Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis

Díez, Juan J.; Anda, Emma; Sastre, Julia; Corral, Begoña Pérez; Álvarez-Escolá, Cristina; Manjón, Laura; Paja, Miguel; Sambo, Marcel; Fernández, Piedad Santiago; Carrera, Concepción Blanco; Galofré, Juan Carlos; Navarro, Elena; Zafón, Carles; Sanz, Eva; Oleaga, Laura; Bandrés, Orosia; Donnay, Sergio; Megía, Ana; Picallo, María; Sánchez-Ragnarsson, Cecilia; Baena-Nieto, Gloria; García, José Carlos Fernández; Lecumberri, Beatriz; Vega, Manel Sahún de la; Romero-Lluch, Ana R.; Iglesias, Pedro

doi:10.1007/s12020-019-02014-8

Cited by 58 publications

(57 citation statements)

References 47 publications

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“…PG autotransplantation is an independent risk factor for transient hypoparathyroidism, which is beyond doubt and has been confirmed by many previous studies ( 16 , 20 , 21 ). When more PGs are autotransplanted, the fewer PGs remaining in situ might not sustain the normal PTH level because of the delayed functioning of the grafts.…”

Section: Discussionsupporting

confidence: 73%

“…In addition, our study demonstrated that autotransplanted 1 PG and 2 PGs both independently increased the risk of transient hypoparathyroidism but reduced the risk of permanent hypoparathyroidism. PG autotransplantation is an independent risk factor for transient hypoparathyroidism, which is beyond doubt and has been confirmed by many previous studies (16,20,21). When more PGs are autotransplanted, the fewer PGs remaining in situ might not sustain the normal PTH level because of the delayed functioning of the grafts.…”

Section: Discussionmentioning

confidence: 64%

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Selective Parathyroid Autotransplantation During Total Thyroidectomy for Papillary Thyroid Carcinoma: A Cohort Study

et al. 2021

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Purpose: The relationship between the selective parathyroid gland (PG) autotransplantation and hypoparathyroidism is still not completely clear. The aim was to ascertain whether the number of autotransplanted PGs affected the incidence of hypoparathyroidism and recovery of parathyroid function in the long-term for patients with papillary thyroid carcinoma (PTC).Methods: A retrospective cohort study included all patients with PTC who had underwent primary total thyroidectomy with central neck dissection between January 2013 and December 2017. The patients were divided into three groups (0, 1, and 2 PGs autotransplanted, respectively).Results: Of the 2,477 patients, 634 (25.6%) received no PG autotransplantation, 1,078 (43.5%) and 765 (30.9%) were autotransplanted 1 and 2 PGs, respectively, and the incidence of permanent hypoparathyroidism (>1 year) was 1.7%, 0.7%, and 0.4% (P = 0.0228). Both 1 or 2 PGs autotransplanted increased the incidence of transient biochemical hypoparathyroidism (odds ratio [OR], 1.567; 95% confidence interval [CI], 1.258–1.953; P < 0.0001; OR, 2.983; 95% CI, 2.336–3.810; P < 0.0001, respectively) but reduced the incidence of permanent hypoparathyroidism (OR, 0.373; 95% CI, 0.145–0.958; P = 0.0404; OR, 0.144; 95% CI, 0.037–0.560; P = 0.0052, respectively). Both 1 or 2 PGs autotransplanted did not independently influence the occurrence of hypocalcemia symptoms.Conclusion: Selective parathyroid autotransplantation is less likely to lead to post-operative symptomatic hypocalcemia, although it could lead to a transient decrease in parathyroid hormone. However, in the long run, it is still an effective strategy to preserve parathyroid function.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 64%

Selective Parathyroid Autotransplantation During Total Thyroidectomy for Papillary Thyroid Carcinoma: A Cohort Study

et al. 2021

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“…In a study of 90 patients, Gupta et al define early transient hypoparathyroidism as hypoparathyroidism that resolves within the first post-operative month, while the term 'delayed transient hypoparathyroidism' is used up to 6 months post-operatively [22]. In another study of 1792 patients, Diez et al use the term 'protracted hypoparathyroidism' for hypoparathyroidism that resolves during the second post-operative semester [8]. Other authors, like Villaroya-Marquina et al, use only the terms 'transient' and 'permanent', but still distinguish two groups of patients in the first category, the ones that recover within 6 months after surgery and the ones who recover during the second semester [20].…”

