Hypoparathyroidism In Patients Research Articles

Intraoperative indocyanine green angiography in preventing hypoparathyroidism after thyroid cancer surgery.

The aim of this study was to determine whether the use of indocyanine green angiography to identify devascularized parathyroids during thyroidectomy for thyroid cancer would decrease the rates of postoperative hypoparathyroidism. Retrospective study of patients who had undergone total thyroidectomy for treatment of thyroid cancer between March 2021 and March 2023. The indocyanine group included patients with all four parathyroids identified and evaluated by indocyanine green angiography at the end of the procedure. Those with parathyroid glands classified with no vascularization had the glands autotransplanted. A group without indocyanine angiography was used to compare results. The analysis included 100 patients in each group. Indocyanine angiography identified 14.75% of devascularized parathyroids at surgery. The number of parathyroids with a score of 2 (i.e., good vascularization) was not a safe predictor of normal parathyroid hormonelevels after surgery. Indeed, 29.2% of the patients with three parathyroids with a score of 2 developed transient hypoparathyroidism. Permanent hypoparathyroidism occurred in 7% of the patients without indocyanine group and in none of the patients in the indocyanine group (p = 0.014). Intraoperative angiography with indocyanine green could contribute to reduce the occurrence of permanent hypoparathyroidism in patients undergoing surgical treatment for thyroid cancer.

Correlation Between Serum 1,25(OH)2D3, Serum Phosphorus, and Parathyroid Hormone and Parathyroid Function After Central Lymph Node Dissection in Patients with Papillary Thyroid Carcinoma.

This work was to demonstrate the relationship between serum 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), serum phosphorus (SP), and parathyroid hormone (PTH) and parathyroid function after central lymph node dissection (CLND) in patients with papillary thyroid carcinoma (PTC). 200 PTC patients after CLND were included, who were rolled into a control group (CG) (n = 89 cases without hypoparathyroidism) and an observation group (OG) (n = 111 cases with complicated hypoparathyroidism). The 1,25(OH)2D3, SP, and PTH levels were detected, and the diagnostic effect of these indicators was assessed. The serum PTH levels of patients in CG after surgery were normal relative to those before surgery, while the serum PTH of patients in OG was relatively lower. 1,25(OH)2D3 concentration of patients in OG was also inferior to CG, while the SP level was superior (P < 0.05). Hypoparathyroidism was positively correlated with serum PTH (r = 0.382) and 1,25(OH)2D3 (r = 0.321) and negatively correlated with SP (r = - 0.211). The area under the curve (AUC) (0.893), sensitivity (90.83%), and specificity (94.77%) of the joint diagnosis of 1,25(OH)2D3 + SP + PTH were greatly superior to those of the single diagnosis and the pairwise diagnosis with the three indicators (P < 0.05). Hypoparathyroidism in patients with PTC after CLND surgery was positively correlated with 1,25(OH)2D3 and PTH and negatively correlated with SP concentration. In addition, the combination diagnosis of 1,25(OH)2D3, PTH, and SP worked well.

A Knock-In Mouse Model of the Gcm2 Variant p.Y392S Develops Normal Parathyroid Glands.

The glial cells missing 2 (GCM2) gene functions as a transcription factor that is essential for parathyroid gland development, and variants in this gene have been associated with 2 parathyroid diseases: isolated hypoparathyroidism in patients with homozygous germline inactivating variants and primary hyperparathyroidism in patients with heterozygous germline activating variants. A recurrent germline activating missense variant of GCM2, p.Y394S, has been reported in patients with familial primary hyperparathyroidism. To determine whether the GCM2 p.Y394S missense variant causes overactive and enlarged parathyroid glands in a mouse model. CRISPR/Cas9 gene editing technology was used to generate a mouse model with the germline heterozygous Gcm2 variant p.Y392S that corresponds to the human GCM2 p.Y394S variant. Wild-type (Gcm2+/+) and germline heterozygous (Gcm2+/Y392S) mice were evaluated for serum biochemistry and parathyroid gland morphology. Gcm2 +/Y392S mice did not show any change compared to Gcm2+/+ mice in serum calcium and parathyroid hormone levels, parathyroid gland histology, cell proliferation, or parathyroid gland size. The mouse model of the p.Y392S variant of Gcm2 shows that this variant is tolerated in mice, as it does not increase parathyroid gland cell proliferation and circulating calcium or PTH levels. Further investigation of Gcm2+/Y392S mice to study the effect of this variant of Gcm2 on early events in parathyroid gland development will be of interest.

