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Abood A, Rolighed L, Triponez F, Vestergaard P, Bach J, Ovesen T. Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions. JAMA Netw Open 2024; 7:e2411384. [PMID: 38748422 PMCID: PMC11096987 DOI: 10.1001/jamanetworkopen.2024.11384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/09/2024] [Indexed: 05/18/2024] Open
Abstract
Importance Hypoparathyroidism following thyroid surgery is a serious complication that occurs frequently when surgery is performed by low-volume thyroid surgeons without experience in parathyroid surgery. Objective To evaluate the occurrence of hypoparathyroidism following total thyroidectomy after the introduction of autofluorescence in low-volume, nonparathyroid institutions. Design, Setting, and Participants This prospective, multicenter cohort study, with a follow-up period of up to 1 year, was conducted in Denmark at 2 low-volume nonparathyroid institutions between January 2021 and November 2023. All adult patients referred for total thyroidectomy were assessed for eligibility (n = 90). Only patients with no history of thyroid surgery were considered (n = 89). Patients who only underwent lobectomy (n = 6) or declined to participate (n = 5) were excluded. All included patients completed follow-up. The prospective cohort was compared with a historical cohort of successive patients undergoing primary total thyroidectomy from 2016 to 2020 (before autofluorescence was available). Intervention Included patients underwent autofluorescence-guided total thyroidectomy. Main outcomes and Measures Rate of hypoparathyroidism. Immediate hypoparathyroidism was defined as the need for active vitamin D postoperatively, whereas permanent hypoparathyroidism was considered when there still was a need for active vitamin D 1 year after surgery. Results Seventy-eight patients underwent autofluorescence-guided surgery (mean [SD] age, 55.6 [13.1] years; 67 [86%] female) and were compared with 89 patients in the historical cohort (mean [SD] age, 49.7 [12.8] years; 78 [88%] female). The rate of immediate hypoparathyroidism decreased from 37% (95% CI, 27%-48%) to 19% (95% CI, 11%-30%) after the introduction of autofluorescence (P = .02). Permanent hypoparathyroidism rates decreased from 32% (95% CI, 22%-42%) to 6% (95% CI, 2%-14%) (P < .001), reaching 0% at the end of the study. More parathyroid glands were identified with autofluorescence (75% [95% CI, 70%-80%] vs 61% [95% CI, 56%-66%]) (P < .001) and less parathyroid glands were inadvertently excised (4% [95% CI, 1%-11%] vs 21% [95% CI, 13%-31%]) (P = .001). Conclusions and Relevance In this cohort study of autofluorescence-guided thyroid surgery in low-volume, nonparathyroid institutions, the use of autofluorescence was associated with a significant decrease in both immediate and permanent hypoparathyroidism. When autofluorescence was used, hypoparathyroidism rates were comparable with those of high-volume surgeons who also perform parathyroid surgery.
