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Dadkhah PA, Farshid A, Khademi R, Yaghoubi S, Asadzadeh A, Moharamnejad N, Jadidian F, Ziaei SA, Haghshoar S, Salimi O, Shafagh SG, Rabiei N, Shahsavari S, Shokravi S, Maroufi Z, Deravi N, Erabi G, Naziri M. Impact of oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy: Systematic review and meta-analysis. Scand J Surg 2024:14574969241251899. [PMID: 38785032 DOI: 10.1177/14574969241251899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND One of the most common complications of total thyroidectomy is post-operative transient or persistent hypoparathyroidism that can cause symptomatic hypocalcaemia. To prevent this complication, shorten the period of hospitalization and reduce morbidity, routine supplementation of oral vitamin D and calcium has been suggested. This systematic review and meta-analysis aims to critically assess the association between pre-operative calcitriol supplementation and post-operative hypocalcaemia. METHODS Randomized controlled trial studies were identified by searching PubMed, Scopus, and Google Scholar databases up to 30 March 2023. Screening of titles, abstracts, and full texts of articles were performed, and data were extracted for a meta-analysis. RESULTS This meta-analysis includes data from nine randomized controlled trials with a total of 1259 patients but with significant heterogeneity. The results demonstrate that calcium levels were higher in patients who had pre-operative calcitriol supplementation, with a weighted mean difference (WMD) 0.18 (95% confidence interval (CI) = 0.00, 0.37). Pre-operative calcitriol supplementation did not lead to significant changes in parathyroid hormone (PTH) levels, with WMD -0.49 (95% CI: -1.91, 0.94). CONCLUSION Pre-operative calcitriol supplementation leads to higher calcium levels, but the high heterogeneity of the included studies (79% to 98.7%) could affect the results.
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Affiliation(s)
- Parisa A Dadkhah
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirali Farshid
- Student Research Committee, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Reza Khademi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shayan Yaghoubi
- Student Research Committee, Faculty of Medicine, Islamic Azad University of Ardabil, Ardabil, Iran
| | - Ailin Asadzadeh
- Student Research Committee, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nima Moharamnejad
- Student Research Committee, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Faezeh Jadidian
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed A Ziaei
- Student Research Committee, Fasa University of Medical Sciences, Fars, Iran
| | - Sepehr Haghshoar
- Faculty of Pharmacy, Cyprus International University, Nicosia, Cyprus
| | - Omid Salimi
- Student Research Committee, Faculty of Medicine, Islamic Azad University of Najafabad, Isfahan, Iran
| | | | - Negin Rabiei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saleh Shahsavari
- Department of Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samin Shokravi
- Department of Research and Academic Affairs, Larkin Community Hospital, Miami, FL, USA
| | - Zahra Maroufi
- Student Research Committee, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gisou Erabi
- Student Research Committee Urmia University of Medical Sciences Resaalat Ave. 5714783734 Urmia Iran
| | - Mahdyieh Naziri
- Student Research Committee School of Medicine Iran University of Medical Sciences (IUMS) Shahid Hemmat Highway 14496-14535 Tehran Iran
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Al-Hakami HA, Alsolamy RM, I Awad B, Mandora RM, Hamdan D, Alzahrani R, Alaqsam Y, Al-Garni M. Incidence of Post-Thyroidectomy Hypoparathyroidism and Associated Preoperative and Intraoperative Risk Factors. Cureus 2024; 16:e56585. [PMID: 38646308 PMCID: PMC11031194 DOI: 10.7759/cureus.56585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Thyroidectomy technique and extent are related to parathyroid injury and hypoparathyroidism. Total thyroidectomy is one of the most commonly performed endocrine surgeries, and the majority of patients recover completely without any complications. However, persistent hypoparathyroidism is the most prevalent long-term consequence following total thyroidectomy. While it is seldom deadly, it can cause severe morbidity for the patient and raise healthcare expenses. METHODS This retrospective cohort study was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia. We included all confirmed thyroid cancer cases that underwent thyroidectomy with or without neck dissection between July 2016 and August 2022. The data was collected from a chart review of the electronic medical record system (BEST-care), and a data collection sheet was utilized. SPSS version 26 was used to analyze the data. RESULTS A total of 192 patients undergoing thyroid surgery were enrolled. One hundred forty-three (74.5%) were females and the mean age of participants was 45.29 ± 16.88 years. Most patients, 170 (88.5%), had a papillary histological type, and total thyroidectomy was performed in 150 (78.1%). A significant association was found between the type of surgery and postoperative hypoparathyroidism (p=<0.05*). In addition, hypocalcemia was seen in 147 (76.6%) of the patients. Postoperative hypoparathyroidism was significantly higher among patients who had asymptomatic postoperative hypocalcemia and those who received IV calcium gluconate (p=<0.05*). Moreover, postoperative hypocalcemia, hypomagnesemia, and hyperphosphatemia were significantly associated with postoperative hypoparathyroidism (p=<0.05*). CONCLUSION The incidence of postoperative hypoparathyroidism is significantly higher among patients who underwent total thyroidectomy and had a normal level of preoperative parathyroid hormone (PTH) and magnesium (Mg) levels. Identifying these factors is a crucial step to minimize the occurrence of such complications.
