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Constant M, Schillo F, Billet S, Heyd B, Doussot A, Bouviez N. Hypoparathyroidism after total thyroidectomy: reactive to symptoms supplementation. BMC Surg 2024; 24:264. [PMID: 39277713 PMCID: PMC11401324 DOI: 10.1186/s12893-024-02534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 08/14/2024] [Indexed: 09/17/2024] Open
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Maxime Constant
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, CHU Besancon, France3 Boulevard Alexandre Fleming, 25000, Besançon Cedex, France.
| | | | | | - Bruno Heyd
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, CHU Besancon, France3 Boulevard Alexandre Fleming, 25000, Besançon Cedex, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, CHU Besancon, France3 Boulevard Alexandre Fleming, 25000, Besançon Cedex, France
| | - Nicolas Bouviez
- Department of Digestive Surgical Oncology - Liver Transplantation Unit, CHU Besancon, France3 Boulevard Alexandre Fleming, 25000, Besançon Cedex, France
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Hashem M, Lim CB, Balasubramanian SP. Postoperative parathyroid hormone (PTH) is equivalent to perioperative PTH drop in predicting postsurgical hypoparathyroidism. Ann R Coll Surg Engl 2024; 106:547-552. [PMID: 38478048 PMCID: PMC11214856 DOI: 10.1308/rcsann.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION Postoperative surgical hypoparathyroidism (PoSH) following thyroid surgery is an established complication. Several predictive factors have been identified including perioperative parathyroid hormone (PTH) levels. The aim of the study is to compare the drop in perioperative PTH to postoperative day 1 PTH in predicting hypocalcaemia and hypoparathyroidism. METHODS Records of consecutive patients who had either total or completion thyroidectomy with or without central neck dissection in a 3-year period in a single thyroid surgery unit were accessed to retrieve data on demographics, pathology, surgery, perioperative biochemistry and management. RESULTS Of 295 included patients, there were 227 (76.9%) females. Forty-five (15.3%) had completion thyroidectomy, and the rest had total thyroidectomy. Seventy-eight (26.4%) had concomitant central neck dissection. Sixty-four (21.7%) had hypocalcaemia on the day after surgery. Hypoparathyroidism persisted in 10.5% of patients at 6 months. Both day 1 PTH and a drop in PTH predicted day 1 hypocalcaemia (p < 0.001) and 6-month hypoparathyroidism (p < 0.001). The area under the receiver operating characteristic (ROC) curves for day 1 PTH and drop in PTH for the prediction of day 1 hypocalcaemia (0.729 vs 0.726, respectively) and for 6-month hypoparathyroidism (0.964 vs 0.958, respectively) were similar, albeit slightly better for day 1 PTH. CONCLUSIONS Day 1 PTH is equivalent to (if not better than) drop in PTH in predicting short- and long-term PoSH. Preoperative PTH measurements may not be needed in the detection and/or management of PoSH after thyroid surgery.
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Affiliation(s)
- M Hashem
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - CB Lim
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
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Roberts SL, El-Shikh M, Alam P, Borumandi F. Incidence of post-surgical hypoparathyroidism (POSH) after total thyroidectomy. Br J Oral Maxillofac Surg 2023; 61:679-685. [PMID: 38126158 DOI: 10.1016/j.bjoms.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 10/04/2023] [Indexed: 12/23/2023]
Abstract
Post-surgical hypoparathyroidism (POSH) is a recognised complication of total thyroidectomy, leading to hypocalcaemia and its associated adverse effects. This retrospective study aimed to determine the incidence of POSH and identify perioperative predictors for its development. Data from patients who underwent total or completion thyroidectomy between January 2017 and July 2022 were retrospectively analysed. The incidence of POSH was assessed, and patients were categorised into transient or prolonged POSH at six months postoperatively. Potential predictors for POSH were investigated including gender, histological diagnosis, and preoperative thyroid function. A total of 133 adult patients were included in the study. The incidence of patients recovering from transient POSH within six months was 15%, and 5% had prolonged POSH beyond six months of surgery. Parathyroid hormone (PTH) levels normalised in 83% of prolonged POSH patients within 14-33 months, reducing the incidence of persistent POSH to 0.75%. Despite normal PTH levels, overall, 3% had persistent marginally low calcium levels (mean 2.11 mmol/L) in keeping with relative parathyroid insufficiency. Histological diagnosis of malignancy was the only significant risk factor for both transient and prolonged POSH (RR 2.95, CI 1.54 to 5.67, p = 0.001) in this cohort. Cautious capsular dissection during thyroidectomy and protection of the parathyroid glands and vascular supply produce a low incidence of POSH. Although the vast majority of patients with POSH recover after six months, hypocalcaemia may persist due to relative parathyroid insufficiency, requiring long-term calcium supplementation. Further research is needed to determine the best strategies for preventing and treating this condition.
