Impact of Permanent Post-thyroidectomy Hypoparathyroidism on Self-evaluation of Quality of Life and Voice: Results From the National QoL-Hypopara Study.


Journal

Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354

Informations de publication

Date de publication:
01 11 2021
Historique:
pubmed: 7 8 2021
medline: 23 11 2021
entrez: 6 8 2021
Statut: ppublish

Résumé

The aim of this study was to compare the quality of life (mental health) and voice in patients with or without permanent hypoparathyroidism after total thyroidectomy. Permanent hypoparathyroidism is an underestimated complication of thyroid surgery owing to suppression of parathormone secretion. Few studies have evaluated the consequences of hypoparathyroidism on quality of life and none has studied its effects on voice. The QoL-hypopara study (ClinicalTrial.gov NCT04053647) was a national observational study. Adult thyroidectomized patients were included between January and June 2020. A serum parathormone level <15 pg/mL >6 months after surgery defined permanent hypoparathyroidism. Patients answered the MOS-36-item short-form health (SF-36), the Voice Handicap Index (VHI) surveys, and a list of questions regarding their symptoms. A total of 141 patients were included, 45 with permanent hypoparathyroidism. The median period between thyroid surgery and the questionnaire was 6 (Q1-Q3 4-11) and 4 (4-5) years in hypoparathyroid patients and controls respectively. Hypoparathyroid patients presented a reduced median mental score ratio (SF-36) [0.88 (Q1-Q3 0.63-1.01) vs 1.04 (0.82-1.13), P = 0.003] and a lower voice quality (incidence rate ratio for total VHI 1.83-fold higher, P < 0.001). In multivariable analysis, hypoparathyroidism [-0.17 (95% confidence interval -0.28 to -0.07), P = 0.002], but not age, female sex, thyroid cancer, or abnormal TSH level, was associated with the reduced mental score ratio. Myalgia, joint pain, paresthesia, tetany, anxiety attack, and exhaustion were the most common symptoms among hypoparathyroid patients (>50%). Hypoparathyroid patients present significantly impaired quality of life, lower voice quality, and frequent symptoms. These results reinforce the importance of preventing this complication.

Sections du résumé

OBJECTIVE
The aim of this study was to compare the quality of life (mental health) and voice in patients with or without permanent hypoparathyroidism after total thyroidectomy.
SUMMARY BACKGROUND DATA
Permanent hypoparathyroidism is an underestimated complication of thyroid surgery owing to suppression of parathormone secretion. Few studies have evaluated the consequences of hypoparathyroidism on quality of life and none has studied its effects on voice.
METHODS
The QoL-hypopara study (ClinicalTrial.gov NCT04053647) was a national observational study. Adult thyroidectomized patients were included between January and June 2020. A serum parathormone level <15 pg/mL >6 months after surgery defined permanent hypoparathyroidism. Patients answered the MOS-36-item short-form health (SF-36), the Voice Handicap Index (VHI) surveys, and a list of questions regarding their symptoms.
RESULTS
A total of 141 patients were included, 45 with permanent hypoparathyroidism. The median period between thyroid surgery and the questionnaire was 6 (Q1-Q3 4-11) and 4 (4-5) years in hypoparathyroid patients and controls respectively. Hypoparathyroid patients presented a reduced median mental score ratio (SF-36) [0.88 (Q1-Q3 0.63-1.01) vs 1.04 (0.82-1.13), P = 0.003] and a lower voice quality (incidence rate ratio for total VHI 1.83-fold higher, P < 0.001). In multivariable analysis, hypoparathyroidism [-0.17 (95% confidence interval -0.28 to -0.07), P = 0.002], but not age, female sex, thyroid cancer, or abnormal TSH level, was associated with the reduced mental score ratio. Myalgia, joint pain, paresthesia, tetany, anxiety attack, and exhaustion were the most common symptoms among hypoparathyroid patients (>50%).
CONCLUSIONS
Hypoparathyroid patients present significantly impaired quality of life, lower voice quality, and frequent symptoms. These results reinforce the importance of preventing this complication.

Identifiants

pubmed: 34353986
doi: 10.1097/SLA.0000000000005129
pii: 00000658-202111000-00024
doi:

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

851-858

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.

