Risk factors for hypocalcemia and correlation between thyroid volume and incidental parathyroidectomy after total thyroidectomy: single center experience
Abstract
Aim: We aimed to investigate correlation between the effects of age, sex, disease, pathologic diagnosis, parathyroid autotransplantation, presence of parathyroid in the pathology specimen and clinicopathological variables and thyroid volume, postoperative hypocalcemia after bilateral total thyroidectomy.
Material and Method: A retrospective study planned in tertiary university hospital on patients undergone bilateral total thyroidectomy and neck dissection when necessary surgery for thyroid pathologies. Minimum calcium values in the postoperative period were recorded as transient or permanent hypocalcemia. The cases were statistically analyzed for the relationship between the volume of the thyroid gland removed and hypocalcemia. The effects of sex, pathological diagnosis, preoperative hyperthyroidism, anatomical retrosternal extension, number of parathyroid glands seen and preserved intraoperatively, parathyroid gland autoimplantation, parathyroid gland removal in the pathological specimen, nerve monitoring, bilateral total thyroidectomy and central and lateral neck dissection were analyzed for postoperative hypocalcemia.
Results: Totally 763 patients were included in the study. The mean age of the patients was 50.6 years (SD:12.8) and the sex of 575 (75.4%) patients was female. Hypocalcemia was more common in women than in men (31% vs 17%; p<0.001). Patients who underwent incidental parathyroidectomy (IPT) (yes, 43% vs no, 25%; p<0.001) and parathyroid autotransplantation (yes, 82% vs no, 27%; p=0.001) had statistically significantly higher rates of hypocalcemia. In the univariate analysis, it was determined from the available data that an increase in thyroid volume had a statistically significant effect on hypocalcemia, albeit at a low level [OR:1.002 (95%CI:1-1.004]. In the multivariate logistic regression model, the independent variables associated with postoperative hypocalcemia were female sex [OR: 2.33 (95%CI: 1.49-3.62)], thyroid volume [OR: 1.003 (95%CI:1-1.005)], IPT [OR:2.29 (95%CI:1.48-3.54)] and parathyroid autotransplantation [OR:1.999 (95%CI:2.1-47.5)]. While the effect of increased thyroid volume on hypocalcemia was very low, being female and incidental parathyroidectomy increased hypocalcemia 2.3 fold and parathyroid autotransplantation increased hypocalcemia 10-fold.
Conclusion: Incidental parathyroidectomy is a remarkable association, which determines the complication of postoperative hypocalcemia, and the presence of parathyroid tissue in the pathology specimen in cases with small thyroid volume.
References
- Ho TW, Shaheen AA, Dixon E, Harvey A. Utilization of thyroidectomy for benign disease in the United States: a 15-year population-based study. Am J Surg 2011; 201: 570-4.
- Wiseman JE, Mossanen M, Ituarte PH, Bath JM, Yeh MW. An algorithm informed by the parathyroid hormone level reduces hypocalcemic complications of thyroidectomy. World J Surg 2010; 34: 532-7.
- Abboud B, Sargi Z, Akkam M. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 2002; 195: 456-61.
- Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V. Hypocalcemia after thyroidectomy. Arch Surg 1992; 127: 854-8.
- Hallgrimsson P, Nordenström E, Bergenfelz A, Almquist M. Hypocalcaemia after total thyroidectomy for Graves' disease and for benign atoxic multinodular goitre. Langenbeck's Arch Surg 2012; 397: 1133-7.
- Baldassarre RL, Chang DC, Brumund KT, Bouvet M. Predictors of hypocalcemia after thyroidectomy: results from the nationwide inpatient sample. ISRN surgery 2012; 2012.
- Karamanakos SN, Markou KB, Panagopoulos K, et al. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones (Athens) 2010; 9: 318-25.
- Bergenfelz A, Jansson S, Kristoffersson A, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008;393: 667-73.
- Bove A, Bongarzoni G, Dragani G, Serafini F. Should female patients undergoing parathyroid-sparing total thyroidectomy receive routine prophylaxis for transient hypocalcemia? The American Surgeon 2004; 70: 533.
- Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian S. Systematic review and meta‐analysis of predictors of post‐thyroidectomy hypocalcaemia. British J Surg 2014; 101: 307-20.
- Del Rio P, Rossini M, Montana CM, et al. Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 2019; 18: 25.
- Puzziello A, Rosato L, Innaro N, et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine 2014; 47: 537-42.
- Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 2003; 133: 180-5.
- Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg 2016; 34: 47-52.
- Testini M, Gurrado A, Avenia N, et al. Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients. Ann Surg Oncol 2011; 18: 2251-9.
- Olson Jr JA, DeBenedetti MK, Baumann DS, Wells Jr SA. Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg 1996; 223: 472.
- Norton JA. History of endocrine surgery. Surgery: Springer; 2001 p. 849-55.
- Henry J-F. Surgical anatomy and embryology of the thyroid and parathyroid glands and recurrent and external laryngeal nerves. Textbook of Endocrine surgery: Elsevier; 2005 p.9-15.