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Affiliation(s)
- Simon L Roberts
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Mahmoud El-Shikh
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Peyman Alam
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK
| | - Farzad Borumandi
- Department of Oral and Maxillofacial Surgery, University Hospitals Sussex NHS Foundation Trust, St. Richard's Hospital, Spitalfield Ln, Chichester PO19 6SE, UK; Worthing Hospital, Lyndhurst Rd, Worthing BN11 2DH, UK.
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Hillary SL, Chooi JE, Wadsley J, Newell-Price JD, Brown NJ, Balasubramanian SP. Quality of Life in Post-Surgical Hypoparathyroidism (PoSH) in Thyroid and Parathyroid Surgery. World J Surg 2022; 46:3025-3033. [PMID: 36184675 PMCID: PMC9636109 DOI: 10.1007/s00268-022-06730-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Post-surgical hypoparathyroidism (PoSH) is often long term, with significant associated morbidity and ongoing treatment. A recent systematic review found impaired quality of life (QoL) in patients with PoSH, despite stable treatment. Most studies did not include an appropriate control arm and further studies were recommended, taking into account underlying disease and comorbidities. This study aims to compare QoL in patients with PoSH with appropriate control groups. METHODS This was a cross-sectional observational study using the general quality of life SF-36 tool and a hypocalcaemia symptom score (HcSS) to assess QoL in patients with PoSH and controls (who had similar surgery but without PoSH). Participants were identified from two patient groups (the Butterfly Thyroid Cancer Trust and the Association for Multiple Endocrine Neoplasia Disorders) and a single tertiary centre in the UK. RESULTS Four hundred and thirty-nine responses (female n = 379, PoSH n = 89) were included with a median (range) age of 52 (19-92) years. Reported dates of surgery ranged from 1973 to 2019. HcSS scores showed significantly more associated symptoms in patients with PoSH than those without (p < 0.001). Although there was no overall difference in QoL between groups, patients with PoSH consistently had lower scores (p = 0.008) in the energy/fatigue subdomain of the SF-36. CONCLUSION Patients with PoSH reported significantly more fatigue and loss of energy compared to appropriately matched controls, but overall QoL was not significantly different. Standardised QoL measures may not be sensitive enough to highlight the impact on QoL in these patients. A disease-specific tool may be required.
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Affiliation(s)
- Sarah L Hillary
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Je Ern Chooi
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jonathan Wadsley
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Weston Park Hospital, Sheffield, UK
| | - John D Newell-Price
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nicola J Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Melikyan A, Menkov A. Postoperative Hypoparathyroidism: Prognosis, Prevention, and Treatment (Review). Sovrem Tekhnologii Med 2020; 12:101-108. [PMID: 34513060 PMCID: PMC8353683 DOI: 10.17691/stm2020.12.2.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Indexed: 12/19/2022] Open
Abstract
This review summarizes the results of studies concerning the problem of post-surgical hypoparathyroidism, a common complication of thyroid gland surgery, decreasing the quality of life in patients and, in some cases, leading to disability. A search for publications was carried out in electronic databases Web of Science, Scopus, Academic Search Complete (EBSCO), eLIBRARY, using keywords. The search depth was 7-10 years. Prevalence of post-surgical hypoparathyroidism was evaluated, the pathogenetic causes of the disease development, its clinical forms, methods of diagnosis and treatment were studied. It has been found that there is no single algorithm for analyzing the prognostic factors for the development of this pathological condition. It is emphasized that drug therapy of post-surgical hypoparathyroidism has a number of adverse effects. Therefore, the issues of prevention and surgical correction are of particular relevance. However, controversial opinions of contemporary authors about their clinical effectiveness determine the scientific and practical significance of further research on these issues.
