Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery

Yazıcıoğlu, Mustafa Ömer; Yilmaz, Abdurrezzak; Kocaöz, Servet; Ozcaglayan, Ruhsen; Parlak, Ömer

doi:10.1038/s41598-021-91277-1

Cited by 17 publications

(18 citation statements)

References 27 publications

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“…This is consistent with the findings of Qiu’s ( 31 ) study. At the same time, we found that the diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism or permanent hypoparathyroidism which was the same conclusion as Yazıcıoğlu et al ( 22 ).…”

Section: Discussionsupporting

confidence: 85%

“…Reported incidence rates of transient hypoparathyroidism range from 5.49% to 67.69%; those for permanent hypoparathyroidism range from 0% to 20% ( 16 , 20 , 21 ). This problem is caused by a number of factors ( 22 , 23 ), one of which is that the definition of the timing of hypoparathyroidism is still being explored. The guidelines of the European Society of Endocrinology ( 24 ) and the ATA ( 25 ) define permanent hypoparathyroidism as a low PTH concentration 6 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

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Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma

Zhang

Wang

et al. 2022

Front. Oncol.

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PurposeThis study aimed to examine the effect of selective inferior parathyroid gland autotransplantation on central lymph node dissection(CLND) and incidence of postoperative hypoparathyroidism in patients undergoing endoscopic radical resection of thyroid carcinoma.MethodsThe data of 310 patients undergoing endoscopic radical resection of thyroid carcinoma will be retrospectively analyzed. The patients will be divided into the experimental group and the control group according to whether they combined with parathyroid autotransplantation. Statistics of the incidence rate of postoperative hypoparathyroidism, the concentration of PTH and Calcium in the systemic circulation at different time points in the two groups, the concentration of PTH in the cubital fossa vein in the transplantation region in the experimental group, and the number of central lymph nodes and positive lymph nodes dissection will be carried out.ResultsThe incidence rate of temporary and permanent hypoparathyroidism in the experimental group was 33.75% and 0.625%, respectively, and in the control group was 22% and 5%, respectively; its difference was statistically significant (X2 = 10.255, P=0.006). Parathyroid autotransplantation increased incidence of transient hypoparathyroidism (OR, 1.806; Cl, 1.088-2.998; P=0.022), and lower incidence of permanent hypoparathyroidism (OR, 0.112; Cl, 0.014-0.904; P=0.040). The diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism (OR, 0.769; Cl, 0.467-1.265; P=0.301) or permanent hypoparathyroidism (OR, 1.434; Cl, 0.316-6.515; P=0.641). Comparison of systemic circulation PTH, between the two groups showed that the PTH of patients in the experimental group was higher than that in the control group from 1 week to 12 months after the operation, and the difference was statistically significant (P<0.05). In the experimental group, from 1 week to 12 months after surgery, PTH concentrations was significantly higher in the cubital fossa of the transplantation side than in the contralateral side, and the differences were statistically significant (P<0.05). The mean number of central lymph node dissected per patient was significantly higher in the experimental group (7.94 ± 3.03 vs. 6.99 ± 2.86; P <0.05); The mean number of positive nodes per patient was significantly higher in the experimental group (3.16 ± 1.86 vs. 2.53 ± 1.59; P <0.05).ConclusionsIn endoscopic radical resection of thyroid carcinoma, parathyroid autotransplantation is more beneficial to postoperative parathyroid glands function recovery, effectively preventing postoperative permanent hypoparathyroidism and realizing more thorough CLND.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma

Zhang

Wang

et al. 2022

Front. Oncol.

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“…The frequency of postoperative hypoparathyroidism is 36.1-42.4%, but it decreases to 1.1-3.9% after 6 months -1 year (32,33). Risk factors for postoperative hypocalcemia are female, bilateral lymphadenectomy, high ligation of the thyroid arteries, large thyroid gland, low levels of preoperative calcium and parathyroid hormone, autotransplantation of the parathyroid gland (32)(33)(34)(35). At the same time, if the parathyroid gland was removed during surgery, its reimplantation with adequate blood supply significantly reduces the risk of hypocalcemia (34,36).…”

Section: Disadvantages Of Central Lymph Node Dissectionmentioning

confidence: 99%

“…Risk factors for postoperative hypocalcemia are female, bilateral lymphadenectomy, high ligation of the thyroid arteries, large thyroid gland, low levels of preoperative calcium and parathyroid hormone, autotransplantation of the parathyroid gland (32)(33)(34)(35). At the same time, if the parathyroid gland was removed during surgery, its reimplantation with adequate blood supply significantly reduces the risk of hypocalcemia (34,36). Due to the fact that permanent hypocalcemia is a rare complication, it is difficult to reliably assess the effect of lymphodissection because a small number of cases creates difficulties for adequate statistical analysis.…”