Guideline for the diagnosis and treatment of hypothyroidism and hypoparathyroidism in patients with blood transfusion-dependent thalassemia

Guideline for the diagnosis and treatment of hypothyroidism and hypoparathyroidism in patients with blood transfusion-dependent thalassemia

Skeletal and nonskeletal consequences of hypoparathyroidism.

Hypoparathyroidism, despite the conventional therapy with calcium and active vitamin D, can lead to skeletal and nonskeletal abnormalities. Chronic hypoparathyroidism is associated with a significant reduction in bone remodeling, increases in areal and volumetric bone density, and improvement in trabecular microarchitecture and in trabecular bone score. Regardless of these advantages in bone mass and microarchitecture, recent data suggest an increased vertebral fracture risk in patients with nonsurgical hypoparathyroidism. Moreover, chronic hypoparathyroidism can lead to abnormalities in multiple organ systems, including the neurological, cardiovascular, renal, neuropsychiatric, ocular, and immune systems. Nephrocalcinosis, nephrolithiasis, and renal insufficiency, as well as decreased quality of life and cataracts, are common in patients with hypoparathyroidism. An increased incidence of hospitalization due to infections and a greater risk of cardiovascular diseases are observed in patients with hypoparathyroidism, particularly in those with nonsurgical disease. All these abnormalities may be because of the disease itself or complications of therapy. We herein reviewed the skeletal and nonskeletal consequences of hypoparathyroidism in patients conventionally managed with calcium and active vitamin D.

PSAT216 Turner Syndrome and Congenital Hypoparathyroidism

Abstract Background Patients with Turner syndrome may have multiple associated metabolic comorbidities, some of which are rare. We present a case report with Turner syndrome and congenital hypoparathyroidism. Clinical Case A 30-year-old Caucasian female with Turner syndrome and primary ovarian insufficiency was referred for evaluation of osteopenia and elevated TSH. On her initial visit, the patient was asymptomatic, physical exam was significant only for short stature. The DEXA scan showed a T-score of -2 at the lumbar spine and -1.8 at the femoral neck. TSH was elevated at 4.81 (0.5–5.0 mIU/L), with normal serum levels of free T3 and free T4 consistent with subclinical hypothyroidism. Patient previously underwent aortic root imaging with no evidence of dilatation. Her only home medication was a combination oral contraceptive tablet (Yaz; drospirenone and ethinyl estradiol) for primary amenorrhea. The patient was started on calcium 500 mg daily and vitamin D3 400 IU. On her next visit, patient's calcium was 8.7 mg/dL (8.6–10.6 mg/dL), phosphorus 4.4 mg/dL (3–4.3 mg/dL), albumin 3.9 g/dL (3.4–5.4 g/dL), 25-hydroxy vitamin D 63.2 ng/dL (30-100 ng/dL), 24-hour urine calcium 93 mg/day (100-300 mg/day), and PTH 20 pg/mL (15–65 pg/mL) suggestive of hypoparathyroidism. There have only been a few case reports of congenital hypoparathyroidism in patients with Turner syndrome. (1) The patient was started on calcitriol 0.25 mcg daily and her calcium was increased to 500 mg twice daily. Repeat serum calcium was 9.1 and 25-hydroxy vitamin D 75.6 ng/dL showing that the patient responded appropriately to calcium and calcitriol supplementation. In the absence of a history of neck surgery or autoimmune diseases, the etiology behind hypoparathyroidism in this patient with Turner syndrome appears to be secondary to genetic mutation. Conclusion We highlight the importance of measuring parathyroid hormone level in patients with Turner syndrome who exhibit symptoms or signs of osteopenia as part of diagnostic workup. Reference (1) Suzuki Y, Watanabe H, Haeno S, Omori T, Hiramatsu R, Asada M, Tanaka F, Maeda T, Okada M, Suzuki T, et al. Primary hypoparathyroidism in Turner's syndrome. Intern Med. 1995 Nov;34(11): 1071-3. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Intraoperative Nerve Monitoring Is Associated with Less Postoperative Vocal Cord Dysfunction and Hypoparathyroidism in Patients Undergoing Thyroidectomy for Thyroid Cancer

