Persistent hypoparathyroidism following thyroidectomy: Analysis of 276 patients.

Mutaz Albrezat; Erhan Aysan

doi:10.58877/japaj.v2i2.140

Authors

Mutaz Albrezat Ministry of health holdings
Erhan Aysan, Md, Prof Yeditepe University

DOI:

https://doi.org/10.58877/japaj.v2i2.140

Keywords:

hypoparathyroidism, thyroidectomy, risk factors, permanent, Parathyroid, surgeon experience

Abstract

AIM - The aim of this study is to investigate the etiopathogenesis in cases of permanent hypoparathyroidism (PHP) after thyroidectomy.

METHOD - 276 cases diagnosed with permanent hypoparathyroidism (PHP) after thyroid surgery were evaluated retrospectively.

RESULTS - 276 patients who developed post-thyroidectomy PHP were included in this study. 98% had a total thyroidectomy and 70% had no lymph node dissection. In 85% of the patients, PHP developed after their first operation. 63% of the patients had benign disease. No parathyroid glands were found on the final pathology report in 68% of the cases. The operations were performed at university hospitals in 20% of patients. Central lymph node dissections (CLND) were conducted on 27% of patients. 59% of CLND procedures were performed by surgeons under 5 years of experience.

CONCLUSION - The onset of PHP after bilateral thyroidectomy is influenced by many factors. Our study observed a trend linking the likelihood of developing PHP to the surgeon’s specialization, experience, the extent of surgery, operations performed in non-academic hospitals, and the conduct of CLND. Notably, even when performed by experienced surgeons, CLND might elevate the risk of this complication. This trend emphasizing surgeon specialization and experience could play an instrumental role in reducing the incidence of this multifaceted complication and underscores the need for greater awareness about the implications of PHP.

References

Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 2002; 128: 389-392.

DOI: 10.1001/archotol.128.4.389 DOI: https://doi.org/10.1001/archotol.128.4.389

Lončar I, van Kinschot CMJ, van Dijk SPJ, et al. Persistent post-thyroidectomy hypoparathyroidism: A multicenter retrospective cohort study. Scand J Surg. 2022 Apr-Jun;111(2):14574969221107282.

doi: 10.1177/14574969221107282. DOI: https://doi.org/10.1177/14574969221107282

Pasieka JL, Wentworth K, Yeo CT, et al. Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review. J Bone Miner Res. 2022 Dec;37(12):2586-2601.

doi: 10.1002/jbmr.4714. DOI: https://doi.org/10.1002/jbmr.4714

Almquist M, Ivarsson K, Nordenström E, Bergenfelz A. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. Br J Surg. 2018 Sep;105(10):1313-1318.

doi: 10.1002/bjs.10843. DOI: https://doi.org/10.1002/bjs.10843

Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid. 2018 Jul;28(7):830-841.

doi: 10.1089/thy.2017.0309. DOI: https://doi.org/10.1089/thy.2017.0309

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

doi: 10.1007/s12020-019-02014-8. DOI: https://doi.org/10.1007/s12020-019-02014-8

Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014 Mar;101(4):307-20.

doi: 10.1002/bjs.9384. . DOI: https://doi.org/10.1002/bjs.9384

Coimbra C, Monteiro F, Oliveira P, Ribeiro L, de Almeida MG, Condé A. Hypoparathyroidism following thyroidectomy: Predictive factors. Acta Otorrinolaringol Esp. 2017 Mar-Apr;68(2):106-111. English, Spanish. DOI: https://doi.org/10.1016/j.otoeng.2016.06.001

doi: 10.1016/j.otorri.2016.06.008. DOI: https://doi.org/10.1016/j.otorri.2016.06.008

Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg. 2017 Apr;25(2):142-146.

doi: 10.1097/MOO.0000000000000346. DOI: https://doi.org/10.1097/MOO.0000000000000346

Canu GL, Medas F, Cappellacci F, Noordzij JP, Marcialis J, Erdas E, Calò PG. Risk factors of permanent hypoparathyroidism after total thyroidectomy Retrospective analysis of 285 consecutive patients. Ann Ital Chir. 2021;92:339-345.