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Affiliation(s)
- Ali Abood
- Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva Switzerland
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Bach
- Department of Otorhinolaryngology, Hospital South West Jutland, Esbjerg, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark
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Abood A, Rolighed L, Ovesen T, Madsen SH, Vestergaard P, Triponez F. Autofluorescence-guided hemithyroidectomy in a low-volume thyroid institution with no experience in parathyroid surgery: randomized clinical trial. Br J Surg 2024; 111:znae075. [PMID: 38573333 DOI: 10.1093/bjs/znae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/20/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Recent studies suggest that low-volume surgeons with no experience in parathyroid surgery are at increased risk of causing parathyroid gland damage during thyroid surgery. The aim of this RCT was to evaluate the impact of using autofluorescence in hemithyroidectomy on parathyroid gland identification and preservation in a low-volume institution with no experience in parathyroid surgery. METHODS Patients referred for hemithyroidectomy were randomized 1 : 1 to either autofluorescence-guided hemithyroidectomy (the near-infrared autofluorescence group) or conventional hemithyroidectomy (the control group). The primary outcome was parathyroid gland identification rate. Secondary outcomes were the rate of parathyroid gland autotransplantation and the rate of inadvertent parathyroid gland excision. RESULTS A total of 170 patients were randomized to either autofluorescence-guided hemithyroidectomy (84 patients) or conventional hemithyroidectomy (86 patients). In the near-infrared autofluorescence group, 81.0% of parathyroid glands were identified, compared with 57.0% in the control group (P < 0.001). Autofluorescence enabled parathyroid gland visualization before the naked eye in 46.3% of cases. Surgeons had lower confidence in the parathyroid gland identification process in the control group than in the near-infrared autofluorescence group (59.1% versus 87.5% respectively; P < 0.001). In the near-infrared autofluorescence group, the parathyroid gland autotransplantation rate was initially high, but declined over time. There was no difference in the rate of inadvertent parathyroid gland excision. CONCLUSION Autofluorescence guidance significantly improved the parathyroid gland identification rate in hemithyroidectomy in a low-volume institution with no experience in parathyroid surgery and provided an increase in surgical confidence. The pattern of parathyroid gland autotransplantation in autofluorescence-guided surgery indicates the presence of a learning curve. REGISTRATION NUMBER NCT05044351 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Ali Abood
- Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark
| | - Stine H Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Reinke R, Udholm S, Christiansen CF, Almquist M, Londero S, Rejnmark L, Rasmussen TB, Rolighed L. Hypoparathyroidism and mortality after total thyroidectomy: A nationwide matched cohort study. Clin Endocrinol (Oxf) 2024; 100:408-415. [PMID: 38375986 DOI: 10.1111/cen.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Total thyroidectomy (TT) carries a risk of hypoparathyroidism (hypoPT). Recently, hypoPT has been associated with higher overall mortality rates. We aimed to evaluate the frequency of hypoPT and mortality in patients undergoing TT in Denmark covering 20 years. DESIGN Retrospective Cohort study. PATIENTS AND MEASUREMENTS Using population-based registries, we identified all Danish individuals who had undergone TT between January 1998 and December 2017. We included a comparison cohort by randomly selecting 10 citizens for each patient, matched on sex and birth year. HypoPT was defined as treatment with active vitamin D after 12 months postoperatively. We used cumulative incidence to calculate risks and Cox regression to compare the rate of mortality between patients and the comparison cohort. We evaluated patients in different comorbidity groups using the Charlson Comorbidity Index and by different indications for surgery. RESULTS 7912 patients underwent TT in the period. The prevalence of hypoPT in the study period was 16.6%, 12 months postoperatively. After adjusting for potential confounders the risk of death due to any causes (hazard ratio; 95% confidence intervals) following TT was significantly increased (1.34; 1.15-1.56) for patients who developed hypoPT. However, subgroup analysis revealed mortality was only increased in malignancy cases (2.48; 1.99-3.10) whereas mortality was not increased when surgery was due to benign indications such as goitre (0.88; 0.68-1.15) or thyrotoxicosis (0.86; 0.57-1.28). CONCLUSIONS The use of active vitamin D for hypoPT was prevalent one year after TT. Patients with hypoPT did not have an increased risk of mortality following TT unless the indication was due to malignancy.
