio, L. Docimo, G. Conzo, Total thyroidectomy without prophylactic central neck dissection combined with routine oral calcium and vitamin D supplements: is it a good option to achieve a low recurrence rate avoiding hypocalcemia? A retrospective study. Minerva Chir. 68, 321–328 (2013)

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, San Giovanni di Dio e Ruggi d’Aragona Hospital, University of Salerno, Salerno, Italy

    Alessandro Puzziello

  2. Department of General Surgery, Ivrea Hospital, Ivrea, Italy

    Lodovico Rosato

  3. Department of General Surgery, Policlinico Universitario ‘Mater Domini’, University Magna Graecia, Catanzaro, Italy

    Nadia Innaro

  4. School of General Surgery, University Magna Graecia, Catanzaro, Italy

    Giulio Orlando

  5. Endocrine Surgical Unit, University of Perugia, Perugia, Italy

    Nicola Avenia

  6. Endocrine Surgical and Mini-invasive Surgery Unit, University of Florence, Florence, Italy

    Giuliani Perigli

  7. Department of General Surgery, Policlinico Universitario of Monserrato, University of Cagliari, Cagliari, Italy

    Pietro G. Calò

  8. General Surgery and Endocrine Surgical Unit, AORN A. Cardarelli, Naples, Italy

    Maurizio De Palma

  9. Via Giuseppe Bonito, 32, 80129, Naples, Italy

    Alessandro Puzziello

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  1. Alessandro Puzziello
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  2. Lodovico Rosato
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  3. Nadia Innaro
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  4. Giulio Orlando
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  5. Nicola Avenia
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  6. Giuliani Perigli
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  8. Maurizio De Palma
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Correspondence to Alessandro Puzziello.

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Puzziello, A., Rosato, L., Innaro, N. et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine 47, 537–542 (2014). https://doi.org/10.1007/s12020-014-0209-y

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  • DOI: https://doi.org/10.1007/s12020-014-0209-y

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