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Affiliation(s)
- Hadi Afandi Al-Hakami
- College of Medicine, Department of Otolaryngology-Head & Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center/Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Renad M Alsolamy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Baraa I Awad
- College of Medicine, Department of Otolaryngology-Head & Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center/Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Roaa M Mandora
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Dalia Hamdan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Rakan Alzahrani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Yousef Alaqsam
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed Al-Garni
- College of Medicine, Department of Otolaryngology-Head & Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center/Ministry of the National Guard - Health Affairs, Jeddah, SAU
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Cappellacci F, Canu GL, Rossi L, De Palma A, Mavromati M, Kuczma P, Di Filippo G, Morelli E, Demarchi MS, Brazzarola P, Materazzi G, Calò PG, Medas F. Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation. Front Surg 2024; 11:1341683. [PMID: 38379818 PMCID: PMC10876881 DOI: 10.3389/fsurg.2024.1341683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/25/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy. Methods In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B). Results We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, p < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, p = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, p = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, p = 0.015). Discussion Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, p = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable.
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Affiliation(s)
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Andrea De Palma
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Maria Mavromati
- Service D'endocrinologie, Diabétologie, Nutrition et éducation du Patient, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Paulina Kuczma
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Giacomo Di Filippo
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Eleonora Morelli
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Brazzarola
- Endocrine Surgery Unit, Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | | | | | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Sartori PV, Andreani S, De Pasquale L, Pauna I, Bulfamante AM, Aiello PSL, Melcarne R, Giacomelli L, Boniardi M. How to Manage Advanced Differentiated Thyroid Cancer: Step-by-Step Analysis from Two Italian Tertiary Referral Centers. J Clin Med 2024; 13:708. [PMID: 38337400 PMCID: PMC10856418 DOI: 10.3390/jcm13030708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) has an excellent prognosis; however, advanced disease is associated with a worse prognosis and is relatively common. Surgery followed by RAI treatment remains the mainstream treatment for a large majority of patients with high- and intermediate-risk DTC, but its benefits should be carefully weighed against the potential for harm. The aim of this paper is to critically review the experience in treating advanced DTC at two tertiary referral centers in Italy. METHODS Retrospective analysis of 300 patients who underwent surgery for ADTC over 30 years. RESULTS The complication rate was 50.33%. A total of 135 patients (45%) remained at regular follow-up, 118 (87.4%) were alive, while 17 (12.6%) were deceased. The mean overall survival at 12 years was 84.8% with a mean of 238 months. Eleven patients (8.1%) experienced a relapse after a median of 13 months. CONCLUSIONS ADTC patients adequately treated can achieve prolonged survival even in the case of metastasis or disease relapse. Patients with ADTC should be referred to high-volume centers with the availability of an extended multidisciplinary team to receive tailored treatment.
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Affiliation(s)
| | - Sara Andreani
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy;
| | - Iuliana Pauna
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Antonio Mario Bulfamante
- Pediatric Otolaryngology Unit, ASST Fatebenefratelli-Sacco, Buzzi Children Hospital, 20162 Milan, Italy;
| | | | - Rossella Melcarne
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Laura Giacomelli
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Marco Boniardi
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
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Materazzi G, Papini P, Fregoli L, Morganti R, De Palma A, Ambrosini CE, Rossi L. The learning curve on robot-assisted transaxillary thyroidectomy performed by a single endocrine surgeon in a third-level institution in Europe: a cumulative sum (CUSUM) analysis. Updates Surg 2023; 75:1653-1660. [PMID: 37531041 PMCID: PMC10435399 DOI: 10.1007/s13304-023-01619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
Robot-assisted transaxillary thyroidectomy is widely performed in Asian countries, although it is still under discussion in the Western World. However, there have been few studies reporting on the learning curve of robot-assisted transaxillary thyroidectomy. We used the cumulative sum (CUSUM) analysis to assess the learning curve of gasless robot-assisted transaxillary thyroidectomy at a third-level institution in Europe. We included all consecutive patients operated by a single surgeon without previous experience of robotic surgery from February 2012 to January 2023. The primary endpoint of the study was the learning curve extracted from the median operative time using the CUSUM method for the quantitative assessment. Overall, 583 patients were enrolled. The median operative time for thyroid lobectomy and total thyroidectomy was 70 and 90 min, respectively. The CUSUM analysis showed that the learning curve for thyroid lobectomy and total thyroidectomy is 66 and 56 cases, respectively. Moreover, the presence of thyroiditis resulted associated with shorter operative time for total thyroidectomy (p = 0.044), whereas no factors resulted associated with surgical complications. The learning curve for performing robotic transaxillary thyroid lobectomy for a surgeon without previous robotic experience is 66 cases. After that, 56 cases must be performed to acquire proficiency in robotic transaxillary total thyroidectomy. Training programs may reduce the slope of the learning curve.
