Preoperative risk factors in total thyroidectomy of substernal goiter

Bove, Aldo; Renzo, Raffaella Maria Di; D'Urbano, Gauro; Bellobono, Manuela; D’Addetta, Vincenzo; Lapergola, Alfonso; Bongarzoni, Giuseppe

doi:10.2147/tcrm.s110464

Cited by 7 publications

(15 citation statements)

References 17 publications

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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%

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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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Section: Resultsmentioning

confidence: 99%

“…Two studies analysed the influence of substernal multinodular goitres. 24,27 Patients with substernal multinodular goitres showed a higher risk of postoperative hypocalcaemia (P ¼ 0.02, OR ¼ 1.70, 95% CI 1.09, 2.64) (Figure 12). Two studies analysed the influence of thyroiditis.…”

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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“…Several studies have investigated predictive factors of hypocalcemia after TT in order to anticipate therapy so as to reduce symptoms and guarantee a timely and safe discharge [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy

Bove

Rocini

Renzo

et al. 2020

International Journal of Endocrinology

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Background. Total thyroidectomy (TT) is recommended in the treatment of malignant and benignant thyroid diseases, and, to date, transient hypocalcemia is the most frequent complication after the procedure. We prospectively evaluated the role of vitamin D deficiency as a predictor of postoperative hypocalcemia. Methods. This is a prospective cohort study which was conducted between January 2016 and April 2019. A total of 177 consecutive patients (141 (79.7%) women and 36 (20.3%) men) who underwent TT were included in the current study. Hypocalcemia occurred when serum calcium levels were below 8.0 mg/dL or 1.10 mmol/L. Patients were divided into two groups (Group 1, normocalcemic; Group 2, hypocalcemic) and were assessed taking into consideration preoperative serum 25-hydroxy vitamin D (25-OHD) levels, preoperative serum calcium levels, thyroid hormone levels, sex, body mass index (BMI), and smoking habits. Vitamin D deficiency was defined as 25-OHD levels <25 ng/mL. Results. The incidence of postoperative asymptomatic and symptomatic hypocalcemia in the two groups was 19.8% and 15.8%, respectively. Preoperative 25-OHD level was significantly different between Group 1 and Group 2 (31.5 ± 15.0 ng/mL vs 18.7 ± 9.8 ng/mL,p=0.017). Logistic regression analysis revealed that preoperative vitamin D deficiency was a significant predictive factor of postoperative hypocalcemia (p=0.012), and, specifically, the risk of hypocalcemia increased 15-fold in patients with a preoperative vitamin D level <25 ng/mL (odds ratio [OR], 14.8). Conclusions. Postoperative hypocalcemia is significantly associated with low preoperative levels of serum 25-OHD. Our studies demonstrate that vitamin D deficiency (<25 ng/mL) is an independent predictive factor of postoperative hypocalcemia.

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“…Medial sternotomy is typically indicated in cases in which substernal extent of the gland goes beyond the aortic arch or the tracheal carina. When compared to removal of cervical goiters, patients undergoing removal of SSG were found to have higher perioperative morbidity and generally require longer hospital stays [5]. The most common complications of thyroid surgery include hematoma, recurrent laryngeal nerve injury, transient post-operative hypocalcemia and permanent hypoparathyroidism [1].…”

Section: Introductionmentioning

confidence: 99%

“…Bove et al additionally found that recurrence and extension of the goiter beyond the carina were statistically signifi cant pre-operative risk factors associated with higher risks of complications. They considered growth of the glandbeyond the level of the carina to be a more signifi cant risk factor than the volume of the gland itself[5].…”

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Factors influencing extent of surgery for Substernal Thyroid Goiters: Hemithyroidectomy versus total Thyroidectomy

Kane¹

2018

Arch Otolaryngol Rhinold

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Background: When compared to removal of cervical goiters, patients undergoing removal of substernal goiter have been found to have higher rates of complications, including recurrent laryngeal nerve injury, bleeding, and hypoparathyroidism. Previous literature has discussed hemithyroidectomy versus total thyroidectomy for cervical goiters showing that the less invasive procedure was a reasonable option with decreased morbidity overall. Methods: A retrospective chart review was performed at 2 tertiary academic medical centers. The search was performed using the CPT codes for substernal removal of thyroid 60270 and 60271. Results: 38 patients were identifi ed between the years 2011-2017. Patients who underwent hemithyroidectomy in this study, had a trend toward older age, higher rate of medical co-morbidities and small size of non-dominant thyroid lobe. No patients who underwent hemithyroidectomy at this institution during this study period required completion thyroidectomy. Conclusion: Hemithyroidectomy is an acceptable treatment option for substernal goiters in appropriate cases.

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Preoperative risk factors in total thyroidectomy of substernal goiter

Cited by 7 publications

References 17 publications

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

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

Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy

Factors influencing extent of surgery for Substernal Thyroid Goiters: Hemithyroidectomy versus total Thyroidectomy

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