Imga NN, Atas H, Torgutalp M, Daglar G, Berker D. Stratifying the risk factors for hypoparathyroidism after total thyroidectomy. A single Center study. Ann Ital Chir. 2019;90:21-30.

Chadwick DR. Hypocalcaemia and permanent hypoparathyroidism after total/bilateral thyroidectomy in the BAETS Registry. Gland Surg. 2017 Dec;6(Suppl 1):S69-S74.

doi: 10.21037/gs.2017.09.14. DOI: https://doi.org/10.21037/gs.2017.09.14

Wang Y, Xiao Y, Pan Y, Yang S, Li K, Zhao W, Hu X. The effectiveness and safety of prophylactic central neck dissection in clinically node-negative papillary thyroid carcinoma patients: A meta-analysis. Front Endocrinol (Lausanne). 2023 Jan 17;13:1094012.

doi: 10.3389/fendo.2022.1094012. DOI: https://doi.org/10.3389/fendo.2022.1094012

Pavlidis ET, Pavlidis TE. Role of prophylactic central neck lymph node dissection for papillary thyroid carcinoma in the era of de-escalation. World J Clin Oncol. 2023 Jul 24;14(7):247-258.

doi: 10.5306/wjco.v14.i7.247. DOI: https://doi.org/10.5306/wjco.v14.i7.247

D. Viola, G. Materazzi, L. Valerio, et al. Prophylactic Central Compartment Lymph Node Dissection in Papillary Thyroid Carcinoma: Clinical Implications Derived From the First Prospective Randomized Controlled Single Institution Study, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 4, April 2015, Pages 1316–1324.

DOI: 10.1210/jc.2014-3825. DOI: https://doi.org/10.1210/jc.2014-3825

Salem FA, Bergenfelz A, Nordenström E, Almquist M. Central lymph node dissection and permanent hypoparathyroidism after total thyroidectomy for papillary thyroid cancer: population-based study. Br J Surg. 2021 Jun 22;108(6):684-690.

doi: 10.1002/bjs.12028. PMID: 34157088. DOI: https://doi.org/10.1002/bjs.12028

Rao SS, Rao H, Moinuddin Z, Rozario AP, Augustine T. Preservation of parathyroid glands during thyroid and neck surgery. Front Endocrinol (Lausanne). 2023 May 31;14:1173950.

doi: 10.3389/fendo.2023.1173950. DOI: https://doi.org/10.3389/fendo.2023.1173950

Meltzer C, Hull M, Sundang A, Adams JL. Association Between Annual Surgeon Total Thyroidectomy Volume and Transient and Permanent Complications. JAMA Otolaryngol Head Neck Surg. 2019;145(9):830–837.

doi:10.1001/jamaoto.2019.1752 DOI: https://doi.org/10.1001/jamaoto.2019.1752

Medas F, Tuveri M, Canu GL, Erdas E, Calò PG. Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases. Updates Surg. 2019 Dec;71(4):705-710.

doi: 10.1007/s13304-019-00647-y. DOI: https://doi.org/10.1007/s13304-019-00647-y

Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. Langenbecks Arch Surg. 2007 Nov;392(6):685-91.

doi: 10.1007/s00423-007-0201-6. DOI: https://doi.org/10.1007/s00423-007-0201-6

Dedhia PH, Stoeckl EM, McDow AD, Pitt SC, Schneider DF, Sippel RS, Long KL. Outcomes after completion thyroidectomy versus total thyroidectomy for differentiated thyroid cancer: A single-center experience. J Surg Oncol. 2020 May 28.

Doi: 10.1002/jso.26044. PMID: 32468708. DOI: https://doi.org/10.1002/jso.26044