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Affiliation(s)
- A.A. Melikyan
- Surgeon, Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko, 190 Rodionova St., Nizhny Novgorod, 603126, Russia
| | - A.V. Menkov
- Professor, Department of General, Operative Surgery and Topographic Anatomy named after A.I. Kozhevnikov, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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Sala DT, Muresan M, Voidazan S, Cvasciuc T, Darie R, Danielopol V, Muresan S, Pascanu I. FIRST DAY SERUM CALCIUM AND PARATHYROID HORMONE LEVELS AS PREDICTIVE FACTORS FOR SAFE DISCHARGE AFTER THYROIDECTOMY. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:225-230. [PMID: 31508181 DOI: 10.4183/aeb.2019.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Context Permanent hypocalcemia is a rare but significant complication of thyroid surgery. Objective The aim of this study was to identify predictive factors of hypocalcemia and hypoparathyroidism after thyroidectomy. Design Study included 134 total patients submitted to thyroidectomy from two endocrine units (January 2015 - August 2016). Methods We measured total serum calcium (sCa) and intact PTH (iPTH) on postoperative day one and 1 month after surgery. Results 118 patients were women with F/M ratio of 7.3/1 and a mean age of 51.8 years. 64 patients were included in group A (iPTH <12 pg/mL) and 70 patients in group B (iPTH >12 pg/mL). sCa and hypocalcemia symptoms were correlated with iPTH, measured 24 hours after surgery. The cut-off value was for sCa 8.05 mg/dL with a sensitivity of 85.29% and a specificity of 88.0% and for iPTH 11.2 pg/mL, with a sensitivity of 82.3% and a specificity of 71.0%. SCa (< 8.05 mg/dL) was a predictive factor with a 99 (IC95%:12.86-761.58) and iPTH (<11.2 pg/mL) with a 10.77 higher risk (CI95%: 3.83-30.30) to be associated with symptoms. Conclusion SCa and iPTH represent good predictive factors of early and safe hospital discharge and can predict the risk of prolonged and permanent hypoparathyroidism.
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Affiliation(s)
- D T Sala
- University of Medicine, Pharmacy, Science and Technology of Targu Mures - Second Department of Surgery, Mures, Romania
| | - M Muresan
- University of Medicine, Pharmacy, Science and Technology of Targu Mures - Second Department of Surgery, Mures, Romania
| | - S Voidazan
- University of Medicine, Pharmacy, Science and Technology of Targu Mures - Epidemiology Department, Mures, Romania
| | - T Cvasciuc
- Royal Victoria Hospital, Department of Endocrine Surgery, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - R Darie
- University of Medicine, Pharmacy, Science and Technology of Targu Mures - Second Department of Surgery, Mures, Romania
| | - V Danielopol
- University of Medicine, Pharmacy, Science and Technology of Targu Mures - Second Department of Surgery, Mures, Romania
| | - S Muresan
- University of Medicine, Pharmacy, Science and Technology of Targu Mures - Physiology Department, Mures, Romania
| | - I Pascanu
- University of Medicine, Pharmacy, Science and Technology of Targu Mures - Endocrinology Department, Targu Mures, Mures, Romania
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Filho EBY, Machry RV, Mesquita R, Scheffel RS, Maia AL. The timing of parathyroid hormone measurement defines the cut-off values to accurately predict postoperative hypocalcemia: a prospective study. Endocrine 2018; 61:224-231. [PMID: 29721800 DOI: 10.1007/s12020-018-1601-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Serum intact parathyroid hormone (iPTH) level is an early marker of post-thyroidectomy hypocalcemia. However, lack of methodological standardization to define timing and cut-off points of iPTH measurement limit its clinical applicability. Here, we evaluated the relationship between two distinct postoperative time sampling and iPTH accuracy on predicting hypocalcemia. METHODS iPTH was measured within 4 h after surgery (iPTH 4 h) and on the morning of the first postoperative day (iPTH 1st PO). Hypocalcemia was defined by levels of total calcium corrected by serum albumin ≤ 8.0 mg/dL and/or by the presence of symptoms. The most accurate iPTH cut-off point for hypocalcemia prediction was established from a ROC curve comparing both time-points. RESULTS The study included 101 patients. The mean age was 52.4 ± 12.9 years, 93 were women (92.1%) and 69 patients underwent total thyroidectomy (68.3%). Hypocalcemia occurred in 25 patients (24.8%), of whom 12 were symptomatic. Total thyroidectomy, longer duration of surgery, surgical complications related to parathyroid glands and lower levels of iPTH 4 h and iPTH 1st PO were associated with postoperative hypocalcaemia (all P < 0.05). Using the ROC curve, the optimal cut-off points were 19.55 pg/mL and 14.35 pg/mL for iPTH 4 h and iPTH 1st PO, respectively. The comparison of the AUC showed no significant difference between these two points of evaluation (0.935 vs. 0.940; P = 0.415). CONCLUSIONS Serum iPTH levels measured within 4 h or on the first morning after surgery are predictors of postoperative hypocalcemia. Notably, both time-points have the same accuracy to predict postoperative hypocalcemia (with different cutoff points).
