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Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study

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Abstract

Purpose

Persistent hypoparathyroidism (hypoPT) is a major complication of total thyroidectomy. Nonetheless, previous reports may have underestimated the prevalence of hypoPT due to patient selection bias. We aimed to estimate the actual prevalence of persistent hypoPT after total thyroidectomy and to find predictive factors for postoperative hypoPT.

Methods

This study retrospectively reviewed data from a health insurance claims-based database provided by the Japan Medical Data Center Co., Ltd. From 2009 to 2019, 2388 patients who underwent total thyroidectomy were identified using the medical procedure codes. Persistent hypoPT was defined as the prescription of active vitamin D supplements for >1 year postoperatively and the assignment of hypoPT codes. The prevalence of persistent hypoPT was estimated at two different levels: minimum and maximum estimations with or without postoperative osteoporosis and/or renal failure codes. Correlates for persistent hypoPT were investigated among several demographic and clinical variables.

Results

Of the 2388 patients, 1752 (73.4%) were women with a mean age of 45 years. The types of diseases were: benign thyroid disease (n = 235), malignant thyroid tumors (n = 1570), Graves ‘ disease (n = 558), and malignancy combined with Graves’ disease (n = 25). The minimum and the maximum estimation of the prevalence of persistent hypoPT were 15.0 and 20.3%, respectively. Multivariate logistic regression analysis showed that the malignant tumor (odds ratio, 1.8) independently correlated with persistent hypoPT.

Conclusions

The prevalence of persistent hypoPT after total thyroidectomy estimated by the claims-based database was higher than previously recognized. Comprehensive attempts to preserve parathyroid function, especially in malignant diseases, are essential.

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Fig. 1: Minimum and maximum prevalence of persistent hypoparathyroidism after total thyroidectomy.

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References

  1. A. Bergenfelz, E. Nordenström, M. Almquist, Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy. Surgery 167(1), 124–128 (2020)

    Article  Google Scholar 

  2. L. Underbjerg, T. Sikjaer, L. Mosekilde, L. Rejnmark Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J. Bone Min. Res. 28(11), 2277–2285 (2013)

    Article  Google Scholar 

  3. L.A. Orloff, S.M. Wiseman, V.J. Bernet et al. American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid 28(7), 830–841 (2018)

    Article  Google Scholar 

  4. D.R. Chadwick, Hypocalcaemia and permanent hypoparathyroidism after total/bilateral thyroidectomy in the BAETS Registry. Gland Surg. 6, S69–S74 (2017)

    Article  Google Scholar 

  5. O. Edafe, R. Antakia, N. Laskar, L. Uttley, S.P. Balasubramanian, Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br. J. Surg. 101(4), 307–320 (2014)

    Article  CAS  Google Scholar 

  6. M. Annebäck, J. Hedberg, M. Almquist, P. Stålberg, O. Norlén, Risk of permanent hypoparathyroidism after total thyroidectomy for benign disease: a nationwide population-based cohort study from Sweden. Ann. Surg. 274(6), e1202–e1208 (2021)

    Article  Google Scholar 

  7. D.T.W. Lui, M.M.H. Fung, C.H. Lee, C.H.Y. Fong, Y.C. Woo, B.H.H. Lang, A territory-wide assessment of the incidence of persistent hypoparathyroidism after elective thyroid surgery and its impact on new fracture risk over time. Surgery 170(5), 1369–1375 (2021)

    Article  Google Scholar 

  8. J.J. Díez, E. Anda, J. Sastre et al. Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis. Endocrine 66(2), 405–415 (2019)

    Article  Google Scholar 

  9. I. Loncar, M.E. Noltes, C. Dickhoff et al. Persistent postthyroidectomy hypoparathyroidism in the Netherlands. JAMA Otolaryngol. Head. Neck Surg. 147(11), 959–965 (2021)

    Article  Google Scholar 

  10. L. Lorente-Poch, J.J. Sancho, J.L. Muñoz-Nova, P. Sánchez-Velázquez, A. Sitges-Serra, Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 4(1), 82–90 (2015)

    PubMed  PubMed Central  Google Scholar 

  11. S. Kimura, T. Sato, S. Ikeda, M. Noda, T. Nakayama, Development of a database of health insurance claims: standardization of disease classifications and anonymous record linkage. J. Epidemiol. 20(5), 413–419 (2010)

    Article  Google Scholar 

  12. R. Nishimura, H. Kato, K. Kisanuki et al. Treatment patterns, persistence and adherence rates in patients with type 2 diabetes mellitus in Japan: a claims-based cohort study. BMJ Open 9(3), e025806 (2019)

    Article  Google Scholar 

  13. K. Sato, T. Ohno, T. Ishii, C. Ito, T. Kaise, The prevalence, characteristics, and patient burden of severe asthma determined by using a Japan health care claims database. Clin. Ther. 41(11), 2239–2251 (2019)

    Article  Google Scholar 

  14. Ministry of Education, Culture, Sports, Science and Technology and Ministry of Health, Labour and Welfare. Ethical guidelines for medical and health research involving human subjects. http://www.mhlw.go.jp/content/000769923.pdf. Accessed January 01, 2022 (in Japanese).