INTRODUCTION: Intraoperative nerve monitoring (IONM) during thyroid operation for benign disease is associated with a lower risk of recurrent laryngeal nerve injury. This study aimed to investigate factors associated with short- and long-term vocal cord (VC) dysfunction in patients undergoing operation for thyroid cancer. METHODS: Patients ≥18 years of age undergoing thyroid operation for malignant disease from January 2014 to April 2021 in the Collaborative Endocrine Surgery Quality Improvement Program database were included. Multivariable logistic regression analyses investigated variables associated with short-term (≤30 days postoperative) and long-term (31 to 180 days) VC dysfunction and characteristics associated with IONM use. RESULTS: Among 5,446 patients, 76.7% were women, and the mean age was 49 years. Papillary thyroid cancer (PTC) was the most common type (84.6%). Few patients had nodal metastases or extrathyroidal extension (27.3% and 3.9%, respectively). Postoperative VC dysfunction was diagnosed by laryngoscopy in 3.0% of patients in the short term and in 2.7% in the long term. Patients with tumors who had extrathyroidal extension or nodal metastases were at higher risk for short-term (odds ratio [OR] 3.17, p < 0.001; OR 1.91, p = 0.005, respectively) and long-term (OR 3.1, p < 0.001; OR 2.34, p < 0,001, respectively) VC dysfunction. IONM was independently associated with a reduced risk of short-term (OR 0.61, p = 0.006) and long-term (OR 0.48, p < 0.001) VC dysfunction. IONM use was associated with outpatient surgery (OR 1.61, p < 0.001) and fewer postoperative hypoparathyroidism events in the short (OR 0.7, p < 0.001) and long term (OR 0.64, p = 0.002). CONCLUSION: IONM is independently associated with a lower rate of endocrine-specific complication and more outpatient surgery. Future studies are needed to identify barriers to broader IONM use.

Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma

PurposeThis study aimed to examine the effect of selective inferior parathyroid gland autotransplantation on central lymph node dissection(CLND) and incidence of postoperative hypoparathyroidism in patients undergoing endoscopic radical resection of thyroid carcinoma.MethodsThe data of 310 patients undergoing endoscopic radical resection of thyroid carcinoma will be retrospectively analyzed. The patients will be divided into the experimental group and the control group according to whether they combined with parathyroid autotransplantation. Statistics of the incidence rate of postoperative hypoparathyroidism, the concentration of PTH and Calcium in the systemic circulation at different time points in the two groups, the concentration of PTH in the cubital fossa vein in the transplantation region in the experimental group, and the number of central lymph nodes and positive lymph nodes dissection will be carried out.ResultsThe incidence rate of temporary and permanent hypoparathyroidism in the experimental group was 33.75% and 0.625%, respectively, and in the control group was 22% and 5%, respectively; its difference was statistically significant (X2 = 10.255, P=0.006). Parathyroid autotransplantation increased incidence of transient hypoparathyroidism (OR, 1.806; Cl, 1.088-2.998; P=0.022), and lower incidence of permanent hypoparathyroidism (OR, 0.112; Cl, 0.014-0.904; P=0.040). The diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism (OR, 0.769; Cl, 0.467-1.265; P=0.301) or permanent hypoparathyroidism (OR, 1.434; Cl, 0.316-6.515; P=0.641). Comparison of systemic circulation PTH, between the two groups showed that the PTH of patients in the experimental group was higher than that in the control group from 1 week to 12 months after the operation, and the difference was statistically significant (P<0.05). In the experimental group, from 1 week to 12 months after surgery, PTH concentrations was significantly higher in the cubital fossa of the transplantation side than in the contralateral side, and the differences were statistically significant (P<0.05). The mean number of central lymph node dissected per patient was significantly higher in the experimental group (7.94 ± 3.03 vs. 6.99 ± 2.86; P <0.05); The mean number of positive nodes per patient was significantly higher in the experimental group (3.16 ± 1.86 vs. 2.53 ± 1.59; P <0.05).ConclusionsIn endoscopic radical resection of thyroid carcinoma, parathyroid autotransplantation is more beneficial to postoperative parathyroid glands function recovery, effectively preventing postoperative permanent hypoparathyroidism and realizing more thorough CLND.