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Affiliation(s)
- Eduardo Bardou Yunes Filho
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Vaz Machry
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo Mesquita
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Selbach Scheffel
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Xiang D, Xie L, Li Z, Wang P, Ye M, Zhu M. Endoscopic thyroidectomy along with bilateral central neck dissection (ETBC) increases the risk of transient hypoparathyroidism for patients with thyroid carcinoma. Endocrine 2016; 53:747-53. [PMID: 26886901 DOI: 10.1007/s12020-016-0884-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/01/2016] [Indexed: 01/01/2023]
Abstract
Increasing number of patients with thyroid carcinoma, especially young female patients, prefer to choose endoscopic thyroidectomy with bilateral central neck dissection (ETBC) for perfect cosmetic effects. However, the incidence of hypoparathyroidism after ETBC has not been well studied. Ninety six patients with papillary thyroid carcinoma were enrolled. All patients, including 49 ETBC and 47 open surgery patients, underwent total thyroidectomy with bilateral central neck dissection (CND). Some patients also underwent lateral neck dissection simultaneously. The incidence of hypoparathyroidism and parathyroid hormone (PTH) level were examined. Patients in the open surgery group had more advanced lesions, with larger tumor (p = 0.000), older age (p = 0.000), and more serious local involvement. The dissection extent of the open group was significantly larger than that of the ETBC group (p = 0.006). In contrast, the ETBC group with less dissection extent showed a significantly higher incidence of transient hypoparathyroidism than the open group (59.2 vs. 29.6 %, p = 0.004). The average PTH decline of the ETBC group was significantly higher than that of the open group on postoperative day 1 (POD1) (32.1 vs. 21.6 pg/ml, p = 0.010). Furthermore, the ETBC group had a significantly higher portion of patients with a PTH <10 pg/ml on POD1 (p = 0.001). One patient in the ETBC group developed permanent hypoparathyroidism. Autotransplantation and inadvertent removal rates of parathyroid did not differ between the two groups. Although generally considered a safe method for patients with thyroid carcinoma, ETBC may increase the risk of transient hypoparathyroidism compared with conventional open surgery.
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Affiliation(s)
- Dapeng Xiang
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Liangqi Xie
- Department of Molecular and Cellular Biology, UC Berkeley, Berkeley, CA, USA
| | - Zhiyu Li
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China.
| | - Ping Wang
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Mao Ye
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Mingzhu Zhu
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
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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 2015; 4:82-90. [PMID: 25713783 DOI: 10.3978/j.issn.2227-684x.2014.12.04] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/23/2014] [Indexed: 11/14/2022]
Abstract
Acute and chronic parathyroid insufficiency syndromes are the most common complication after total thyroidectomy. Permanent hypoparathyroidism imposes an important medical burden on patient lifestyle due to the need for lifetime medication, regular visits and significant long-term costs. Its true prevalence has been underestimated due to lack of clear definitions, inadequate follow-up and conflicts of interest when reporting individual patient series. The aim of this review is to propose precise definitions for the different syndromes associated to parathyroid failure based on the follow-up and management of patients developing hypocalcemia (<8 mg/dL at 24 hours) after first-time total thyroidectomy for cancer or goiter at our unit. Short and long-term post-thyroidectomy parathyroid failure presents as three different metabolic syndromes: (I) postoperative hypocalcemia is defined as a s-Ca <8 mg/dL (<2 mmol/L) within 24 hours after surgery requiring calcium/vit D replacement therapy at the time of hospital discharge; (II) protracted hypoparathyroidism as a subnormal iPTH concentration (<13 pg/mL) and/or need for calcium/vit D replacement at 4-6 weeks; and (III) permanent hypoparathyroidism as a subnormal iPTH concentration (<13 pg/mL) and/or need for calcium/vit D replacement 1 year after total thyroidectomy. Each of these syndromes has its own pattern of recovery and should be approached with different therapeutic strategies.
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Affiliation(s)
- Leyre Lorente-Poch
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Juan J Sancho
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Jose Luis Muñoz-Nova
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Patricia Sánchez-Velázquez
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Antonio Sitges-Serra
- 1 Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain ; 2 Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain ; 3 General and Digestive Surgery Department, Hospital de la Princesa, Madrid, Spain
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