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Affiliation(s)
- Gabriele Materazzi
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Piermarco Papini
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Lorenzo Fregoli
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Andrea De Palma
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Carlo Enrico Ambrosini
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Leonardo Rossi
- Endocrine Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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A Parathyroid Hormone-guided Calcium and Calcitriol Supplementation Protocol Reduces Hypocalcemia-related Readmissions Following Total Thyroidectomy. Endocr Pract 2023; 29:260-265. [PMID: 36682414 DOI: 10.1016/j.eprac.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine the effect of a 4 hour postoperative serum parathyroid hormone (PTH) guided calcium and calcitriol supplementation protocol on the incidence of hypocalcemia and hospital readmissions in patients undergoing total thyroidectomy. METHODS This was a single institution, retrospective chart review of patients who underwent total thyroidectomy, 148 had been operated on prior to the protocol implementation and 389 after. Hypocalcemia risk was stratified as low (PTH >30 pg/ml), medium (15-30 pg/ml), and high (<15 pg/ml), using serum PTH values obtained 4 hours postoperatively. Hypocalcemia was defined as a total serum calcium level <8 mg/dl. Baseline demographic and operative characteristics, and postoperative outcome were recorded for both groups. Fisher's exact test or Wilcoxon rank sum test were used to compare the characteristics of the two groups. A multivariable logistic regression model was applied to account for potentially confounding variables. RESULTS Postoperative hypocalcemia occurred significantly less frequently in the protocol group compared to the preprotocol group (10.3% vs. 20.9%, P=.002). The reduction in hypocalcemia in the protocol group was observed both in patients with (16.3% vs. 25.6%) and without (8.4% vs. 19.3%) cervical lymph node dissection. There was a significantly lower incidence of hospital readmission events in the protocol group compared to the preprotocol group (1.0% vs. 4.7%, P=.013). CONCLUSIONS Compared to a historical cohort, a PTH-guided protocol for calcium and calcitriol supplementation significantly reduces postoperative hypocalcemia and hospital readmission rates, in patients undergoing total thyroidectomy.
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Mahvi DA, Witt RG, Lyu HG, Gawande AA, Nehs MA, Doherty GM, Cho NL. Increased BMI is Associated With Lower Risk of Hypocalcemia in Total Thyroidectomy Patients. J Surg Res 2022; 279:240-246. [DOI: 10.1016/j.jss.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/01/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
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Gambardella C, Docimo L, Candela G, Cozzolino G, Mongardini F, Serilli F, Nesta G, Filograna Pignatelli M, Ferrandes S, Gambardella A, Docimo G. Thyroid-Bed Schwannoma Mimicking a Thyroid Neoplasm: A Challenging Diagnosis: Report of a Case and Literature Review. Medicina (B Aires) 2022; 58:medicina58101345. [PMID: 36295506 PMCID: PMC9611195 DOI: 10.3390/medicina58101345] [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] [Received: 09/01/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Schwannomas, also called neurinomas, are rare benign tumors of the neural cells that can develop from the sheaths of nervous structures of several districts, although the most frequent sites are the cranial nerves (25%–45%). Rarely, cases show neck schwannomas in the thyroid parenchyma, while the cases of thyroid-bed schwannomas mimicking a thyroid-gland lesions are anecdotal. Methods: We report the case of a 70-year-old man with a preoperative-imaging diagnosis of a thyroid neoplasm, confirmed as Thyr 4 by fine-needle cytology. Results: During surgery, an extra-thyroidal lesion was discovered, determined to be a neck schwannoma through definitive pathology. A literature review of cases of thyroid-bed-lesion schwannomas misinterpreted as thyroid neoplasms was carried out. Conclusions: In the case of suspicious extra-thyroidal lesions, we advocate for a close routine cooperation between the cytologist, the radiologist, and the surgeon in the attempt to reach an accurate preoperative diagnosis.