Références

Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004; 28:271–276.
Reeve T, Thompson NW. Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 2000; 24:971–975.
Cho N, Moalem J, Chen L, et al. Surgeons and patients disagree on the potential consequences from hypoparathyroidism. Endoc Pract 2014; 20:427–446.
Powers J, Joy K, Ruscio A, et al. Prevalence and incidence of hypoparathyroidism in the United States using a large claims database: epidemiology of hypoparathyroidism. J Bone Miner Res 2013; 28:2570–2576.
Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol 2007; 121:237–241.
Sitges-Serra A, Ruiz S, Girvent M, et al. Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg 2010; 97:1687–1695.
Duclos A, Peix JL, Colin C, et al. Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study. BMJ 2012; 344:d8041.
Abate EG, Clarke BL. Review of hypoparathyroidism. Front Endocrinol (Lausanne) 2017; 7:172.
Stack BC, Bimston DN, Bodenner DL, et al. American association of clinical endocrinologists and american college of endocrinology disease state clinical review: postoperative hypoparathyroidism - definitions and management. Endoc Pract 2015; 21:674–685.
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; 393:667–673.
Frey S, Blanchard C, Caillard C, et al. Thyroid surgery in obese patients: a review of the literature. J Visc Surg 2020; 157:401–409.
Bilezikian JP, Khan A, Potts J, et al. Hypoparathyroidism in the adult: Epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res 2011; 26:2317–2337.
Büttner M, Musholt TJ, Singer S. Quality of life in patients with hypoparathyroidism receiving standard treatment: a systematic review. Endocrine 2017; 58:14–20.
Almquist M, Ivarsson K, Nordenström E, et al. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. Br J Surg 2018; 105:1313–1318.
Bergenfelz A, Nordenström E, Almquist M. Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy. Surgery 2020; 167:124–128.
Hadker N, Egan J, Sanders J, et al. Understanding the burden of illness associated with hypoparathyroidism reported among patients in the paradox study. Endoc Pract 2014; 20:671–679.
Borel F, Tresallet C, Hamy A, et al. Self-assessment of voice outcomes after total thyroidectomy using the Voice Handicap Index questionnaire: results of a prospective multicenter study. Surgery 2020; 167:129–136.
Mirallié E, Borel F, Tresallet C, et al. Impact of total thyroidectomy on quality of life at 6 months: the prospective ThyrQoL multicentre trial. Eur J of Endocrinol 2020; 182:195–205.
Blanchard C, Pattou F, Brunaud L, et al. Randomized clinical trial of ultrasonic scissors versus conventional haemostasis to compare complications and economics after total thyroidectomy (FOThyr): Ultrasonic scissors in total thyroidectomy. BJS Open 2017; 1:2–10.
Contopoulos-Ioannidis DG, Karvouni A, Kouri I, et al. Reporting and interpretation of SF-36 outcomes in randomised trials: systematic review. BMJ 2009; 338:a3006.
Promberger R, Hermann M, Pallikunnel SJ, et al. Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto's thyroiditis. Am J Surg 2014; 207:974–979.
Perneger TV, Leplège A, Etter J-F, et al. Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults. J Clin Epidemiol 1995; 48:1051–1060.
Perneger T, Leplège A, Ecosse E. Le questionnaire MOS SF-36: manuel de l’utilisateur et guide d’interprétation des scores. 2001; Paris: Editions Estem, 1–156.
Jacobson BH, Johnson A, Grywalski C, et al. The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol 1997; 6:66.
Woisard V, Bodin S, Puech M. The Voice Handicap Index: impact of the translation in French on the validation. Rev Laryngol Otol Rhinol (Bord) 2004; 125:307–312.
Kletzien H, Macdonald CL, Orne J, et al. Comparison between patient-perceived voice changes and quantitative voice measures in the first postoperative year after thyroidectomy: a secondary analysis of a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2018; 144:995–1003.
Sikjaer T, Rolighed L, Hess A, et al. Effects of PTH(1-84) therapy on muscle function and quality of life in hypoparathyroidism: results from a randomized controlled trial. Osteoporos Int 2014; 25:1717–1726.
Sikjaer T, Moser E, Rolighed L, et al. Concurrent hypoparathyroidism is associated with impaired physical function and quality of life in hypothyroidism. J Bone Miner Res 2016; 31:1440–1448.
Cusano NE, Rubin MR, McMahon DJ, et al. The effect of PTH(1-84) on quality of life in hypoparathyroidism. J Clin Endoc Metab 2013; 98:2356–2361.
Astor MC, Løvås K, Debowska A, et al. Epidemiology and health-related quality of life in hypoparathyroidism in Norway. J Clin Endoc Metab 2016; 101:3045–3053.
Samuels MH, Schuff KG, Carlson NE, et al. Health status, psychological symptoms, mood, and cognition in L-thyroxine-treated hypothyroid subjects. Thyroid 2007; 17:249–258.
Arlt W, Fremerey C, Callies F, et al. Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D. Eur J Endocrinol 2002; 215–222.
Underbjerg L, Sikjaer T, Mosekilde L, et al. Postsurgical hypoparathyroidism-risk of fractures, psychiatric diseases, cancer, cataract, and infections: postsurgical hypoparathyroidism. J Bone Miner Res 2014; 29:2504–2510.
Bagó AG, Dimitrov E, Saunders R, et al. Parathyroid hormone 2 receptor and its endogenous ligand tuberoinfundibular peptide of 39 residues are concentrated in endocrine, viscerosensory and auditory brain regions in macaque and human. Neuroscience 2009; 162:128–147.
Mannstadt M, Clarke BL, Vokes T, et al. Efficacy and safety of recombinant human parathyroid hormone (1-84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study. Lancet Diabetes Endocrinol 2013; 1:275–283.
Tabacco G, Tay Y-KD, Cusano NE, et al. Quality of life in hypoparathyroidism improves with rhPTH(1-84) throughout 8 years of therapy. J Clin Endocrinol Metab 2019; 104:2748–2756.
Vokes TJ, Mannstadt M, Levine MA, et al. Recombinant human parathyroid hormone effect on health-related quality of life in adults with chronic hypoparathyroidism. J Clin Endocrinol Metab 2018; 103:722–731.
Shoback DM, Bilezikian JP, Costa AG, et al. Presentation of hypoparathyroidism: etiologies and clinical features. J Clin Endocrinol Metab 2016; 101:2300–2312.
Minni A, Ruoppolo G, Barbaro M, et al. Long-term (12 to 18 months) functional voice assessment to detect voice alterations after thyroidectomy. Eur Rev Med Pharmacol Sci 2014; 18:1704–1708.
Underbjerg L, Sikjaer T, Mosekilde L, et al. Cardiovascular and renal complications to postsurgical hypoparathyroidism: A Danish nationwide controlled historic follow up study. J Bone Miner Res 2013; 28:2277–2285.
Mitchell DM, Regan S, Cooley MR, et al. Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab 2012; 97:4507–4514.
Underbjerg L, Sikjaer T, Mosekilde L, et al. The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Bone Miner Res 2015; 30:1738–1744.
Watt T, Cramon P, Hegedüs L, et al. The thyroid-related quality of life measure ThyPRO has good responsiveness and ability to detect relevant treatment effects. J Clin Endocrinol Metab 2014; 99:3708–3717.
Coles T, Chen K, Nelson L, et al. Psychometric evaluation of the hypoparathyroidism symptom diary. Patient Relat Outcome Meas 2019; 10:25–36.
Singer S, Lincke T, Gamper E, et al. Quality of life in patients with thyroid cancer compared with the general population. Thyroid 2012; 22:117–124.