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Affiliation(s)
- Rasmus Reinke
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology and Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Martin Almquist
- Department of Surgery, Lund University Hospital, Lund, Sweden
| | - Stefano Londero
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Díez JJ, Anda E, Pérez-Corral B, Paja M, Alcázar V, Sánchez-Ragnarsson C, Orois A, Romero-Lluch AR, Sambo M, Oleaga A, Caballero Á, Alhambra MR, Urquijo V, Delgado-Lucio AM, Fernández-García JC, Kishore-Doulatram V, Dueñas-Disotuar S, Martín T, Peinado M, Sastre J. Incident comorbidities in patients with chronic hypoparathyroidism after thyroidectomy: a multicenter nationwide study. Front Endocrinol (Lausanne) 2024; 15:1348971. [PMID: 38481445 PMCID: PMC10936239 DOI: 10.3389/fendo.2024.1348971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Population-based and registry studies have shown that chronic hypoparathyroidism is accompanied by long-term complications. We aimed to evaluate the risk of incident comorbidity among patients with chronic postsurgical hypoparathyroidism in real-life clinical practice in Spain. Methods We performed a multicenter, retrospective cohort study including patients with chronic postsurgical hypoparathyroidism lasting ≥3 years with at least a follow-up visit between January 1, 2022 and September 15, 2023 (group H). The prevalence and incidence of chronic complications including chronic kidney disease, nephrolithiasis/nephrocalcinosis, hypertension, dyslipidemia, diabetes, cardiovascular disease, central nervous system disease, mental health disorders, eye disorders, bone mineral density alterations, fracture and cancer were evaluated. Patient data were compared with a group of patients who did not develop hypoparathyroidism, matched by gender, age, and follow-up time after thyroidectomy (group NH). Results We included 337 patients in group H (median [IQR] age, 45 [36-56] years; median time of follow-up, 8.9 [6.0-13.0] years; women, 84.3%) and 669 in group NH (median age, 47 [37-55] years; median time of follow-up, 8.0 [5.3-12.0] years; women, 84.9%). No significant differences were found in the prevalence of comorbidities at the time of thyroidectomy between both groups. In multivariable adjusted analysis, patients with chronic hypoparathyroidism had significantly higher risk of incident chronic kidney disease (OR, 3.45; 95% CI, 1.72-6.91; P<0.001), nephrolithiasis (OR, 3.34; 95% CI, 1.55-7.22; P=0.002), and cardiovascular disease (OR, 2.03; 95% CI, 1.14-3.60; P=0.016), compared with patients without hypoparathyroidism. On the contrary, the risk of fracture was decreased in patients with hypoparathyroidism (OR, 0.09; 95% CI, 0.01-0.70; P=0.021). Conclusion This study demonstrates that, in the clinical practice of Spanish endocrinologists, a significant increase in the risk of chronic kidney disease, nephrolithiasis and cardiovascular disease, as well as a reduction in the risk of fractures is detected. These results are of interest for the development of new clinical guidelines and monitoring protocols for patients with hypoparathyroidism.
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Affiliation(s)
- Juan J. Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Majadahonda, Spain
| | - Emma Anda
- Department of Endocrinology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Begoña Pérez-Corral
- Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain
| | - Miguel Paja
- Department of Endocrinology, Hospital Universitario de Basurto, Universidad del País Vasco (UPV/EHU), Bilbao, Spain
| | - Victoria Alcázar
- Department of Endocrinology, Hospital Severo Ochoa, Leganés, Spain
| | - Cecilia Sánchez-Ragnarsson
- Department of Endocrinology, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Aida Orois
- Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain
| | - Ana R. Romero-Lluch
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Marcel Sambo
- Department of Endocrinology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Amelia Oleaga
- Department of Endocrinology, Hospital Universitario de Basurto, Universidad del País Vasco (UPV/EHU), Bilbao, Spain
| | - Águeda Caballero
- Department of Endocrinology, Hospital Universitario de Canarias, Tenerife, Spain
| | - María R. Alhambra
- Department of Endocrinology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Virginia Urquijo
- Department of Endocrinology, Hospital Universitario de Cruces, Bilbao, Spain
| | | | - José C. Fernández-García
- Department of Endocrinology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain
| | - Viyey Kishore-Doulatram
- Department of Endocrinology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain
| | - Suset Dueñas-Disotuar
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Tomás Martín