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Scappaticcio L, Trimboli P, Iorio S, Maiorino MI, Longo M, Croce L, Pignatelli MF, Ferrandes S, Cozzolino I, Montella M, Ronchi A, Franco R, Rotondi M, Docimo G, Esposito K, Bellastella G. Repeat thyroid FNAC: Inter-observer agreement among high- and low-volume centers in Naples metropolitan area and correlation with the EU-TIRADS. Front Endocrinol (Lausanne) 2022; 13:1001728. [PMID: 36187133 PMCID: PMC9519850 DOI: 10.3389/fendo.2022.1001728] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Our institution (University Hospital "L. Vanvitelli" - Naples, Italy) is a high-volume (HV) center in Naples metropolitan area and many patients are referred there to repeat thyroid fine-needle aspiration cytology (FNAC) after initial FNAC performed in low-volume institutions (LV). The aims of the study were to 1) examine the inter-observer agreement between HV and LV institutions according to the Italian thyroid cytology system, and 2) explore how the discordant FNAC reports were distributed in the European Thyroid Imaging and Reporting Data System (EU-TIRADS) categories. All consecutive cases of repeat FNAC performed at University Hospital "L. Vanvitelli" from January 2016 to December 2021 were retrospectively reviewed. Fleiss' kappa (κ) was used to assess the inter-observer agreement, and categorical variables were compared by chi-square testing. P < 0.05 was considered statistically significant. A total of 124 nodules from 124 adults (mean age 49 years; mean maximum diameter 19 mm) were evaluated. Initial FNAC reports at LV were: 4 (3.2%) TIR1c, 64 (51.6%) TIR2, 48 (38.7%) TIR3A, 8 (6.5%) TIR3B, 0 TIR4, 0 TIR5. The overall FNAC reports were significantly different between the LV and HV institutions. At repeated FNAC, cytological diagnosis was unchanged in 64 (51.6%) cases including TIR2 and TIR3A results. A downgraded FNAC diagnosis (i.e., TIR2 vs TIR3A, TIR2 vs TIR3B) was observed in 36 (29%) nodules. An upgraded FNAC diagnosis (i.e., TIR3B vs TIR2, TIR3B vs TIR3A, TIR4 vs TIR3A, TIR5 vs TIR2, TIR5 vs TIR3B) was recorded in 24 (19.4%) nodules. The weighted inter-observer agreement between LV and HV institutions was poor (κ=0.133). Changed FNAC results were significantly (p=0.0023) more frequent in nodules at intermediate/high-risk (i.e., EU-TIRADS 4/5) than in those at no/low risk (EU-TIRADS 2/3) [i.e., 32/48 (66.7%) and 28/76 (36.8%), respectively]. Downgraded FNAC results were significantly more frequent in EU-TIRADS 2/3 (p=0.001) while upgraded FNAC were present only in EU-TIRADS 4/5 (24/24, 100.0%). The inter-observer agreement among LV and HV thyroid services was poor. The EU-TIRADS 4 and 5 categories included all the malignant nodules with FNAC results reclassified as higher risk (i.e., TIR3B-TIR4-TIR5) by the high-volume cytology service.
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Affiliation(s)
- Lorenzo Scappaticcio
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, Naples, Italy
- *Correspondence: Lorenzo Scappaticcio,
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Sergio Iorio
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Maria Ida Maiorino
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Miriam Longo
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Laura Croce
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
| | | | - Sonia Ferrandes
- Division of Thyroid Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L.Vanvitelli”, Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L.Vanvitelli”, Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L.Vanvitelli”, Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L.Vanvitelli”, Naples, Italy
| | - Mario Rotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Pavia, Italy
| | - Giovanni Docimo
- Division of Thyroid Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Katherine Esposito
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, Naples, Italy
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Díaz-Granados Goenaga E, Granados Calixto Á, Zambrano JDF, Ulloa Gordon FM, Salgar Sarmiento JC. Trastornos posoperatorios del metabolismo del calcio postiroidectomía. REPERTORIO DE MEDICINA Y CIRUGÍA 2021. [DOI: 10.31260/repertmedcir.01217372.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: revisión narrativa que revela como la tiroidectomía ha aumentado en los últimos años y con ella sus complicaciones: la hipocalcemia y el hipoparatiroidismo. Métodos: los motores de búsqueda utilizados fueron PubMed, Clinical Key, Embase, Cochrane y Lilacs, se incluyeron referencias en español e inglés, publicadas entre 2016 y 2020. Los artículos seleccionados se revisaron utilizando CONSORT, STROBE o PRISMA, según el caso. Resultados: fueron seleccionados 35 artículos que tenían relación directa con el tema, entre ellos: metanálisis, revisiones sistemáticas, estudios prospectivos y observacionales, revisiones narrativas y consensos de expertos, procedentes de los cinco continentes. La hipocalcemia y el hipotiroidismo en sus dos formas se relacionan con la afectación de la vascularización de las glándulas paratiroides o su exérecis accidental, existiendo factores predisponentes propios del paciente, derivados de la técnica quirúrgica o la característica patológica de la lesión en el tiroides. Como estrategias de prevención disponemos de herramientas ópticas para definir en el perioperatorio la disposición de las paratiroides; además existe la posibilidad de autotrasplantarlas al identificarlas en la pieza anatómica. El mejor marcador del estado metabólico del calcio es la PTHi. Conclusiones: la preservación de las paratiroides y de su irrigación es la mejor estrategia para prevenir los trastornos posoperatorios del calcio.
