Hypoparathyroidism after total thyroidectomy: reactive to symptoms supplementation.
Endocrine
Postoperative hypoparathyroidism
Severe hypocalcaemia
Thyroidectomy
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
14 Sep 2024
14 Sep 2024
Historique:
received:
10
03
2024
accepted:
14
08
2024
medline:
15
9
2024
pubmed:
15
9
2024
entrez:
14
9
2024
Statut:
epublish
Résumé
After total thyroidectomy (TT), postoperative hypoparathyroidism (PH) is the most frequent complication. Yet, management strategies for PH remain disputed. The aim of this study was to evaluate outcomes of a reactive supplementation in case of symptomatic PH. Additionally, risk factors for symptomatic PH and readmission due to PH were analyzed. All consecutive patients who underwent TT or completion from 2017 to 2022 were considered for inclusion. During this period, a reactive to symptom vitamin-calcium supplementation was used. The primary outcome was the occurrence of severe PH after discharge resulting in readmission. Overall, 307 patients were included, of which 98 patients (31.9%) developed symptomatic PH including 43 patients before discharge. Independent risk factors for developing symptomatic PH were age (p = 0.010) and postoperative day 1 (POD1) PTH level (p < 0.001). Overall, 264 patients (86%) did not present PH before discharge and were discharged home. Among them, 55 patients (20.8%) experienced symptomatic PH, requiring readmission in 18 patients. The overall readmission rate owing to symptomatic PH requiring intravenous supplementation despite oral vitamin-calcium supplementation was 6.8% (n = 18). Independent risk factors for symptomatic PH-related readmission were age (p = 0.007) and POD1 PTH level (p < 0.001). Adequate cut-off values for predicting readmission were POD1 albumin-adjusted calcium = 2.1 mmol/l (Sensibility = 0.95, Specificity = 0.30) and POD1 PTH = 11.5 pg/ml (Sensibility = 0.90, Specificity = 0.71). Supplementing only symptomatic patients was safe and efficient. This attitude does not alter on morbidity, mortality or readmission rate which is in line with current literature.
Identifiants
pubmed: 39277713
doi: 10.1186/s12893-024-02534-9
pii: 10.1186/s12893-024-02534-9
doi:
Substances chimiques
Calcium
SY7Q814VUP
Vitamins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
264Informations de copyright
© 2024. The Author(s).
Références
Lifante J C, Payet C, Ménégaux F, Sebag F, Kraimps J L, Peix J L, et al. Can we consider immediate complications after thyroidectomy as a quality metric of operation? Surgery. 2017;161(1):156–65.
doi: 10.1016/j.surg.2016.04.049
pubmed: 27866716
Bollerslev J, Rejnmark L, Marcocci C, Shoback DM, Sitges-Serra A, van Biesen W, Dekkers OM. European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol. 2015;173(2):G1–20.
doi: 10.1530/EJE-15-0628
pubmed: 26160136
Orloff LA, Wiseman SM, Bernet VJ, Fahey TJ 3rd, Shaha AR, Shindo ML, et al. American thyroid association statement on post- operative hypoparathyroidism: Diagnosis, prevention, and management in adults. Thyroid. 2018;28(7):830–41.
doi: 10.1089/thy.2017.0309
pubmed: 29848235
Kazaure HS, Sosa JA. Surgical Hypoparathyroidism. Endocrinol Metab Clin North Am. 2018;47(4):783–96.
doi: 10.1016/j.ecl.2018.07.005
pubmed: 30390813
Wu J, Harrison B. Hypocalcemia after Thyroidectomy: The Need for Improved Definitions. World Journal of Endocrine Surgery. 2010;2(1):17–20.
doi: 10.5005/jp-journals-10002-1015
Mehanna HM, Jain A, Randeva H, Watkinson J, Shaha A. Postoperative hypocalcemia–the difference a definition makes. Head Neck. 2010;32(3):279–83.