- Department of Endocrinology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mercedes Peinado
- Department of Endocrinology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Julia Sastre
- Department of Endocrinology, Hospital Universitario de Toledo, Toledo, Spain
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Abood A, Ovesen T, Rolighed L, Triponez F, Vestergaard P. Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution. Front Endocrinol (Lausanne) 2024; 15:1330524. [PMID: 38304463 PMCID: PMC10833226 DOI: 10.3389/fendo.2024.1330524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Background Hypoparathyroidism following total thyroidectomy is globally the most common complication to thyroid surgery. The reported complication rates vary widely and might be highly dependent on the surgical experience. In this study we aimed to evaluate the rate of hypoparathyroidism following primary total thyroidectomy at a low-volume institution that only performs thyroid surgery and does not have any experience with parathyroid surgery. Methods Retrospective cohort study. All patients undergoing primary total thyroidectomy at the ENT-Department, Goedstrup Hospital, Denmark, over a 5-year period (2016-2020) were identified through the procedure codes for total thyroidectomy. Medical records, pathology reports, biochemical and medical histories were fully assessed for each patient. The primary endpoint was the rate of hypoparathyroidism- both immediate and permanent. Secondary outcomes were parathyroid gland identification rates, rates of parathyroid gland autotransplantation, and rates of inadvertent parathyroid gland excision. Results A total of 89 patients were included in the final analysis. A total of 33 patients (37.1%) experienced immediate hypoparathyroidism following surgery, while 30 patients (33.7%) still were on active vitamin D two months postoperatively. One year following surgery, 28 patients (31.5%) were still on active vitamin D and were considered as having permanent hypoparathyroidism. Sixty-one percent of the parathyroid glands were identified intraoperatively, and 19% of the patients experienced parathyroid autotransplantation. Inadvertent parathyroid gland excision occurred for 21% of the patients and was associated with a significantly increased risk of permanent hypoparathyroidism (RR = 2.99; 95% CI: 1.36 - 6.62, p = 0.005). Conclusion Both transient and permanent hypoparathyroidism following total thyroidectomy at a low-volume, non-parathyroid institution occurred with much higher frequencies than previously reported. The elevated rates were most likely due to the low-volume, non-parathyroid nature of the surgeons which in part was mirrored in low parathyroid gland identifications rates, and high rates of autotransplantation and inadvertent parathyroid gland excision.
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Affiliation(s)
- Ali Abood
- Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark
| | - Therese Ovesen
- Department of Otorhinolaryngology, Goedstrup Hospital, Herning, Denmark
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Frédéric Triponez
- Thoracic and Endocrine Surgery Division, Geneva University Hospital, Geneva, Switzerland
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Bergenfelz A, Barczynski M, Heie A, Muth A, Passler C, Schneider M, Wierzbicka P, Konturek A, Brauckhoff K, Elf AK, Dahlberg J, Hermann M. Impact of autofluorescence for detection of parathyroid glands during thyroidectomy on postoperative parathyroid hormone levels: parallel multicentre randomized clinical trial. Br J Surg 2023; 110:1824-1833. [PMID: 37758507 PMCID: PMC10638529 DOI: 10.1093/bjs/znad278] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/20/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Techniques for autofluorescence have been introduced to visualize the parathyroid glands during surgery and to reduce hypoparathyroidism after thyroidectomy. METHODS This parallel multicentre RCT investigated the use of Fluobeam® LX to visualize the parathyroid glands by autofluorescence during total thyroidectomy compared with no use. There was no restriction on the indication for surgery. Patients were randomized 1 : 1 and were blinded to the group allocation. The hypothesis was that autofluorescence enables identification and protection of the parathyroid glands during thyroidectomy. The primary endpoint was the rate of low parathyroid hormone (PTH) levels the day after surgery. RESULTS Some 535 patients were randomized, and 486 patients received an intervention according to the study protocol, 246 in the Fluobeam® LX group and 240 in the control group. Some 64 patients (26.0 per cent) in the Fluobeam® LX group and 77 (32.1 per cent) in the control group had low levels of PTH after thyroidectomy (P = 0.141; relative risk (RR) 0.81, 95 per cent c.i. 0.61 to 1.07). Subanalysis of 174 patients undergoing central lymph node