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Gut L, Bernet S, Huembelin M, Mueller M, Baechli C, Koch D, Nebiker C, Schuetz P, Mueller B, Christ E, Ebrahimi F, Kutz A. Sex-Specific Differences in Outcomes Following Thyroidectomy: A Population-Based Cohort Study. Eur Thyroid J 2021; 10:476-485. [PMID: 34950600 PMCID: PMC8647072 DOI: 10.1159/000510618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/28/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Numbers of thyroidectomies and awareness of postoperative quality measures have both increased. Potential sex-specific variations in clinical outcomes of patients undergoing thyroidectomy are controversial. OBJECTIVE The aim of this study was to investigate sex-specific differences in outcomes following thyroidectomy. METHODS This is a population-based cohort study of all adult patients undergoing either hemi- or total thyroidectomy in Switzerland from 2011 to 2015. The primary outcome was all-cause 30-day readmission rate. The main secondary outcomes were intensive care unit (ICU) admission, surgical re-intervention, in-hospital mortality, length of hospital stay (LOS), postoperative calcium disorder, vocal cord paresis, and hematoma. RESULTS Of 16,776 patients undergoing thyroidectomy, the majority of patients undergoing thyroidectomy were female (79%), with a median age of 52 (IQR 42-64) years. Within 30 days after the surgery, male patients had significantly higher rates of hospital readmission (adjusted risk ratio [RR] 1.38; 95% confidence interval [95% CI] 1.11-1.72, p = 0.008) and higher risks for postoperative ICU admission (RR 1.25; 95% CI, 1.09-1.44, p = 0.003) than female patients. There were no significant differences among sexes in the LOS, rates of surgical re-interventions, or in-hospital mortality. While postoperative calcium disorders due to hypoparathyroidism were less prevalent among male patients (RR 0.63; 95% CI, 0.54-0.72, p < 0.001), a 2-fold higher incidence rate of postoperative hematoma was observed (RR 1.93, 95% CI, 1.51-2.46, p < 0.001). CONCLUSIONS Male patients undergoing thyroidectomy have higher 30-day hospital readmission and ICU admission rates. Following surgery, male patients revealed higher rates of neck hematoma, while hypocalcemia was more frequent among female patients.
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Affiliation(s)
- Lara Gut
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Selina Bernet
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Monika Huembelin
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Magdalena Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ciril Baechli
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Nebiker
- Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
- *Fahim Ebrahimi, Division of Endocrinology, University Hospital Basel, Petersgraben 4, CH 4031 Basel (Switzerland),
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
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Risk Factors for Low Levels of Parathyroid Hormone after Surgery for Thyroid Cancer: A Single Center Study. J Clin Med 2021; 10:jcm10184113. [PMID: 34575224 PMCID: PMC8469662 DOI: 10.3390/jcm10184113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 07/30/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Thyroidectomy is the definitive treatment for most patients with thyroid cancer. Hypoparathyroidism is the most frequent complication of thyroidectomy, and its pathogenesis is multifactorial. The aim of this study is to evaluate the patient- and surgical-related risk factors for hypoparathyroidism after surgery for thyroid cancer. Methods: In this retrospective study, patients referred to surgery for thyroid cancer from 2016 to 2019 were enrolled. Preoperative serum calcium and parathyroid hormone (PTH) and postoperative 24 h PTH and calcium levels were evaluated. Demographic data, type of surgery, incidence of hypoparathyroidism and hypocalcemia were recorded for all the patients. Patients were divided into two groups based on post-operative PTH levels (≤12 and >12 pg/mL). Results: A total of 189 patients were enrolled in this study. There were 146 women (87.3%) and 43 men (22.7%), with a mean age of 51.3 years. A total of 79 patients (41.7%) underwent a neck dissection. A total of 59 patients (31.1%) had a postoperative PTH level < 12 pg/mL. Female sex, neck dissection, the yield of lymph node dissection and incidental parathyroidectomy were significantly associated with postoperative hypoparathyroidism. Incidental parathyroidectomy was reported in 44 (23.2%) patients and was correlated with younger age (<40 years) and neck dissection. There was no difference in the rate of post-operative hypocalcemia between patients with incidental parathyroidectomy and those without. Conclusions: Young patients undergoing neck dissection and with incidental parathyroidectomy have the highest risk of postoperative hypoparathyroidism after surgery for thyroid cancer. However, a large proportion of patients without incidental parathyroidectomy may have temporary hypocalcemia, suggesting that impaired blood supply of parathyroid glands during their identification and dissection may play a relevant role.
