Risk Factors for Medically Treated Hypocalcemia after Surgery for Graves’ Disease: A Swedish Multicenter Study of 1,157 Patients

Hallgrimsson, Palli; Nordenström, Erik; Almquist, Martin; Bergenfelz, Anders

doi:10.1007/s00268-012-1574-4

Cited by 68 publications

(65 citation statements)

References 39 publications

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“…This result correlates with a large registry-based study that found younger patients have an increased incidence of hypocalcemia after thyroidectomy for GD. 13 Since definitions of hypocalcemia in these series include (in part) the development of symptoms, this was hypothesized to be due to younger patients possibly being more sensitive to and having more symptoms of hypocalcemia in the post-operative period, consistent with a previous analysis of hypocalcemia after thyroidectomy for GD. 26 However, this result is not consistent across studies, and some studies have identified older age as a risk factor for post-thyroidectomy complications.…”

Section: Discussionsupporting

confidence: 53%

Total thyroidectomy for Graves’ disease: Compliance with American Thyroid Association guidelines may not always be necessary

Shinall

Broome

Nookala

et al. 2013

Surgery

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Background Total thyroidectomy (TT) is the preferred surgical approach to Graves' disease (GD). Current American Thyroid Association (ATA) guidelines call for administration of potassium iodide (KI) and achievement of euthyroid state before operation. Small numbers and a mixture of surgical approaches spanning several decades hinder previous surgical series. We present the outcomes for TT at a single high-volume center. Methods A retrospective cohort study was conducted on 165 patients undergoing TT for GD from 7/2007 to 5/2012. Results Mean age was 43 years (Range: 17-78), and 128 patients (78%) were female. 95% of patients were on methimazole or propylthiouracil, and 42% remained hyperthyroid at time of surgery. Only 3 (2%) patients received KI. Mean operative time was 132 minutes (Range 59-271). Mean gland size and blood loss were 41 grams (Range 8-180) and 55 mL (Range 10-1050), respectively. No patient developed thyroid storm. Median follow-up was 7.5 months. Temporary and permanent hypocalcemia developed in 51 (31%) and two patients (1.2%), respectively. Temporary and permanent recurrent laryngeal nerve paresis occurred in 12 (7%) and one (0.6%) patient, respectively. Sixty-one (37%) patients experienced at least one complication. On multivariate analysis, patient age less than 45 years (OR 2.93, 95% CI 1.39-6.19) and obesity (OR 2.11, 95% CI 1.00-4.43) were associated with occurrence of complications. Conclusion This high-volume surgeon experience demonstrates no appreciable detriment to patient outcomes when ATA recommendations for routine use of KI and euthyroid state before thyroidectomy are not met. Transient hypocalcemia and hoarseness are frequent complications of TT for GD resolving within six months in most patients. Age less than 45 years and obesity are risk factors for post-operative complications.

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Section: Discussionsupporting

confidence: 53%

Total thyroidectomy for Graves’ disease: Compliance with American Thyroid Association guidelines may not always be necessary

Shinall

Broome

Nookala

et al. 2013

Surgery

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“…Issues regarding case volume and setting (university vs district general hospitals, MDT participation) are well documented across the generality of surgery, 22,38 cancer management 21,23 and endocrine practice. 19,20 These apply at both individual surgeon and hospital level with patients being more likely to receive appropriate surgical management for DTC in a higher volume centre. 39 BAETS recommends a minimum annual caseload of 25 thyroidectomies per year (personal communication from John Watkinson, Past President of BAETS, 2011) and the multidisciplinary guideline recommends 30.…”

Section: Discussionmentioning

confidence: 99%

“…Improved outcomes are associated with increased case volume in both thyroid surgery [17][18][19][20] and the wider consideration of cancer management [21][22][23] in a multidisciplinary team (MDT) setting. 5 Traditionally the realm of general surgeons, often with an endocrine interest, thyroid surgery has in the last 15 years seen a higher proportion of service delivery by ear, nose and throat (ENT)/head and neck surgeons.…”

mentioning

confidence: 99%

A cross-specialty survey to assess the application of risk stratified surgery for differentiated thyroid cancer in the UK

Ramsay¹,

Fielding²,

Krukowski

2014

annals

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INTRODUCTION This study describes variability of treatment for differentiated thyroid cancer among thyroid surgeons, in the context of changing patterns of thyroid surgery in the UK. METHODS Hospital Episodes Statistics on thyroid operations between 1997 and 2012 were obtained for England. A survey comprising six scenarios of varying 'risk' was developed. Patient/tumour information was provided, with five risk stratified or non-risk stratified treatment options. The survey was distributed to UK surgical associations. Respondent demographics were categorised and responses analysed by assigned risk stratified preference. RESULTS From 1997 to 2012, the Hospital Episode Statistics data indicated there was a 55% increase in the annual number of thyroidectomies with a fivefold increase in otolaryngology procedures and a tripling of cancer operations. Of the surgical association members surveyed, 264 respondents reported a thyroid surgery practice. Management varied across and within the six scenarios, and was not related consistently to the level of risk. Associations were demonstrated between overall risk stratified preference and higher volume practice (>25 thyroidectomies per year) (p=0.011), fewer years of consultant practice (p=0.017) and multidisciplinary team participation (p=0.037). Logistic regression revealed fewer years of consultant practice (odds ratio [OR]: 0.96/year in practice, 95% confidence interval [CI]: 0.922-0.997, p=0.036) and caseload of >25/year (OR 1.92, 95% CI: 1.044-3.522, p=0.036) as independent predictors of risk stratified preference. CONCLUSIONS There is a substantial contribution to thyroid surgery in the UK by otolaryngology surgeons. Adjusting management according to established case-based risk stratification is not widely applied. Higher caseload was associated with a preference for management tailored to individual risk.

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“…Two meta-analyses [5,7] reported lower incidence of hypocalcemia after the use of UD, whereas two other studies found no difference [6,21]. Medication for hypocalcemic symptoms was considered a reliable indicator of clinically relevant hypocalcemia in the early postoperative period, which was in line with another study [22].…”

Section: Discussionmentioning

confidence: 80%

Risk of Complications with Energy‐Based Surgical Devices in Thyroid Surgery: A National Multicenter Register Study

et al. 2015

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Risk Factors for Medically Treated Hypocalcemia after Surgery for Graves’ Disease: A Swedish Multicenter Study of 1,157 Patients

Cited by 68 publications

References 39 publications

Total thyroidectomy for Graves’ disease: Compliance with American Thyroid Association guidelines may not always be necessary

Total thyroidectomy for Graves’ disease: Compliance with American Thyroid Association guidelines may not always be necessary

A cross-specialty survey to assess the application of risk stratified surgery for differentiated thyroid cancer in the UK

Risk of Complications with Energy‐Based Surgical Devices in Thyroid Surgery: A National Multicenter Register Study

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