Section: Disadvantages Of Central Lymph Node Dissectionmentioning

confidence: 99%

A Narrative Review of Preventive Central Lymph Node Dissection in Patients With Papillary Thyroid Cancer - A Necessity or an Excess

et al. 2022

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ObjectiveThis review article summarises the latest evidence for preventive central lymph node dissection in patients with papillary thyroid cancer taking into account the possible complications and risk of recurrence.BackgroundPapillary thyroid cancer is the most frequent histological variant of malignant neoplasms of the thyroid gland. It accounts for about 80-85% of all cases of thyroid cancer. Despite good postoperative results and an excellent survival rate in comparison with many other malignant diseases, tumor metastases to the cervical lymph nodes are frequent. Most researchers agree that the presence of obvious metastases in the lymph nodes requires careful lymph node dissection. It was suggested to perform preventive routine lymphadenectomy in all patients with malignant thyroid diseases referred to surgery.MethodsIt was performed the literature review using the “papillary thyroid cancer”, “central lymph node dissection”, “hypocalcemia”, “recurrent laryngeal nerve paresis”, “metastasis”, “cancer recurrence” along with the MESH terms. The reference list of the articles was carefully reviewed as a potential source of information. The search was based on Medline, Scopus, Google Scholar, eLibrary engines. Selected publications were analyzed and their synthesis was used to write the review and analyse the role of preventive central lymph node dissection in patients with papillary thyroid cancer.ConclusionsThe necessity of preventive central lymph node dissection in patients with differentiated papillary thyroid carcinoma is still controversial. There is much evidence that it increases the frequency of transient hypocalcemia. Due to the fact that this complication is temporary, its significance in clinical practice is debatable. It can also be assumed that an extant of surgery in the neck area is associated with an increased risk of recurrent laryngeal nerve injury. However, most studies indicate that this injury is associated more with thyroidectomy itself than with lymph node dissection. Recurrent laryngeal nerve dysfunction is also a temporary complication in the vast majority of cases. At the same time, a large amount of data shows that central lymph node dissection reduces the risk of thyroid cancer recurrence in two times.

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“…Especially in the case of permanent hypoparathyroidism, which worsens the quality of life due to replacement therapy and undefined controls, the differences are even more marked if one compares the case histories of dedicated surgical centres, general centres and general epidemiological surveys including patients who have escaped specialist controls. In fact, contrary to what has been estimated, the majority of the studies report hypoparathyroidism with percentages of more than 10%, even though these are often mild forms that can be easily controlled with low doses of calcium and vitamin D, which rarely expose the patient to complications such as calcification of the extra-skeletal soft tissues, basal ganglia and kidney, as observed in cases that require much higher doses to compensate for the almost total lack of parathyroid hormone [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

Perigli

Cianchi

Giudici

et al. 2021

JCM

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Background: The diagnosis of thyroid cancer is continuously increasing and consequently the amount of thyroidectomy. Notwithstanding the actual surgical skill, postoperative hypoparathyroidism still represents its most frequent complication. The aims of the present study are to analyze the rate of postoperative hypoparathyroidism after thyroidectomy, performed for cancer by a single first operator, without any technological aid, and to compare the data to those obtained adopting the most recent technological adjuncts developed to reduce the postoperative hypoparathyroidism. Methods: During the period 1997–2020 at the Endocrine Surgery Unit of the Department of Clinical and Experimental Medicine of the University of Florence, 1648 consecutive extracapsular thyroidectomies for cancer (401 with central compartment node dissection) were performed. The percentage of hypoparathyroidism, temporary or permanent, was recorded both in the first period (Group A) and in the second, most recent period (Group B). Total thyroidectomies were compared either with those with central compartment dissection and lobectomies. Minimally invasive procedures (MIT, MIVAT, some transoral) were also compared with conventional. Fisher’s exact and Chi-square tests were used for comparison of categorical variables. p < 0.01 was considered statistically significant. Furthermore, a literature research from PubMed® has been performed, considering the most available tools to better identify parathyroid glands during thyroidectomy, in order to reduce the postoperative hypoparathyroidism. We grouped and analyzed them by technological affinity. Results: On the 1648 thyroidectomies enrolled for the study, the histotype was differentiated in 93.93 % of cases, medullary in 4% and poorly differentiated in the remaining 2.06%. Total extracapsular thyroidectomy and lobectomy were performed respectively in 95.45% and 4.55%. We recorded a total of 318 (19.29%) cases of hypocalcemia, with permanent hypoparathyroidism in 11 (0.66%). In regard to the literature, four categories of tools to facilitate the identification of the parathyroids were identified: (a) vital dye; (b) optical devices; (c) autofluorescence of parathyroids; and (d) autofluorescence enhanced by contrast media. Postoperative hypoparathyroidism had a variable range in the different groups. Conclusions: Our data confirm that the incidence of post-surgical hypoparathyroidism is extremely low in the high volume centers. Its potential reduction adopting technological adjuncts is difficult to estimate, and their cost, together with complexity of application, do not allow immediate routine use. The trend towards increasingly unilateral surgery in thyroid carcinoma, as confirmed by our results in case of lobectomy, is expected to really contribute to a further reduction of postsurgical hypoparathyroidism.

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Risks and prediction of postoperative hypoparathyroidism due to thyroid surgery

Cited by 17 publications

References 27 publications

Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma

Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma

A Narrative Review of Preventive Central Lymph Node Dissection in Patients With Papillary Thyroid Cancer - A Necessity or an Excess

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

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