clearance showed that 15 of 82 (18 per cent) in the Fluobeam® LX group and 31 of 92 (33 per cent) in the control group had low levels of PTH on postoperative day 1 (P = 0.021; RR 0.54, 0.31 to 0.93). More parathyroid glands were identified during operation in patients who had surgery with Fluobeam® LX, and fewer parathyroid glands in the surgical specimen on definitive histopathology. No specific harm related to the use of Fluobeam® LX was reported. CONCLUSION The use of autofluorescence during thyroidectomy did not reduce the rate of low PTH levels on postoperative day 1 in the whole group of patients. It did, however, reduce the rate in a subgroup of patients. Registration number: NCT04509011 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Anders Bergenfelz
- Department of Clinical Sciences—Lund, Medical Faculty, Lund University, Lund, Sweden
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Anette Heie
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Andreas Muth
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Passler
- Department of Surgery, Klinik Landstraße, Wiener Gesundheitsverbund, Vienna, Austria
| | - Max Schneider
- Department of Surgery, Klinik Landstraße, Wiener Gesundheitsverbund, Vienna, Austria
| | - Paulina Wierzbicka
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Alexander Konturek
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anna-Karin Elf
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jakob Dahlberg
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Hermann
- Department of Surgery, Klinik Landstraße, Wiener Gesundheitsverbund, Vienna, Austria
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García Pascual L, García González L, Lao Luque X, Palomino Meneses L, Viscasillas Pallàs G. Evaluation of an early detection protocol, intensive treatment and control of post-surgical hypoparathyroidism in the first month after total thyroidectomy. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2023; 70:202-211. [PMID: 37002121 DOI: 10.1016/j.endien.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/29/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND OBJECTIVE Hypoparathyroidism is the most common complication of total thyroidectomy and usually requires monitoring of calcaemia, whereby it is one of the factors that most contributes to hospital stay. The objective of the study is to evaluate the clinical usefulness of the application of our protocol for early detection, intensive treatment and control of hypoparathyroidism in the first month after thyroidectomy. PATIENTS AND METHOD Retrospective observational cross-sectional study of 79 patients who underwent total thyroidectomy in whom parathormone (PTH) and calcemia determinations were performed at 6-8 h and 18-24 h post-surgery. When the PTH value was lower than inferior limit of the reference (15 pg/ml), oral treatment was started with 1000 mg of calcium and 0.25 μg of calcitriol every 8 h followed by calcemia controls. RESULTS Twenty-six cases (32.9%) of normocalcemic hypoparathyroidism were detected in whom treatment prevented their progression to hypocalcaemia, except for 3 cases that had an episode of mild asymptomatic hypocalcaemia. There were no cases of moderate/severe hypocalcaemia and only one case of asymptomatic mild hypercalcaemia. There were no readmissions due to calcium abnormalities. No case with PTH > 15 pg/ml had hypocalcaemia. The protocol allowed a hospital stay of 24 h. The prevalence of permanent hypoparathyroidism was 5.1%. CONCLUSIONS The application of our protocol during the first month after thyroidectomy is very useful because it avoids the appearance of moderate/severe hypocalcaemia and hypercalcaemia, allows a short hospital stay and is associated with a low prevalence of permanent hypoparathyroidism.
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Affiliation(s)
- Luis García Pascual
- Servei d'Endocrinologia, Hospital Universitari Mútua de Terrasa, Terrassa, Barcelona, Spain.
| | - Lluís García González
- Servei de Cirurgia General i Aparell Digestiu, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Xavier Lao Luque
- Servei d'Otorrinolaringologia, Hospital Universitari Mútua de Terrasa, Terrassa, Barcelona, Spain
| | - Laura Palomino Meneses
- Servei d'Otorrinolaringologia, Hospital Universitari Mútua de Terrasa, Terrassa, Barcelona, Spain
| | - Guillem Viscasillas Pallàs
- Servei d'Otorrinolaringologia, Althaia, Xarxa Assistencial Universitaria de Manresa, Manresa, Barcelona, Spain
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Evaluación de un protocolo de detección precoz, tratamiento intensivo y control del hipoparatiroidismo posquirúrgico en el primer mes después de una tiroidectomía total. ENDOCRINOL DIAB NUTR 2023. [DOI: 10.1016/j.endinu.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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