Role of hemithyroid preservation in total laryngectomy for laryngeal/hypopharyngeal malignancy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Thyroid gland invasion in advanced laryngeal/hypopharyngeal malignancy is not uncommon. The preservation of the contralateral lobe of thyroid and associated parathyroid glands with its blood supply, in suitable patients, can be beneficial in reducing the incidence of both hypothyroidism and hypoparathyroidism. The aim of the study was to assess the functionality of the contralateral preserved hemi-thyroid gland with its parathyroid glands, during total laryngectomy with or without partial/total pharyngectomy (TL/TLP), with or without post-operative radiation therapy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study of patients with advanced laryngeal or hypopharyngeal malignancy who underwent TL/TLP with contralateral hemi-thyroid and parathyroid gland preservation, between January 2012 and May 2019 were included in this study. Pre-operative thyroid/parathyroid function was assessed by estimation of blood levels of T3, T4, TSH and calcium. The same were evaluated at 1week and 6 weeks following surgery and 4 weeks following radiotherapy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 72.7% patients developed hypothyroidism and only 22.7% developed hypocalcemia following surgery alone at the end of 6 weeks post-surgery. 60% developed hypothyroidism and 10% had hypocalcemia in the group of patients who underwent surgery followed by radiotherapy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Preservation of contralateral hemi-thyroid with parathyroid glands, significantly reduces the incidence of hypoparathyroidism in patients undergoing TL/TLP. Though incidence of hypothyroidism in such cases is still high, reduced dose of thyroid hormone supplementation was achieved. Post-operative radiotherapy did not significantly alter the thyroid and parathyroid function in such cases.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Establishing a predictive model of hypoparathyroidism after total thyroidectomy and central lymph node dissection for postoperative calcium supplementation selectively.

BackgroundThe core goal of this article is to find some meaningful risk factors that can affect the postoperative hypoparathyroidism of thyroid cancer, create an effective prediction model on this basis, and use it to selectively implement routine prophylactic calcium supplementation for patients after thyroid carcinoma surgery.MethodsThe clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) who underwent conventional bilateral total thyroidectomy (TT) + bilateral central lymph node dissection from January 2020 to August 2021 in the Affiliated Hospital of Nantong University were retrospectively analyzed. Firstly, this study analyzed the relationship between postoperative hypocalcemia and hypoparathyroidism. Then, we included many potential risk factors such as gender, age, body mass index (BMI), lateral lymph node dissection (LLND) and so on and also performed univariate and multivariate analysis of the independent risk factors for postoperative hypoparathyroidism in patients, and established a predictive scoring model.ResultsAmong the 401 patients with PTC, 50.1% developed postoperative hypoparathyroidism. There was significant difference in serum calcium concentration between normal parathyroid group and hypoparathyroidism group after thyroid carcinoma surgery. BMI <24 kg/m2, lateral lymph node dissection, multifocality, and extrathyroidal extension (ETE) were all identified as independent risk factors for postoperative hypoparathyroidism. Based on these independent risk factors, a nine-point risk scoring model was created to firstly assess the postoperative parathyroid function status of patients and then to determine whether routine prophylactic calcium supplementation is needed. Importantly, the area under the curve (AUC) of the risk scoring model is equal to 0.979.ConclusionsAt present, prophylactic calcium supplementation after thyroid carcinoma surgery is a controversial postoperative treatment. It should be selectively implemented for high-risk patients with hypoparathyroidism after surgery. Routine prophylactic calcium supplementation is recommended for PTC patients with a score greater than or equal to 5, although there are no clinical symptoms of postoperative hypocalcemia caused by hypoparathyroidism. However, prophylactic calcium supplementation is not recommended for patients with PTC with a score of less than 5; if the patient develops hypocalcemia at the later stage, therapeutic calcium supplementation can then be implemented.

