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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hallgrimsson P, Nordenstrom E, Bergenfelz A, Almquist M (2012) Hypocalcaemia after total thyroidectomy for Graves’ disease and for benign atoxic multinodular goitre. Langenbecks Arch Surg 397(7):1133–1137
Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB et al (2012) Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab 97(12):4507–4514
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(11):1687–1695
Delbridge L (2002) Parathyroid autotransplantation: an essential technique for safe thyroid surgery. ANZ J Surg 72(12):852–853
Gourin CG, Tufano RP, Forastiere AA, Koch WM, Pawlik TM, Bristow RE (2010) Volume-based trends in thyroid surgery. Arch Otolaryngol Head Neck Surg 136(12):1191–1198
Cusano NE, Anderson L, Rubin MR, Silva BC, Costa AG, Irani D et al (2013) Recovery of parathyroid hormone secretion and function in postoperative hypoparathyroidism: a case series. J Clin Endocrinol Metab 98(11):4285–4290
Roh JL, Kim JM, Park CI (2011) Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol 18(8):2245–2250
Spiliotis J, Vaxevanidou A, Sergouniotis F, Tsiveriotis K, Datsis A, Rogdakis A et al (2010) Risk factors and consequences of incidental parathyroidectomy during thyroidectomy. Am Surg 76(4):436–441
Gonzalez-Sanchez C, Franch-Arcas G, Gomez-Alonso A (2013) Morbidity following thyroid surgery: does surgeon volume matter? Langenbecks Arch Surg 398(3):419–422
Kandil E, Noureldine SI, Abbas A, Tufano RP (2013) The impact of surgical volume on patient outcomes following thyroid surgery. Surgery 154(6):1346–1353
Pisanu A, Piu S, Cois A, Uccheddu A (2005) Hypocalcemia following total thyroidectomy: early factors predicting long-term outcome. G Chir 26(4):131–134
Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B (2008) Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg 143(2):132–137 discussion 138
Julian MT, Balibrea JM, Granada ML, Moreno P, Alastrue A, Puig-Domingo M et al (2013) Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term. Am J Surg 206(5):783–789
Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393(5):667–673
Lombardi CP, Raffaelli M, De Crea C, Traini E, Oragano L, Sollazzi L et al (2007) Complications in thyroid surgery. Minerva Chir 62(5):395–408
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 5,846 consecutive patients. Surgery 133(2):180–185
Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I et al (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24(11):1335–1341. doi:10.1007/s002680010221
Pesce CE, Shiue Z, Tsai HL, Umbricht CB, Tufano RP, Dackiw AP et al (2010) Postoperative hypocalcemia after thyroidectomy for Graves’ disease. Thyroid 20(11):1279–1283
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Almquist, M., Hallgrimsson, P., Nordenström, E. et al. Prediction of Permanent Hypoparathyroidism after Total Thyroidectomy. World J Surg 38, 2613–2620 (2014). https://doi.org/10.1007/s00268-014-2622-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2622-z