Abstract
Background: Thyroidectomy is the definitive treatment for most patients with thyroid cancer. Hypoparathyroidism is the most frequent complication of thyroidectomy, and its pathogenesis is multifactorial. The aim of this study is to evaluate the patient- and surgical-related risk factors for hypoparathyroidism after surgery for thyroid cancer. Methods: In this retrospective study, patients referred to surgery for thyroid cancer from 2016 to 2019 were enrolled. Preoperative serum calcium and parathyroid hormone (PTH) and postoperative 24 h PTH and calcium levels were evaluated. Demographic data, type of surgery, incidence of hypoparathyroidism and hypocalcemia were recorded for all the patients. Patients were divided into two groups based on post-operative PTH levels (≤12 and >12 pg/mL). Results: A total of 189 patients were enrolled in this study. There were 146 women (87.3%) and 43 men (22.7%), with a mean age of 51.3 years. A total of 79 patients (41.7%) underwent a neck dissection. A total of 59 patients (31.1%) had a postoperative PTH level < 12 pg/mL. Female sex, neck dissection, the yield of lymph node dissection and incidental parathyroidectomy were significantly associated with postoperative hypoparathyroidism. Incidental parathyroidectomy was reported in 44 (23.2%) patients and was correlated with younger age (<40 years) and neck dissection. There was no difference in the rate of post-operative hypocalcemia between patients with incidental parathyroidectomy and those without. Conclusions: Young patients undergoing neck dissection and with incidental parathyroidectomy have the highest risk of postoperative hypoparathyroidism after surgery for thyroid cancer. However, a large proportion of patients without incidental parathyroidectomy may have temporary hypocalcemia, suggesting that impaired blood supply of parathyroid glands during their identification and dissection may play a relevant role.
Highlights
Thyroid cancer is the most common endocrine tumor and its incidence has significantly increased over the last three decades [1]
A recent meta-analysis reported a median incidence of temporary and permanent hypoparathyroidism following thyroidectomy ranging from 19% to 38% and 0% to 3%, respectively, suggesting that a large number of patients undergoing thyroid surgery may suffer from this complication [13]
This study investigated the patient- and surgery-related risk factors associated with low postoperative parathyroid hormone (PTH) levels
Summary
Thyroid cancer is the most common endocrine tumor and its incidence has significantly increased over the last three decades [1]. Parathyroid hormone (PTH) levels are the most frequently evaluated biochemical factor in the development of post-operative hypocalcemia, but the association between PTH levels and postoperative hypocalcemia has been reported with conflicting results [9,15,16]. The aim of this study is to evaluate the patient- and surgical-related risk factors for hypoparathyroidism after surgery for thyroid cancer. Incidental parathyroidectomy was reported in 44 (23.2%) patients and was correlated with younger age (
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