Experience in using teriparatide for the treatment of postoperative hypoparathyroidism in hemodialysis patients

The frequency of chronic postoperative hypoparathyroidism after total parathyroidectomy for secondary and tertiary hyperparathyroidism in patients with end-stage renal failure, according to various authors, can reach 20% or more. Prescribing active metabolites of vitamin D and calcium it is not always sufficient for achievement of target goals. This dictates the need for replacement therapy with recombinant parathyroid hormone. Teriparatide is the only drug of this series approved by the American Food and Drug Administration (FDA) and registered in the Russian Federation. However, it is registered as an anabolic anti-osteoporotic drug and is not indicated for the treatment of chronic hypoparathyroidism. The use of teriparatide in postoperative hypoparathyroidism in patients receiving renal replacement therapy with programmed hemodialysis in the Russian Federation has not been previously studied. Data on this issue is also limited in foreign literature. However, it is a potential treatment option for hemodialysis patients with chronic hypoparathyroidism and severe bone disorders. In this article, we present 2 clinical cases of substitution and anabolic therapy with teriparatide in this cohort of patients.

The PARADIGHM (physicians advancing disease knowledge in hypoparathyroidism) registry for patients with chronic hypoparathyroidism: study protocol and interim baseline patient characteristics

BackgroundThe PARADIGHM registry of adult and pediatric patients with chronic hypoparathyroidism evaluates the long-term safety and effectiveness of treatment with recombinant human parathyroid hormone, rhPTH(1-84), and describes the clinical disease course under conditions of routine clinical practice. In this first report, we detail the registry protocol and describe the baseline characteristics of two adult patient cohorts from an interim database analysis. One cohort after study entry were prescribed rhPTH(1-84), and the other cohort received conventional therapy of calcium and active vitamin D.MethodsAn observational study of patients with chronic hypoparathyroidism in North America and Europe, collecting data for ≥10 years per patient. Main outcome measures were baseline patient demographics, clinical characteristics, medications, and disease outcome variables of symptoms, biochemical parameters, and health assessments. Baseline is the enrollment assessment for all variables except biochemical measurements in patients treated with rhPTH(1-84); those measurements were the most recent value before the first rhPTH(1-84) dose. Exclusion criteria applied to the analysis of specified outcomes included pediatric patients, patients who initiated rhPTH(1-84) prior to enrollment, and those who received rhPTH(1-34). Clinically implausible biochemical outlier data were excluded.ResultsAs of 30 June 2019, data of 737 patients were analyzed from 64 centers; 587 (80%) were women, mean ± SD age 49.1±16.45 years. At enrollment, symptoms reported for patients later prescribed rhPTH(1-84) (n=60) and those who received conventional therapy (n=571), respectively, included fatigue (51.7%, 40.1%), paresthesia (51.7%, 29.6%), muscle twitching (48.3%, 21.9%), and muscle cramping (41.7%, 33.8%). Mean serum total calcium, serum phosphate, creatinine, and estimated glomerular filtration rate were similar between cohorts. Health-related quality of life (HRQoL) 36-item Short Form Health Survey questionnaire scores for those later prescribed rhPTH(1-84) were generally lower than those for patients in the conventional therapy cohort.ConclusionsAt enrollment, based on symptoms and HRQoL, a greater percentage of patients subsequently prescribed rhPTH(1-84) appeared to have an increased burden of disease than those who received conventional therapy despite having normal biochemistry measurements. PARADIGHM will provide valuable real-world insights on the clinical course of hypoparathyroidism in patients treated with rhPTH(1-84) or conventional therapy in routine clinical practice.Trial registrationEUPAS16927, NCT01922440

The prevalence of hypoparathyroidism after thyroid surgery depending on the diagnosis, the extent of the procedure, and the presence of parathyroid glands in the postoperative examination.

