Abstract
Objective We performed this study to investigate the risk factors for postoperative hypocalcemia after total thyroidectomy with central lymph node dissection (CLND). Study Design. This was a single-center prospective study based on 176 consecutive patients who underwent total thyroidectomy for papillary thyroid carcinoma. Setting. Patients were recruited between January 2016 and June 2018. Subjects and Methods. Patients who underwent bilateral (n = 155, bilateral group) and ipsilateral CLND (n = 21) after total thyroidectomy were included. The preoperative and postoperative parathyroid hormone (PTH) and calcium levels were detected. The risk factors for transient hypocalcemia were identified using logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results Fifty-one (28.98%) patients developed transient hypocalcemia, and 2 patients (1.14%) developed permanent hypoparathyroidism. There was no difference in the gender ratio or the morbidity of hypocalcemia between the patients who underwent bilateral and ipsilateral CLND. On postoperative day 1, PTH decrease was a risk factor for transient hypocalcemia in the whole cohort (β = 0.043, OR = 1.044, 95% CI 1.023–1.065, p < 0.001), bilateral group (β = 0.042, OR = 1.043, 95% CI 1.022–1.064, p < 0.001), and female patients (β = 0.049, OR = 1.050, 95% CI 1.026–1.075, p < 0.001). Tumor diameter was a risk factor for transient hypocalcemia in female patients (β = 0.499, OR = 1.647, 95% CI 1.003–2.704, p=0.049). The ROC curve analysis illustrated that 65.58%, 71.00%, and 71.00% PTH level reduction had high accuracy in predicting transient hypocalcemia in the whole cohort, bilateral group, and female patients, respectively (AUC = 0.986, 0.987, and 0.987). Conclusion Asymptomatic female patients with bilateral CLND and a 71.00% PTH level reduction were at a high risk of transient hypocalcemia.
Highlights
Total thyroidectomy or radical thyroidectomy is the main surgical management for papillary thyroid carcinoma (PTC)
Several trials demonstrated that the combination of bilateral or International Journal of Endocrinology ipsilateral central lymph node dissection (CLND) could increase the incidence of transient or permanent hypocalcemia and prolong the length of hospital stay [7, 8]
We found that the serum parathyroid hormone (PTH) remained at stable levels within the first five days postsurgery. e low PTH level observed during hospitalization may be due to data missing from patients with normal PTH and Ca levels on postoperative day 1. e number of patients with recorded postoperative Ca levels decreased from 176 on day 1 to 101
Summary
Total thyroidectomy or radical thyroidectomy is the main surgical management for papillary thyroid carcinoma (PTC). Transient postoperative hypocalcemia is a common complication following thyroidectomy with a worldwide incidence of 3∼30% [1,2,3]. Female gender is a risk factor for transient hypocalcemia. The recurrence of secondary hypoparathyroidism, especially in chronic kidney disease could be significantly reduced by autotransplantation [4, 5], the high incidence of transient hypocalcemia after total thyroidectomy is still a dilemma. E treatment strategy for PTC remains controversial due to the incidence of postoperative hypoparathyroidism and hypocalcemia. Total thyroidectomy plus central lymph node dissection (CLND) potentially reduces the recurrence of PTC compared to total thyroidectomy alone [6, 7]. The malignant pathology, age, female gender, and number of parathyroid glands are indicated as risk factors for asymptomatic and transient hypocalcemia [8, 9]
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