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Chen Z, Zhao Q, Du J, Wang Y, Han R, Xu C, Chen X, Shu M. Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis. J Int Med Res 2021; 49:300060521996911. [PMID: 33779362 PMCID: PMC8010841 DOI: 10.1177/0300060521996911] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective A meta-analysis to investigate the risk factors for postoperative hypocalcaemia after thyroidectomy in adult patients. Methods A systematic search of publications in the electronic databases (PubMed®, The Cochrane Library, Web of Science, OVID and Embase®) from inception to June 2020 was conducted. Screening of titles, abstracts and full texts and data extraction were independently performed by two authors. The OR was selected as the pooled estimate. Results The analysis included 23 studies. Twelve significant risk factors for postoperative hypocalcaemia were identified: hypoparathyroidism, OR 5.58; total thyroidectomy, OR 3.59; hypomagnesaemia, OR 2.85; preoperative vitamin D deficiency, OR 2.32; female sex, OR 1.49; thyroid malignancy, OR 1.85; thyroiditis, OR 1.48; substernal multinodular goitres, OR 1.70; parathyroidectomy, OR 1.58; central compartment neck dissection, OR 1.17; modified radical neck dissection, OR 1.57; and central neck dissection, OR 1.54. Conclusions This meta-analysis provides moderate-to-high quality evidence that the 12 risk factors were predictive of postoperative hypocalcaemia, which should be monitored closely before thyroidectomy.
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Affiliation(s)
- Zhimei Chen
- Department of Nursing, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Qiyuan Zhao
- Department of Nursing, School of Medicine, Huzhou University, Huzhou, Zhejiang Province, China
| | - Jinlei Du
- Department of Nursing, School of Medicine, Huzhou University, Huzhou, Zhejiang Province, China
| | - Ya Wang
- Department of Nursing, School of Medicine, Huzhou University, Huzhou, Zhejiang Province, China
| | - Rongrong Han
- Department of Nursing, School of Medicine, Huzhou University, Huzhou, Zhejiang Province, China
| | - Caijuan Xu
- Department of Nursing, Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiaofang Chen
- Department of Nursing, School of Medicine, Huzhou University, Huzhou First People's Hospital, Huzhou, Zhejiang Province, China
| | - Min Shu
- Department of Nursing, School of Medicine, Huzhou University, Huzhou, Zhejiang Province, China
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Xing Z, Qiu Y, Fei Y, Xia B, Abuduwaili M, Zhu J, Su A. Protective strategy of parathyroid glands during thyroid lobectomy: A retrospective cohort and case-control study. Medicine (Baltimore) 2021; 100:e21323. [PMID: 33832057 PMCID: PMC8036091 DOI: 10.1097/md.0000000000021323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
Parathyroid protection during thyroid lobectomy was not illustrated previously. Aim of this study was to find out the influence of parathyroid glands in situ preservation and autotransplantation on postoperative parathyroid function in thyroid lobectomy.Consecutive patients who underwent primary thyroid lobectomy with unilateral central neck dissection for papillary thyroid carcinoma in our center were included retrospectively. Postoperative hypoparathyroidism was defined as low parathyroid hormone (PTH) levels (<1.6 pmol/L) and keeping over 6 months was defined as permanent. Patients were divided into 3 groups: all identified parathyroid glands preserved in situ (preservation group); at least one parathyroid gland autotransplanted without accidental resection (autotransplantation group); at least one parathyroid gland accidental resected (resection group).A total of 425 patients were included. No permanent hypoparathyroidism was reported, and the rates of transient hypoparathyroidism were similar among all groups. Significantly lower serum PTH levels were found in autotransplantation group versus preservation group at postoperative 1-day (3.77 ± 1.61 vs 4.72 ± 2.31, P < .001). Transient hypoparathyroidism was significantly associated with reduced intraoperative carbon nanoparticles utilization (57.1% vs 77.4%, P = .039).Thyroid lobectomy was a safe surgical method for parathyroid protection no matter the practice to ipsilateral parathyroid glands. However, preservation of all parathyroid glands was still recommended considering relatively stable PTH levels.