doi: 10.1002/hed.21175
pubmed: 19691027
Sitges-Serra A, Ruiz S, Girvent M, Manjón H, Dueñas JP, Sancho JJ. Outcome of protracted hypoparathyroidism after total thyroidectomy. Br J Surg. 2010;97(11):1687–95.
doi: 10.1002/bjs.7219
pubmed: 20730856
Balasubramanian SP. Iatrogenic/post-surgical hypoparathyroidism: where do we go from here? Endocrine. 2014N;47(2):357–9.
doi: 10.1007/s12020-014-0397-5
pubmed: 25150036
Lorente-Poch L, Sancho JJ, Muñoz-Nova JL, Sánchez-Velázquez P, Sitges-Serra A. Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 2015F;4(1):82–90.
pubmed: 25713783
pmcid: 4321048
Nicholson KJ, Smith KJ, McCoy KL, Carty SE, Yip L. A comparative cost-utility analysis of postoperative calcium supplementation strategies used in the current management of hypocalcemia. Surgery. 2020J;167(1):137–43.
doi: 10.1016/j.surg.2019.05.077
pubmed: 31515122
van Dijk SPJ, van Driel MHE, van Kinschot CMJ, Engel MFM, Franssen GJH, van Noord C, et al. Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia-Related Complications: A Meta-Analysis. Otolaryngol Head Neck Surg. 2024F;170(2):359–72.
doi: 10.1002/ohn.594
pubmed: 38013484
Edafe O, Mech C E, Balasubramanian S P. Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism. Cochrane Database Syst Rev. 2019;5(5):CD012845.
pubmed: 31116878
Sanabria A, Rojas A, Arevalo J. Meta-analysis of routine calcium/vitamin D3 supplementation versus serum calcium level-based strategy to prevent postoperative hypocalcaemia after thyroidectomy. Br J Surg. 2019;106(9):1126–37.
doi: 10.1002/bjs.11216
pubmed: 31236917
Paladino NC, Guérin C, Graziani J, Morange I, Loundou A, Taïeb D, et al. Predicting risk factors of postoperative hypocalcemia after total thyroidectomy: is safe discharge without supplementation possible? A large cohort study. Langenbecks Arch Surg. 2021N;406(7):2425–31.
doi: 10.1007/s00423-021-02237-2
pubmed: 34374848
Raffaelli M, De Crea C, D’Amato G, et al. Post-thyroidectomy hypocalcemia is related to parathyroid dysfunction even in patients with normal parathyroid hormone concentrations early after surgery. Surgery. 2016;159(1):78–84.
doi: 10.1016/j.surg.2015.07.038
pubmed: 26456131
Järhult J, Landerholm K. Outcome of hypocalcaemia after thyroidectomy treated only in symptomatic patients. Br J Surg. 2016;103(6):676–83.
doi: 10.1002/bjs.10086
pubmed: 26933938
Leng C, Charlesworth G, Nofal E, Balasubramanian SP. Hypercalcemia following Alfacalcidol for Post-Surgical Hypoparathyroidism-An Underestimated Complication? J Endocrinol Diab. 2015;2(5):1–5.
doi: 10.15226/2374-6890/2/5/00135
Hosseini M, Otaghvar HA, Tizmaghz A, Shabestanipour G, Vahid PA. Evaluating the Time Interval for Presenting the Signs of Hypocalcaemia after Thyroidectomy. J Clin Diagn Res. 2016;10(3):19–22.
Li Z, Fei Y, Li Z, Wei T, Zhu J, Su A. Outcome of parathyroid function after total thyroidectomy when calcium supplementation is administered routinely versus exclusively to symptomatic patients: A prospective randomized clinical trial. Endocrine. 2022;75(2):583–92.
doi: 10.1007/s12020-021-02921-9
pubmed: 34748169
Kazaure HS, Zambeli-Ljepovic A, Oyekunle T, Roman SA, Sosa JA, Stang MT, et al. Severe Hypocalcemia After Thyroidectomy: An Analysis of 7366 Patients. Ann Surg. 2021;274(6):e1014–21.