- Sheahan P, Murphy MS. Thyroid tubercle of Zuckerkandl: importance in thyroid surgery. The Laryngoscope 2011; 121: 2335-7.
- Özden S, Erdoğan A, Simsek B, Saylam B, Yıldız B, Tez M. Clinical course of incidental parathyroidectomy: Single center experience. Auris Nasus Larynx 2018; 45: 574-7.
- Shuchleib-Cung A, Garcia-Gordillo JA, Ferreira-Hermosillo A, Mercado M. Risk factors for hypocalcemia after total thyroidectomy. Cir Cir 2022; 90-6: 765-9.
- Karadeniz E, Akcay MN. Risk factors of ıncidental parathyroidectomy and its relationship with hypocalcemia after thyroidectomy: a retrospective study. Cureus 2019;11-10: e5920.
- Akgün Y, Öngören A, Kuru S, Acar E, Cengiz A, Gülhan D. Tiroid cerrahisi sonrası tetani. Turkish Med J 2007; 1: 80-5.
- Karabeyoğlu M, Ünal B, Dirican A, et al. The relation between preoperative ultrasonographic thyroid volume analysis and thyroidectomy complications. Endocrine Regulations 2008; 42: 83-7.
Abstract
References
- Ho TW, Shaheen AA, Dixon E, Harvey A. Utilization of thyroidectomy for benign disease in the United States: a 15-year population-based study. Am J Surg 2011; 201: 570-4.
- Wiseman JE, Mossanen M, Ituarte PH, Bath JM, Yeh MW. An algorithm informed by the parathyroid hormone level reduces hypocalcemic complications of thyroidectomy. World J Surg 2010; 34: 532-7.
- Abboud B, Sargi Z, Akkam M. Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 2002; 195: 456-61.
- Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V. Hypocalcemia after thyroidectomy. Arch Surg 1992; 127: 854-8.
- Hallgrimsson P, Nordenström E, Bergenfelz A, Almquist M. Hypocalcaemia after total thyroidectomy for Graves' disease and for benign atoxic multinodular goitre. Langenbeck's Arch Surg 2012; 397: 1133-7.
- Baldassarre RL, Chang DC, Brumund KT, Bouvet M. Predictors of hypocalcemia after thyroidectomy: results from the nationwide inpatient sample. ISRN surgery 2012; 2012.
- Karamanakos SN, Markou KB, Panagopoulos K, et al. Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures. Hormones (Athens) 2010; 9: 318-25.
- Bergenfelz A, Jansson S, Kristoffersson A, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008;393: 667-73.
- Bove A, Bongarzoni G, Dragani G, Serafini F. Should female patients undergoing parathyroid-sparing total thyroidectomy receive routine prophylaxis for transient hypocalcemia? The American Surgeon 2004; 70: 533.
- Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian S. Systematic review and meta‐analysis of predictors of post‐thyroidectomy hypocalcaemia. British J Surg 2014; 101: 307-20.
- Del Rio P, Rossini M, Montana CM, et al. Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 2019; 18: 25.
- Puzziello A, Rosato L, Innaro N, et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine 2014; 47: 537-42.
- Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 2003; 133: 180-5.
- Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg 2016; 34: 47-52.
- Testini M, Gurrado A, Avenia N, et al. Does mediastinal extension of the goiter increase morbidity of total thyroidectomy? A multicenter study of 19,662 patients. Ann Surg Oncol 2011; 18: 2251-9.
- Olson Jr JA, DeBenedetti MK, Baumann DS, Wells Jr SA. Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg 1996; 223: 472.
- Norton JA. History of endocrine surgery. Surgery: Springer; 2001 p. 849-55.
- Henry J-F. Surgical anatomy and embryology of the thyroid and parathyroid glands and recurrent and external laryngeal nerves. Textbook of Endocrine surgery: Elsevier; 2005 p.9-15.
- Sheahan P, Murphy MS. Thyroid tubercle of Zuckerkandl: importance in thyroid surgery. The Laryngoscope 2011; 121: 2335-7.
- Özden S, Erdoğan A, Simsek B, Saylam B, Yıldız B, Tez M. Clinical course of incidental parathyroidectomy: Single center experience. Auris Nasus Larynx 2018; 45: 574-7.
- Shuchleib-Cung A, Garcia-Gordillo JA, Ferreira-Hermosillo A, Mercado M. Risk factors for hypocalcemia after total thyroidectomy. Cir Cir 2022; 90-6: 765-9.
- Karadeniz E, Akcay MN. Risk factors of ıncidental parathyroidectomy and its relationship with hypocalcemia after thyroidectomy: a retrospective study. Cureus 2019;11-10: e5920.
- Akgün Y, Öngören A, Kuru S, Acar E, Cengiz A, Gülhan D. Tiroid cerrahisi sonrası tetani. Turkish Med J 2007; 1: 80-5.
- Karabeyoğlu M, Ünal B, Dirican A, et al. The relation between preoperative ultrasonographic thyroid volume analysis and thyroidectomy complications. Endocrine Regulations 2008; 42: 83-7.
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| Publication Date | March 27, 2023 |
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