Introduction Postoperative hypoparathyroidism can be one of the complications associated with total thyroid removal due to cancer or benign goitre. Purpose The paper aimed to evaluate the prevalence of hypoparathyroidism in patients operated on due to thyroid cancer and nodular goitre, including procedures performed between January 2015 and March 2019 at the Department of Oncological Surgery of the Medical University of Silesia in Katowice. Material and methods The studied group consisted of 595 patients operated on due to cancer and benign nodular goitres. Calcium and phosphate metabolism was assessed using PTH and ionised calcium tests four hours after the surgery. Ionised calcium was checked 30 days after the procedure. Patients who had borderline or below-normal PTH levels in the postoperative period were also subjected to PTH testing after 30 days. In patients with low PTH levels, supplementation with calcium and vitamin D3 was introduced after the surgery. Results Compared to patients operated on for benign goitres, persons diagnosed with cancer were significantly more likely to have PTH levels below 15 pg/ml and serum ionised calcium levels below 4 mg/dl after 30 days following the surgery. The recovery rate was 65.05% vs 82.6% (p < 0.003) and 64.2% vs 84.25% (p < 0.001). The results were similar among patients who underwent lateral and central lymphadenectomy - 33.3% vs 67.3% (p < 0.021) and 25.6% vs 67.6% (p < 0.018). In patients with mild goitres, no significant differences in the recovery rate were observed - 82.6% vs 92.8% (p < 0.327) and 84.25% vs 92.3% (p < 0.437). Patients in whom parathyroid glands were found in the postoperative material were significantly more likely to have decreased PTH and calcium levels after 30 days following the procedure. The recovery rate was 64.1% vs 78.9% (p < 0.027) and 58.06% vs 80.8% (p < 0.004). Conclusions Hypoparathyroidism is not an uncommon occurrence after thyroidectomy, even in facilities with extensive experience in this matter. Compared to total thyroid removal due to benign goitre, surgery for cancer with associated central and lateral lymphadenectomy significantly increases the risk of postoperative hypoparathyroidism. In surgical practice, it is reasonable to conduct routine Ca and PTH level checks after the procedure and 30 days following thyroidectomy.

The impact of intraoperative elements on postoperative hypoparathyroidism in patients after total thyroidectomy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Assessment of Inter-Institutional Post-Operative Hypoparathyroidism Status Using a Common Data Model.

Post-thyroidectomy hypoparathyroidism may result in various transient or permanent symptoms, ranging from tingling sensation to severe breathing difficulties. Its incidence varies among surgeons and institutions, making it difficult to determine its actual incidence and associated factors. This study attempted to estimate the incidence of post-operative hypoparathyroidism in patients at two tertiary institutions that share a common data model, the Observational Health Data Sciences and Informatics. This study used the Common Data Model to extract explicitly specified encoding and relationships among concepts using standardized vocabularies. The EDI-codes of various thyroid disorders and thyroid operations were extracted from two separate tertiary hospitals between January 2013 and December 2018. Patients were grouped into no evidence of/transient/permanent hypoparathyroidism groups to analyze the likelihood of hypoparathyroidism occurrence related to operation types and diagnosis. Of the 4848 eligible patients at the two institutions who underwent thyroidectomy, 1370 (28.26%) experienced transient hypoparathyroidism and 251 (5.18%) experienced persistent hypoparathyroidism. Univariate logistic regression analysis predicted that, relative to total bilateral thyroidectomy, radical tumor resection was associated with a 48% greater likelihood of transient hypoparathyroidism and a 102% greater likelihood of persistent hypoparathyroidism. Moreover, multivariate logistic analysis found that radical tumor resection was associated with a 50% greater likelihood of transient hypoparathyroidism and a 97% greater likelihood of persistent hypoparathyroidism than total bilateral thyroidectomy. These findings, by integrating and analyzing two databases, suggest that this analysis could be expanded to include other large databases that share the same Observational Health Data Sciences and Informatics protocol.

Near-Infrared Autofluorescence Imaging May Reduce Temporary Hypoparathyroidism in Patients Undergoing Total Thyroidectomy and Central Neck Dissection.