  15. R. Promberger, J. Ott, F. Kober, M. Karik, M. Freissmuth, M. Hermann, Normal parathyroid hormone levels do not exclude permanent hypoparathyroidism after thyroidectomy. Thyroid 21(2), 145–150 (2011)

    Article  CAS  Google Scholar 

  16. S.M. Kim, H.K. Kim, K.J. Kim et al. Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid 25(7), 830–833 (2015)

    Article  CAS  Google Scholar 

  17. M. Kihara, A. Miyauchi, K. Kontani, A. Yamauchi, H. Yokomise, Recovery of parathyroid function after total thyroidectomy: long-term follow-up study. ANZ J. Surg. 75(7), 532–536 (2005)

    Article  Google Scholar 

  18. Y. Ito, M. Kihara, K. Kobayashi, A. Miya, A. Miyauchi, Permanent hypoparathyroidism after completion total thyroidectomy as a second surgery: How do we avoid it? Endocr. J. 61(4), 403–408 (2014)

    Article  Google Scholar 

  19. L. Underbjerg, T. Sikjaer, L. Rejnmark, Long-term complications in patients with hypoparathyroidism evaluated by biochemical findings: a case-control study. J. Bone Min. Res. 33(5), 822–831 (2018)

    Article  CAS  Google Scholar 

  20. L. Lorente-Poch, J.J. Sancho, L. Carballo, A. Sitges-Serra, Clinical profile and long-term follow-up of 32 patients with postoperative permanent hypoparathyroidism. Gland Surg. 6(Suppl 1), S3–S10 (2017)

    Article  Google Scholar 

  21. M.A. McWade, M.E. Sanders, J.T. Broome, C.C. Solorzano, A. Mahadevan-Jansen, Establishing the clinical utility of autofluorescence spectroscopy for parathyroid detection. Surgery 159(1), 193–202 (2016)

    Article  Google Scholar 

  22. T. Takahashi, K. Yamazaki, H. Ota, R. Shodo, Y. Ueki, A. Horii, Near-infrared fluorescence imaging in the identification of parathyroid glands in thyroidectomy. Laryngoscope 131(5), 1188–1193 (2021)

    Article  CAS  Google Scholar 

  23. N. Bhattacharyya, M.P. Fried, Assessment of the morbidity and complications of total thyroidectomy. Arch. Otolaryngol. Head. Neck Surg. 128(4), 389–392 (2002)

    Article  Google Scholar 

  24. E.M. Salinger, J.T. Moore, Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone. Am. J. Surg. 206(6), 876–882 (2013)

    Article  Google Scholar 

  25. Y. Erbil, A. Bozbora, N. Ozbey et al. Predictive value of age and serum parathormone and vitamin d3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch. Surg. 142(12), 1182–1187 (2007)

    Article  CAS  Google Scholar 

  26. Y. Erbil, U. Barbaros, B. Temel et al. The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am. J. Surg. 197(4), 439–446 (2009)

    Article  CAS  Google Scholar 

  27. R. Vashishta, A. Mahalingam-Dhingra, L. Lander, E.J. Shin, R.K. Shah, Thyroidectomy outcomes: a national perspective. Otolaryngol. Head. Neck Surg. 147(6), 1027–1034 (2012)

    Article  Google Scholar 

  28. A. Ramouz, S.Z. Rasihashemi, A. Safaeiyan, M. Hosseini, Comparing postoperative complication of LigaSure Small Jaw instrument with clamp and tie method in thyroidectomy patients: a randomized controlled trial [IRCT2014010516077N1]. World J. Surg. Oncol. 16(1), 154 (2018)

    Article  Google Scholar 

  29. F.Y. Chiang, K.D. Lee, K. Tae et al. Comparison of hypocalcemia rates between LigaSure and clamp-and-tie hemostatic technique in total thyroidectomies. Head. Neck 41(10), 3677–3683 (2019)

    Article  Google Scholar 

  30. A. Puzziello, L. Rosato, N. Innaro et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine 47(2), 537–542 (2014)

    Article  CAS  Google Scholar 

  31. P. Del Rio, P. Carcoforo, F. Medas et al. Adverse events in thyroid surgery: observational study in three surgical units with high volume/year. BMC Surg. 21(1), 352 (2021)

    Article  Google Scholar 

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Acknowledgements

We thank Dr. Kazuya Fujiwara (Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan) for introducing us to the JMDC database and teaching us how to use it.

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Authors

Contributions

T.T., K.Y., R.S., Y.U. and A.H. were involved in study design and data interpretation. T.T. was involved in the data analysis. All authors commented and critically revised the drafts of the manuscript, and approved the final version.

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Correspondence to Takeshi Takahashi.

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Takahashi, T., Yamazaki, K., Shodo, R. et al. Actual prevalence of hypoparathyroidism after total thyroidectomy: a health insurance claims-database study. Endocrine 78, 151–158 (2022). https://doi.org/10.1007/s12020-022-03153-1

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