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Affiliation(s)
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery
- Department of Ultrasound, West China Hospital, Sichuan University, PR China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery
| | | | | | | | - Anping Su
- Center of Thyroid & Parathyroid Surgery
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15
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Qin Y, Sun W, Wang Z, Dong W, He L, Zhang T, Zhang H. A Meta-Analysis of Risk Factors for Transient and Permanent Hypocalcemia After Total Thyroidectomy. Front Oncol 2021; 10:614089. [PMID: 33718114 PMCID: PMC7943836 DOI: 10.3389/fonc.2020.614089] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background As hypocalcemia is the most common complication of total thyroidectomy, identifying its risk factors should guide prevention and management. The purpose of this study was to determine the risk factors for postthyroidectomy hypocalcemia. Methods We searched PubMed, Web of Science and EMBASE through January 31, 2019, and assessed study quality using the Newcastle–Ottawa Scale. Results Fifty studies with 22,940 patients met the inclusion criteria, of which 24.92% (5716/22,940) had transient hypocalcemia and 1.96% (232/11,808) had permanent hypocalcemia. Significant (P < 0.05) predictors of transient hypocalcemia were: younger age, female, parathyroid autotransplantation (PA), inadvertent parathyroid excision (IPE), Graves’ disease (GD), thyroid cancer, central lymph node dissection, preoperative severe Vitamin D deficiency, preoperative Vitamin D deficiency and a lower postoperative 24 h parathyroid hormone (PTH) level. Preoperative magnesium, preoperative PTH and Hashimoto’s thyroiditis were not significant predictors of transient hypocalcemia. IPE, GD, and thyroid cancer were associated with an increased rate of permanent hypocalcemia, but gender and PA did not predict permanent hypocalcemia. Conclusion Important risk factors for transient and permanent hypocalcemia were identified. However, given the limited sample size and heterogeneity of this meta-analysis, further studies are required to confirm our preliminary findings.
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Affiliation(s)
- Yuan Qin
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zhihong Wang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wenwu Dong
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Liang He
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ting Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
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Donahue C, Pantel HJ, Yarlagadda BB, Brams D. Does Preoperative Calcium and Calcitriol Decrease Rates of Post-Thyroidectomy Hypocalcemia? A Randomized Clinical Trial. J Am Coll Surg 2021; 232:848-854. [PMID: 33631337 DOI: 10.1016/j.jamcollsurg.2021.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postoperative hypocalcemia is the most common complication after thyroidectomy. Postoperative supplementation with calcium and calcitriol reduces its occurrence; however, prophylactic preoperative supplementation has not been studied systematically. The primary objective of this study was to determine whether pre- and postoperative calcium and calcitriol supplementation reduces postoperative hypocalcemia after total thyroidectomy compared with postoperative supplementation alone. STUDY DESIGN We conducted a single-institution prospective randomized trial enrolling 82 patients undergoing total thyroidectomy from July 2017 through May 2019. Those undergoing partial thyroidectomy or concurrent planned parathyroidectomy were excluded. The intervention group started calcitriol 0.25 μg po bid and calcium carbonate 1,500 mg po tid 5 days preoperatively and continued postoperatively. The control group started these medications postoperatively. The primary end point was clinical or biochemical hypocalcemia. Secondary outcomes were postoperative calcium levels, need for intervention, length of stay, and readmission. RESULTS Thirty-eight patients were randomized to the intervention group and 44 to the control group. There were 12 episodes of hypocalcemia; 5 (13.2%) in the intervention and 7 (15.9%) in the control group (p = 0.76). No differences were found in secondary outcomes; including postoperative calcium levels at each measured time point, need for intervention (n = 10 [26.3%], n = 15 [34.1%]; p = 0.48), length of stay (mean [SD] 32.3 [15.6] hours, 30.7 [10.5] hours; p = 0.6), or readmissions (n = 0 [0.0%], n = 3 [6.8%]; p = 0.24). CONCLUSIONS Starting supplementation with calcium and calcitriol preoperatively does not reduce postoperative hypocalcemia compared with postoperative supplementation alone after total thyroidectomy. These findings do not support the practice of routine calcium and calcitriol supplementation before total thyroidectomy.
