The impact of different surgical procedures on hypoparathyroidism after thyroidectomy

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Abstract

The main objective of this study is to investigate the outcome between surgical procedures and the risk of development of hypoparathyroidism followed by surgical procedure in patients with thyroid disorders.

We analyzed the data acquired from Taiwan's Bureau of National Health Insurance (BNHI) research database from 1998 to 2011 and found 9316 patients with thyroid surgery. Cox regression model was used to calculate the hazard ratio (HR).

A count of 314 cases (3.4%) of hypoparathyroidism was identified. The 9 years cumulated incidence of hypoparathyroidism was the highest in patient undergone bilateral total thyroidectomy (13.5%) and the lowest in the patient with unilateral subtotal thyroidectomy (1.2%). However, in the patients who had undergone unilateral subtotal, the risk was the highest in bilateral total (HR: 11.86), followed by radical thyroidectomy with unilateral neck lymph node dissection (HR: 8.56), unilateral total (HR, 4.39), and one side total and another side subtotal (HR: 2.80).

The extent of thyroid resection determined the risk of development of hypoparathyroidism. It is suggested that the association of these factors is investigated in future studies.

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Clinical practice. Hypoparathyroidism.

D M Shoback (2008)

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Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research.

John Bilezikian, Aliya Khan, John Potts … (2011)

Recent advances in understanding the epidemiology, genetics, diagnosis, clinical presentations, skeletal involvement, and therapeutic approaches to hypoparathyroidism led to the First International Workshop on Hypoparathyroidism that was held in 2009. At this conference, a group of experts convened to discuss these issues with a view towards a future research agenda for this disease. This review, which focuses primarily on hypoparathyroidism in the adult, provides a comprehensive summary of the latest information on this disease. Copyright © 2011 American Society for Bone and Mineral Research.

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The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients.

Henning Dralle, Michael Brauckhoff, Andreas Machens … (2003)

Limited information exists about risk factors for postoperative hypoparathyroidism after bilateral thyroid surgery. Between January 1 and December 31, 1998, bilateral thyroid surgery was performed on 5846 patients for benign and malignant thyroid disease. Data were prospectively collected by questionnaires from 45 hospitals. A logistic regression model was used to determine independent risk factors. The overall incidence of transient and permanent hypoparathyroidism was 7.3% and 1.5%, respectively. On logistic regression analysis, total thyroidectomy (odds ratio [OR], 4.7), female gender (OR, 1.9), Graves' disease (OR, 1.9), recurrent goiter (OR, 1.7), and bilateral central ligation of the inferior thyroid artery (OR, 1.7) constituted independent risk factors for transient hypoparathyroidism. When the multivariate analysis was confined to permanent hypoparathyroidism, total thyroidectomy (OR, 11.4), bilateral central (OR, 5.0) and peripheral (OR, 2.0) ligation of the inferior thyroid artery, identification and preservation of no or only a single parathyroid gland (OR, 4.1), and Graves' disease (OR, 2.4) emerged as independent risk factors. Extent of resection and surgical technique had a greater impact on the rates of permanent postoperative hypoparathyroidism than thyroid pathologic condition. In bilateral thyroid surgery, peripheral ligation of the inferior thyroid artery at the thyroid capsule should be favored over central ligation, and at least 2 parathyroid glands should be identified and preserved. High-risk procedures, such as total thyroidectomy and Graves' disease, require special surgical training and expertise.

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Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: October 2017

Publication date (Electronic): 27 October 2017

Volume: 96

Issue: 43

Electronic Location Identifier: e8245

Affiliations

[a ]Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan

[b ]International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan

[c ]Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan

[d ]Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

[e ]School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

[f ]School of Health Care Administration, Taipei Medical University, Taipei, Taiwan

[g ]Faculty of Health Sciences, Macau University of Science and Technology, Macau, China

[h ]Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan.

Author notes

[∗ ]Correspondence: Wen-Shan Jian, International Center for Health Information Technology (ICHIT), School of Health Care Administration, Taipei Medical University, No. 172–1, Section 2, Keelung Road, Da’an District, Taipei 10675, Taiwan (e-mail: jjtmutw@ 123456gmail.com ); Chung-Huei Hsu, Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (e-mail: chhsu@ 123456tmu.edu.tw ).

Article

Publisher ID: MD-D-17-00901 Accession ID: 08245

DOI: 10.1097/MD.0000000000008245

PMC ID: 5671821

PubMed ID: 29068988

SO-VID: 8740c7fa-1e7c-4a4e-a470-b1d6849f1625

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This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

History

Date received : 15 February 2017

Date revision received : 5 July 2017

Date accepted : 7 July 2017

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Keywords: hypoparathyroidism,multinodular goiter,surgical procedure,thyroid diseases,thyroidectomy

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Keywords: hypoparathyroidism, multinodular goiter, surgical procedure, thyroid diseases, thyroidectomy

The impact of different surgical procedures on hypoparathyroidism after thyroidectomy : A population-based study

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Most cited references 24

Clinical practice. Hypoparathyroidism.

Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research.

The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients.

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