Factors predicting hypocalcemia after total thyroidectomy – A retrospective cohort analysis

Falch, Claudius; Hornig, Jan; Senne, Moritz; Braun, Manuel; Königsrainer, Alfred; Kirschniak, Andreas; Müller, Sven

doi:10.1016/j.ijsu.2018.05.014

Cited by 43 publications

(47 citation statements)

References 29 publications

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“…In six studies, age was found to have a statistically significant association with transient biochemical hypocalcaemia, 12,26,30,33,46,47 with four papers reporting this only in younger patients 12,26,30,33 and two papers reporting significance in older patients. 46,47 This is in comparison to 26 studies 11,16–19,24,25,27–29,31,32,38–40,42–44,49,52,54,56,58–61 that found no significant association to age.…”

Section: Resultscontrasting

confidence: 62%

“…These included an increasing number of parathyroid glands left in situ at the time of surgery (significant results in four of four studies 18,28,32,34 ), and evidence of parathyroid glands in the pathology specimen (8 significant results from 12 studies) 20,33,38,42,46–49 . However, other surgical factors related to the parathyroid glands do not demonstrate the same connection; a higher number of parathyroid glands identified during the procedure was more frequently not statistically significant (six of nine results were not significant 31,34,40,43,50,51 ) and equivocal results were seen when parathyroid glands are auto-transplanted (nine results significant 19,20,33,38,42,47–49,52 , eight non-significant 19,30,50,53–57 ). Similarly, the majority of studies which addressed the connection between transient biochemical hypocalcaemia and the extent of thyroidectomy and with neck dissection did not find a statistically significant association.…”

Section: Resultsmentioning

confidence: 98%

“…Further surgical factors offer little to explain the difference, with prolonged operating times (more than 120 minutes) 12,24,25,40,44,46,49,52,61,66 , the experience of the surgeon 19,51,61 and the surgical devices used 46,60,67 showing no overall association with post-thyroidectomy hypocalcaemia.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

2020

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AbstractObjectiveHypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention.MethodTwo authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019.ResultsSixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection.ConclusionMany factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.

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Section: Resultscontrasting

confidence: 62%

Section: Resultsmentioning

confidence: 98%

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Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

2020

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“…3,9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The quality of all included studies was assessed using the NOS, of which 10 studies were rated as high quality (four with 8 stars and six with 7 stars) and 13 studies were rated as moderate quality (11 with 6 stars and two with 5 stars) (Table 1). 3,9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] According to the heterogeneity for the meta-analyses on preoperative vitamin D levels (I 2 ¼ 74%, P ¼ 0.010), preoperative PTH (I 2 ¼ 92%, P < 0.0001) and preoperative calcium levels (I 2 ¼ 79%, P < 0.0009), a random-effects model was used for the meta-analyses. According to the heterogeneity for the meta-...…”

Section: Resultsmentioning

confidence: 99%

“…CI, confidence interval. 3,15,16,19,20,22,23,25,27,29,34 Figure 3. Forest plot of a meta-analysis to evaluate the relationship between preoperative vitamin D and the risk for postoperative hypocalcaemia after thyroidectomy in adult patients.…”

Section: Resultsmentioning

confidence: 99%

Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

Chen

Zhao

et al. 2021

J Int Med Res

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Objective A meta-analysis to investigate the risk factors for postoperative hypocalcaemia after thyroidectomy in adult patients. Methods A systematic search of publications in the electronic databases (PubMed®, The Cochrane Library, Web of Science, OVID and Embase®) from inception to June 2020 was conducted. Screening of titles, abstracts and full texts and data extraction were independently performed by two authors. The OR was selected as the pooled estimate. Results The analysis included 23 studies. Twelve significant risk factors for postoperative hypocalcaemia were identified: hypoparathyroidism, OR 5.58; total thyroidectomy, OR 3.59; hypomagnesaemia, OR 2.85; preoperative vitamin D deficiency, OR 2.32; female sex, OR 1.49; thyroid malignancy, OR 1.85; thyroiditis, OR 1.48; substernal multinodular goitres, OR 1.70; parathyroidectomy, OR 1.58; central compartment neck dissection, OR 1.17; modified radical neck dissection, OR 1.57; and central neck dissection, OR 1.54. Conclusions This meta-analysis provides moderate-to-high quality evidence that the 12 risk factors were predictive of postoperative hypocalcaemia, which should be monitored closely before thyroidectomy.

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Intraoperative near‐infrared autofluorescence imaging for hypocalcemia risk reduction after total thyroidectomy: Evidence from a meta‐analysis

et al. 2021

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This meta‐analysis evaluates whether near‐infrared autofluorescence (NIRAF) imaging reduces the risk of hypocalcemia after total thyroidectomy. A systematic literature search in PubMed, EMBASE, Web of Science, and Cochrane Library for studies from June 2011 to January 2021 comparing total thyroidectomy with NIRAF and conventional surgery (naked eye). Six eligible studies involving 2180 patients were included. The prevalence of transient hypocalcemia was 8.11% (40/493) and 25.19% (425/1687) in the NIRAF and naked eye groups (p < 0.0001), respectively. The prevalence of permanent hypocalcemia was 0% (0/493) and 2.19% (37/1687) in the NIRAF and naked eye groups (p = 0.05), respectively. NIRAF reduces the risk of transient hypocalcemia and may possibly lower the rate of permanent hypocalcemia. Nonetheless, further studies are needed to verify our results and evaluate the cost‐effectiveness of NIRAF in real‐world clinical practice.

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Factors predicting hypocalcemia after total thyroidectomy – A retrospective cohort analysis

Cited by 43 publications

References 29 publications

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis

Intraoperative near‐infrared autofluorescence imaging for hypocalcemia risk reduction after total thyroidectomy: Evidence from a meta‐analysis

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