doi: 10.1097/SLA.0000000000003725
pubmed: 31804395
Lang BH, Chow FC. Evaluating the Incidence, Cause, and Risk Factors for Unplanned 30-Day Readmission and Emergency Department/General Practitioner Visit After Short-Stay Thyroidectomy. World J Surg. 2016;40(2):329–36.
doi: 10.1007/s00268-015-3215-1
pubmed: 26306892
Nagel K, Hendricks A, Lenschow C, Meir M, Hahner, Fassnacht M, Wiegering A, Germer CT, Schlegel N. Definition and diagnosis of postsurgical hypoparathyroidism after thyroid surgery: meta-analysis. BJS Open. 2022;6(5):zrac102.
doi: 10.1093/bjsopen/zrac102
pubmed: 36050906
pmcid: 9437325
Lim ST, Jeon YW, Gwak H, Suh YJ. Incidence, Risk Factors, and Clinical Implications of Delayed Hypoparathyroidism on Postoperative Day two Following Total Thyroidectomy for Papillary Thyroid Carcinoma. Endocr Pract. 2020;26(7):768–76.
doi: 10.4158/EP-2019-0544
pubmed: 33471646
Anastasiou OE, Yavropoulou MP, Papavramidis TS, Tzouvara C, Triantafyllopoulou K, Papavramidis S, et al. Secretory capacity of the parathyroid glands after total thyroidectomy in normocalcemic subjects. J Clin Endocrinol Metab. 2012;97(7):2341–6.
doi: 10.1210/jc.2012-1170
pubmed: 22511794
Cartwright C, Anastasopoulou C. Hungry Bone Syndrome. 2023 May 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 31751070.
Song CM, Jung JH, Ji YB, Min HJ, Ahn YH, Tae K. Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol. 2014;12:200.
doi: 10.1186/1477-7819-12-200
pubmed: 25000948
pmcid: 4105163
Chang YK, Lang BHH. To identify or not to identify parathyroid glands during total thyroidectomy. Gland Surg. 2017;6(Suppl 1):S20–9.
doi: 10.21037/gs.2017.06.13
pubmed: 29322019
pmcid: 5756751
Benmiloud F, Godiris-Petit G, Gras R, Gillot JC, Turrin N, Penaranda G, et al. Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk: Results of the PARAFLUO Multicenter Randomized Clinical Trial. JAMA Surg. 2020F 1;155(2):106–12.
doi: 10.1001/jamasurg.2019.4613
pubmed: 31693081
Di Lorenzo S, Carrillo Lizarazo JL, Dionigi G, Kraimps JL, Donatini G. Impact of near-infrared fluorescence imaging plus indocyanine green fluorescence on postoperative hypoparathyroidism rates after total thyroidectomy and central neck lymph node dissection. Br J Surg. 2024;111(2):znae022.
doi: 10.1093/bjs/znae022
pubmed: 38381933
Privitera F, Centonze D, La Vignera S, Condorelli RA, Distefano C, Gioco R, et al. Risk Factors for Hypoparathyroidism after Thyroid Surgery: A Single-Center Study. J Clin Med. 2023M 1;12(5):1956.
doi: 10.3390/jcm12051956
pubmed: 36902740
pmcid: 10004126
Wang YH, Bhandari A, Yang F, Zhang W, Xue LJ, Liu HG, et al. Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer Manag Res. 2017N;15(9):627–35.
doi: 10.2147/CMAR.S148090
Del Rio P, Rossini M, Montana CM, Viani L, Pedrazzi G, Loderer T, et al. Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg. 2019A 24;18(Suppl 1):25.
pubmed: 31074401
pmcid: 7402573
Azadbakht M, Emadi-Jamali SM, Azadbakht S. Hypocalcemia following total and subtotal thyroidectomy and associated factors. Ann Med Surg (Lond). 2021M;25(66).
Karatzanis AD, Ierodiakonou DP, Fountakis ES, Velegrakis SG, Doulaptsi MV, Prokopakis EP, et al. Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy. Head Neck. 2018M;40(5):1040–5.
doi: 10.1002/hed.25081
pubmed: 29389043