Background: Near-infrared autofluorescence (NIRAF) imaging is known to reduce the incidence of post-thyroidectomy hypocalcemia. However, there are no studies on how much NIRAF imaging affects the serum parathyroid hormone (PTH) level after surgery. We investigated the changes of the serum PTH level and ionized calcium (iCa.) in patients undergoing total thyroidectomy with central neck dissection (CND). Materials and Methods: This retrospective study with historical control enrolled 542 patients who underwent total thyroidectomy with CND. Patients were divided into two groups: the NIRAF group (261 patients) and the control group (281 patients). PTH and iCa. levels were measured at the hospital stay, 1, 3, and 6 months after surgery. In addition, the number of identified parathyroid glands (PGs), autotransplanted PGs, and the inadvertent resection rate of PGs was evaluated. Results: The incidence of postoperative hypoparathyroidism (PTH <15 pg/mL) was significantly lower in the NIRAF group during the hospitalization (88 patients: 33.7% vs. 131 patients: 46.6%; p = 0.002) and at 1 month postoperatively (23 patients: 8.8% vs. 53 patients: 18.9%; p = 0.001). There was no difference in the permanent hypoparathyroidism rate (6 months after surgery) between the NIRAF group and the control group (4.2% vs. 4.6%; p = 0.816). There was no difference in the incidence of hypocalcemia (iCa. <1.09 mmol/L) (during hospitalization: 6.5% vs. 10.0%; 1 month: 2.3% vs. 2.5%; 3 months: 0.8% vs. 0.7%; 6 months after surgery: 1.1% vs. 1.1%) between the two groups. The number of inadvertently resected PGs was significantly lower in the NIRAF group (18:6.9% vs. 36:12.8%; p = 0.021). Conclusions: These results suggest that NIRAF imaging may reduce temporary hypoparathyroidism and the risk of inadvertent resection of PGs in patients undergoing total thyroidectomy with CND.

Correlación de calcio total, calcio iónico como valor pronóstico de hipoparatiroidismo posterior a tiroidectomía total en el Instituto de Previsión Social Hospital Central – Paraguay – 2019

Introducción: La hipocalcemia es una complicación frecuente posterior a tiroidectomía total, el dosaje de la paratohormona en el posoperatorio resulta importante para identificar el riesgo de hipocalcemia sintomática precoz pos-tiroidectomía total, empero es importante identificar otros tipos de indicadores. Objetivo: correlacionar el dosaje de calcio total y calcio iónico con el dosaje de paratohormona como valor pronóstico de hipoparatiroidismo en pacientes sometidos a tiroidectomía total en el servicio de Cirugía General del Hospital Central del Instituto de Previsión Social en el periodo de junio 2018 a junio 2019. Metodología: Estudio descriptivo retrospectivo, en el que se evaluaron factores como datos demográficos, clínicos, laboratoriales y anatomopatológicos. Se emplearon las fichas médicas, quirúrgicas y de consultorio. Resultados evaluaron a 58 pacientes, 93,1%: Se eran mujeres. El promedio de edad fue de 52±14años. El 65,5% de los pacientes presentaron normocalcemia, el 13,8% Hipoparatiroidismo transitorio (HT) y el 20,7% Hipoparatiroidismo permanente (HP). Previa a la operación los pacientes presentan dosaje normal de calcio total (CAT) e ionizado (CAI); cabe resaltar que los pacientes con HP presentan dosaje de CAT y CAI menores en todos los controles y los pacientes con HT muestran un aumento al tercer control (96hs). Conclusión: Un paciente con hipocalcemia determinado con CAI a las 24h mostró un factor de riesgo de 90 veces más de HP. La medición de CAT 96hs y de CAI 24hs, mostraron una correlación alta de predecir el HP medido por PTH (r=0,734 y r=0,719, respectivamente).

A comparison of the quantitative evaluation of in situ parathyroid gland perfusion by indocyanine green fluorescence angiography and by visual examination in thyroid surgery.

Objective The most vital complications of thyroidectomy are recurrent nerve damage and hypocalcaemia. We aimed to compare the tissue perfusion scores (PS) of IG fluorescence angiography (IGFA) and visual examination by the surgeon after total thyroidectomy. Subjects and methods Forty-three patients were accepted into the study. Localisation of the parathyroid gland (PG) was determined by the naked eye and scored in terms of tissue perfusion. The averages of fluorescent light intensities for each IGFA were calculated, the perfusions were scored and compared with the PS given by the surgeon. Biochemical parameters were noted. Results 37.2% of patients had autotransplanted PGs, according to their visual scores. The means of IGFA-PS for PGs scored as 0, 1 or 2 on visual inspection were 48.58 ± 4.49 [30-70], 89.65 ± 8.93 [36-144] and 158.76 ± 8.93 [70-253], respectively, which correlated with the visual PSs in a statistically significant manner (P < 0.0001). The predictive cut-off value for IGFA-PS was determined to be 70, given a visual PS of 0 (95% CI [0.72-0.85]), and this was interpreted to be a candidate cut-off point for the autotransplantation of PGs. Conclusion IGFA scoring may be considered as an operative predictor, providing objective criteria to evaluate the tissue and blood perfusion of PGs after thyroidectomy. IGFA scoring may be considered to have value in minimising postoperative permanent hypoparathyroidism in patients.