Section: Discussionmentioning

confidence: 99%

What are the real rates of temporary hypoparathyroidism following thyroidectomy? It is a matter of definition: a systematic review

et al. 2021

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Introduction Post-operative hypoparathyroidism is the most encountered complication of thyroid surgery and is classified as temporary or permanent. However, its incidence varies greatly in the literature ranging from 0.5% to 65%. This can be mainly attributed to the different definition of hypoparathyroidism used in each study and especially to the different time cutoff applied to distinguish temporary from permanent hypoparathyroidism. Methods We conducted a systematic literature search in PubMed, Scopus, Cochrane and GoogleScholar databases, as well as grey literature. Ultimately, 45 articles with 23,164 patients in total were included in this review. These articles used either the cutoff of six or twelve post-operative months to distinguish temporary from permanent hypoparathyroidism. Results The overall incidence of permanent hypoparathyroidism diagnosed at 6 months post-operatively was 4.11% and 4.08% at 12 months post-operatively. There was no statistically significant difference between the two groups (p = 0.92). Conclusions We suggest that adhering to the current guidelines that recommend diagnosing temporary hypoparathyroidism when recovery is made within 6 months after surgery is important when conducting future research in order to narrow the gap that exists currently in the literature, as well as when deciding to put patients on long-term calcium supplements.

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“…A meta-analysis including 10 studies with 3860 patients who underwent at least total thyroidectomy found that the incidence of postoperative transient hypocalcemia in female patients was significantly higher than that in male patients (OR 1.70; 95% CI 1.03–2.80) [ 16 ]. However, the mechanism behind this risk factor for females is not yet clear [ 7 , 17 , 18 ]. There might be differences in the effect of sex hormones on PTH secretion [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Role of the 2018 American Thyroid Association statement on postoperative hypoparathyroidism: a 5-year retrospective study

et al. 2021

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Background Definitions of postoperative hypoparathyroidism (hypoPT) have never reached consent until the American Thyroid Association (ATA) statement was released, with new characteristics and challenges. Methods Patients with papillary thyroid carcinoma who underwent primary total thyroidectomy between January 2013 and June 2018 were retrospectively enrolled. Symptoms of hypocalcemia and their frequency were stringently followed. Patients were divided into groups according to the ATA statement. Incidence of postoperative hypoPT and serum parathyroid hormone levels accompanied by calcium levels, from 1-day to at least 24-month follow-up. Results A total of 1749 patients were included: 458 (26.2%) had transient and 63 (3.6%) had permanent hypoPT. Transient hypoPT was found in 363 (20.7%) patients with biochemical hypoPT, 72 (4.1%) with clinical hypoPT, and 23 (1.3%) with relative hypoPT; permanent hypoPT was detected in 8 (0.5%) patients with biochemical hypoPT, 55 (3.1%) with clinical hypoPT, and none with relative hypoPT. Female sex, age ≥ 55 years, unintentional parathyroid gland resection, and autotransplantation of ≥ 2 parathyroid glands were independent risk factors for transient biochemical hypoPT. Age ≥ 55 years, bilateral central neck dissection, and isthmus tumor location were independent risk factors for transient clinical hypoPT. A postoperative 1-day percentage of parathyroid hormone (PTH) reduction of > 51.1% was an independent risk factor for relative hypoPT (odds ratio, 4.892; 95% confidence interval, 1.653–14.480; P = 0.004). No independent risk factor for permanent hypoPT was found. Conclusion ATA diagnostic criteria for postoperative hypoPT are of great value in differentiating patients by hypocalcemia symptoms and choosing corresponding clinical assistance; however, they may underestimate the actual incidence.

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Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis

Cited by 58 publications

References 47 publications

Selective Parathyroid Autotransplantation During Total Thyroidectomy for Papillary Thyroid Carcinoma: A Cohort Study

Selective Parathyroid Autotransplantation During Total Thyroidectomy for Papillary Thyroid Carcinoma: A Cohort Study

What are the real rates of temporary hypoparathyroidism following thyroidectomy? It is a matter of definition: a systematic review

Role of the 2018 American Thyroid Association statement on postoperative hypoparathyroidism: a 5-year retrospective study

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