Abstract
PurposeThe aim of the present study is to investigate the time to recovery of parathyroid function in patients with protracted hypoparathyroidism at 1 month after total thyroidectomy of papillary thyroid carcinoma.Materials and MethodsAdult patients who underwent total thyroidectomy for papillary thyroid cancer were included. Cases of long-term hypoparathyroidism were studied for recovery of parathyroid function during the follow-up. The duration of recovery and associated variables were recorded.ResultsOut of the 964 patients, 128 (13.28%) developed protracted hypoparathyroidism and of these, 23 (2.39%) developed permanent hypoparathyroidism and 105 (10.89%) recovered: 86 (8.92%) before 6 months, 11 (1.14%) within 6 and 12 months and 8 (0.83%) after 1 year follow-up. Variables significantly associated with the time to parathyroid function recovery were number of autotransplanted parathyroid glands (HR, 1.399; 95% CI, 1.060 – 1.846; P = 0.018), serum calcium concentration >2.07 mmol/L (Hazard ratio [HR], 1.628; 95% confidence interval [CI], 1.009 – 2.628; P = 0.046) and PTH level > 1.2 pmol/L (HR, 1.702; 95% CI, 1.083 – 2.628; P = 0.021) at 1 month postoperatively.ConclusionPermanent hypoparathyroidism should not be diagnosed easily by time, since up to one-fifth of the patients will experience recovery after a period of 6 months and a few patients even beyond one year. The number of autotransplanted parathyroid glands is positively associated with the time to parathyroid function recovery.
Highlights
The most common risk after a total thyroidectomy for differentiated thyroid cancer is transient hypoparathyroidism caused by either inadvertently removed or devascularized parathyroid glands during the surgery [1]
The American Association of Clinical Endocrinologists extended the follow-up period to one year to diagnose permanent hypoparathyroidism [5]
The initial cohort enrolled 964 patients, and 128 (13.28%) patients with protracted hypoparathyroidism were included in this study
Summary
The most common risk after a total thyroidectomy for differentiated thyroid cancer is transient hypoparathyroidism caused by either inadvertently removed or devascularized parathyroid glands during the surgery [1]. There is still a lack of consensus regarding the follow-up period necessary to make a firm diagnosis of permanent hypoparathyroidism. The European Guidelines defined permanent hypoparathyroidism as low serum parathyroid hormone (PTH) levels and/or need for replacement therapy after six months after surgery [3], and the American Thyroid Association chose six months as the cut-off time as well [4]. The American Association of Clinical Endocrinologists extended the follow-up period to one year to diagnose permanent hypoparathyroidism [5]. During this period, the main goal of the treatment is to maintain serum calcium within the reference range to avoid symptoms of hypocalcemia and to promote restoration of parathyroid function. Hypoparathyroidism related complications such as decrease in renal function and higher risk for cardiovascular diseases, not just hypoparathyroidism itself, would highly impair the quality of life [9, 10]
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