Risk of Permanent Hypoparathyroidism After Total Thyroidectomy for Benign Disease: A Nationwide Population-based Cohort Study From Sweden.

To investigate the prevalence and risk factors for permanent hypoparathyroidism after total thyroidectomy for benign disease in a population-based setting with data independent of input of complication data. The reported rate of permanent hypoparathyroidism is highly variable and mostly rely on reported complication data from national or institutional registries. All patients who underwent total thyroidectomy in Sweden from 2005 to 2015 were identified through Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery and the Swedish National Patient Register. Patients were matched to outcome data from the Swedish Prescribed Drug Register. Permanent hypoparathyroidism was defined as treatment with calcium and/or active vitamin D more than 1 year after surgery. Seven thousand eight hundred fifty-two patients were included and 938 (12.5%) developed permanent hypoparathyroidism. The risk was lower in patients registered in the quality register (11.0% vs 16%, P < 0.001). In a multivariable analysis there was a higher risk of permanent hypoparathyroidism in patients with parathyroid autotransplantation [Odds ratio (OR) 1.72; 95% confidence interval 1.47-2.01], center-volume <100 thyroidectomies per year (OR 1.22; 1.03-1.44), age above 60 year (OR 1.64; 1.36-1.98) and female sex (OR 1.27; 1.05-1.54). Reported data from the quality register only identified 178 of all 938 patients with permanent hypoparathyroidism. The risk of permanent hypoparathyroidism after total thyroidectomy was high and associated with parathyroid autotransplantation, higher age, female sex and surgery at a low volume center. Reported follow-up data might underestimate the rate of permanent hypoparathyroidism.

Elective Central Compartment Lymph Node Dissection Does not Increase the Risk of Postoperative Hypoparathyroidism in Patients Treated for Differentiated Thyroid Cancer

SUMMARYAimThe aim of this study was to compare the incidence of postoperative hypoparathyroidism in two groups of patients who were treated for differentiated thyroid cancer.MethodsA retrospective analysis of 179 patients who were treated for differentiated thyroid cancer in our institution from January 2011 until December 2018 was performed. Only patients initially treated with total thyroidectomy and those who did not have preoperatively confirmed central compartment and lateral neck lymph node metastases were included in this study. Two main groups of patients were analysed. The patients who were treated with total thyroidectomy and elective central compartment lymph node dissection simultaneously were included in the first group. The patients who were treated only with total thyroidectomy were included in the second group. The rate of transitory and persistent postoperative hypoparathyroidism was compared between the two groups.ResultsA total of 117 patients (65.4%) underwent total thyroidectomy and elective central compartment lymph node dissection simultaneously (TT + CCLNd group). The remaining 62 patients (34.6%) underwent total thyroidectomy only (TT group). A total of 22.6% patients in the TT group developed postoperative hypoparathyroidism compared with 25.6% in the TT + CCLNd group. The rate of persistent hypoparathyroidism in the TT and TT + CCLNd groups was 3.2% and 6.0%, respectively. The difference in the rate of transient and persistent postoperative hypoparathyroidism was not statistically significant between the two groups. Within the TT + CCLNd group, 82.9% of patients underwent ipsilateral paratracheal lymph node dissection and 17.1% underwent bilateral paratracheal lymph node dissection. The rate of postoperative hypoparathyroidism was analysed in those two subgroups of patients and did not prove to be statistically significant.DiscussionWhile its impact on the local recurrence rate is still controversial, elective central compartment lymph node dissection could be a great tool for selection of patients who could profit from adjuvant radioiodine treatment. On the other hand, central compartment lymph node dissection could potentially increase the risk of hypoparathyroidism due to involuntary injury to parathyroid glands and/or their blood supply. Our study did not find a statistically significant difference regarding postoperative hypoparathyroidism between patients who underwent central compartment lymph node dissection compared with patients who underwent total thyroidectomy only. Our data are not in accordance with some of the previously published studies.ConclusionOur results demonstrated that elective central compartment lymph node dissection is a safe procedure and does not significantly increase the risk of postoperative hypoparathyroidism when it is performed simultaneously with total thyroidectomy.