Auteurs

Samuel Frey (S)

Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, Nantes CEDEX, France.
Université de Nantes, Quai de Tourville, Nantes.

Lucile Figueres (L)

Université de Nantes, Quai de Tourville, Nantes.
Service de Néphrologie-Immunologie Clinique, CHU de Nantes, Nantes cedex, France.

François Pattou (F)

CHU Lille, Université de Lille, Chirurgie Générale et Endocrinienne Lille, France.

Maëlle Le Bras (M)

Endocrinologie, Maladies Métaboliques et Nutrition, CHU de Nantes, Hôpital Laënnec, boulevard Jacques-Monod, Saint-Herblain, France.

Cécile Caillard (C)

Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, Nantes CEDEX, France.

Muriel Mathonnet (M)

CHU de Limoges - Hôpital Dupuytren, Chirurgie Digestive, Générale et Endocrinienne, Limoges cedex, France.

Antoine Hamy (A)

CHU Angers, Chirurgie Digestive et Endocrinienne, Angers cedex 09, France.

Laurent Brunaud (L)

Université de Lorraine, Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), CHRU Nancy, Hôpital de Brabois (7 étage), Vandœuvre-lès-Nancy, France.

Jean-Christophe Lifante (JC)

Hôpital Lyon-Sud, Chirurgie Digestive et Endocrinienne, 69495 Pierre Bénite cedex, France, 9bis- Research on Healthcare Professionals and Performance (RESHAPE) UMR- Université Claude Bernard Lyon 1 - INSERM 1290. Domaine Rockefeller- 2 étage (couloir CD), Lyon, France.

Christophe Trésallet (C)

Service de Chirurgie Digestive, Bariatrique et Endocrinienne, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, 93000, France.

Frédéric Sebag (F)

AP-HM - Hôpital de La Conception, Chirurgie Générale, Marseille, France.

Fabrice Menegaux (F)

Service Chirurgie Digestive, Sorbonne University, CHU Pitié-Salpêtrière, Paris, France.

Claire Blanchard (C)

Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, Nantes CEDEX, France.
Université de Nantes, Quai de Tourville, Nantes.

Maxime Leroy (M)

Plateforme de Méthodologie et de Biostatistique - DRCi - CHU de Nantes, Nantes, France.

Eric Mirallié (E)

Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, Nantes CEDEX, France.
Université de Nantes, Quai de Tourville, Nantes.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH