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. 2024 Aug 17;16(16):2867.
doi: 10.3390/cancers16162867.

Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients

Silvia Dughiero  1 , Francesca Torresan  1 , Simona Censi  2 , Caterina Mian  2 , José Luis Carrillo Lizarazo  1 , Maurizio Iacobone  1
Affiliations

Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients

Silvia Dughiero et al. Cancers (Basel). .

Abstract

Background: Postoperative hypoparathyroidism (HypoPTH) is the most common complication following total thyroidectomy. Several risk factors have been identified, but data on postoperative follow-up are scarce.

Methods: The study focused on 1965 patients undergoing surgery for benign and malignant thyroid diseases at a tertiary-level academic center. Anamnestic, biochemical, surgical, pathological, and follow-up data were evaluated. HypoPTH was defined by a serum concentration of PTH < 10 pg/mL on the first or the second post-operative day. Persistent HypoPTH was defined by the need for calcium/active vitamin D treatment > 12 months after surgery.

Results: Postoperative HypoPTH occurred in 542 patients. Multivariate analysis identified the association of central lymph-nodal dissection, reduced preoperative PTH levels, a lower rate of parathyroid glands preserved in situ, and longer duration of surgery as independent risk factors. At a median follow-up of 47 months, HypoPTH regressed in 443 patients (more than 6 months after surgery in 7%) and persisted in 53 patients. Patients receiving a lower dose of calcium/active vitamin D treatment at discharge (HR 0.559; p < 0.001) or undergoing prolonged, tailored, and direct follow-up by the operating endocrine surgeon team had a significantly lower risk of persistent HypoPTH (2.4% compared to 32.8% for other specialists) (HR 2.563; p < 0.001).

Conclusions: Various patient, disease, and surgeon-related risk factors may predict postoperative HypoPTH. Lower postoperative calcium/active vitamin D treatment and prolonged, tailored follow-up directly performed by operating endocrine surgeons may significantly reduce the rate of persistent HypoPTH.

Keywords: hypoparathyroidism; lymph-node neck dissection; morbidity; total thyroidectomy.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Regression of postoperative hypoparathyroidism in a series of 496 patients after bilateral thyroid surgery.
Figure 2
Figure 2
Regression of postoperative hypoparathyroidism in patients undergoing follow-up by endocrine surgeons (Group A) and other physicians (Group B) (a); regression in patients with hypoparathyroidism lasting more than 6 months after surgery (b).
Figure 3
Figure 3
Regression of postoperative hypoparathyroidism according to the dose of calcium/active vitamin D treatment at discharge.
See this image and copyright information in PMC

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