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Affiliation(s)
| | | | | | - David Brams
- Lahey Hospital and Medical Center, Burlington, MA
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17
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Leonard-Murali S, Ivanics T, Nasser H, Tang A, Singer MC. Intraoperative Nerve Monitoring in Thyroidectomies for Malignancy: Does it Matter? Am Surg 2021; 88:1187-1194. [PMID: 33522279 DOI: 10.1177/0003134821991967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) injury and postoperative hypocalcemia are potential complications of thyroidectomy, particularly in malignancy. Intraoperative nerve monitoring (IONM) remains controversial. We sought to evaluate the impact of IONM on these complications using a national data set. METHODS The American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-targeted data set was queried for patients who underwent thyroidectomies from 2016 to 2017. Patients were grouped according to IONM use. Logistic regression models were constructed to evaluate associations of variables with 30-day hypocalcemic events (HCEs) and RLN injury. Associations were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). A subgroup analysis was performed of patients with malignancy. RESULTS A total of 9527 patients were identified; 5969 (62.7%) underwent thyroidectomy with IONM and 3558 (37.3%) without. By multivariable analysis, IONM had protective associations with HCE (OR = .81, 95% CI = .68-.96; P = .013) and RLN injury (OR = .83, 95% CI = .69-.98; P = .033). Malignancy increased risk of HCE (OR = 1.21, 95% CI=1.01-1.45; P = .038) and RLN injury (OR = 1.22, 95% CI = 1.02-1.46; P = .034). A large proportion (5943/9527, 62.4%) of patients had malignancy; 3646 (61.3%) underwent thyroidectomy with IONM and 2297 (38.7%) without. In the subgroup analysis, IONM had stronger protective associations with HCE (OR = .73, 95% CI = .60-.90; P = .003) and RLN injury (OR = .76, 95% CI = .62-.94; P = .012). DISCUSSION Malignancy was associated with increased risk of HCE and RLN injury. Intraoperative nerve monitoring had a protective association with HCE and RLN injury, both overall, and in the malignant subgroup. Intraoperative nerve monitoring was correlated with improved thyroidectomy outcomes, especially if the indication was malignancy. This warrants further study to clarify cause and effect.
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Affiliation(s)
| | - Tommy Ivanics
- Department of Surgery, 24016Henry Ford Hospital, Detroit, MI, USA
| | - Hassan Nasser
- Department of Surgery, 24016Henry Ford Hospital, Detroit, MI, USA
| | - Amy Tang
- Department of Public Health Sciences, 2971Henry Ford Health System, Detroit, MI, USA
| | - Michael C Singer
- Department of Otolaryngology, Head & Neck Surgery, Division of Thyroid & Parathyroid Surgery, 24016Henry Ford Hospital, Detroit, MI, USA
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18
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Xing Z, Qiu Y, Xia B, Abuduwaili M, Fei Y, Zhu J, Su A. Surgical strategy when identifying less than four parathyroid glands during total thyroidectomy: a retrospective cohort study. Gland Surg 2021; 10:10-22. [PMID: 33633958 DOI: 10.21037/gs-20-486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Parathyroid glands protection is still controversial in patients with less than 4 parathyroid glands during thyroidectomy. The aim of this study was to investigate the strategy of parathyroid autotransplantation or in situ preservation in patients with 3 parathyroid glands. Methods Consecutive patients who underwent primary total thyroidectomy with bilateral central neck dissection for papillary thyroid carcinoma (PTC) in our center were included retrospectively. Serum calcium and parathyroid hormone (PTH) levels (pg/mL), incidence of hypocalcemia and hypoparathyroidism during 24 months follow-up were compared grouping by the number of parathyroid glands both identified intraoperatively and confirmed postoperatively by pathology. Results A total of 1,424 patients were included. Serum PTH and calcium levels were lower and the incidence of hypocalcemia was higher in patients with 3 identified parathyroid glands. When excluding patients with accidental parathyroid resection, the results remained similar. Of the 212 patients with 3 identified parathyroid glands, PTH levels at postoperative 12-month in patients underwent autotransplantation were significantly lower than patients with all parathyroid glands preserved in situ (3.65±1.30 vs. 4.67±1.89, P=0.026). Conclusions The parathyroid function was weaker in patients with 3 parathyroid glands than patients with 4 before and after operation. Parathyroid glands preserved all in situ promoted better recovery of postoperative function in patients with 3 identified parathyroid glands.
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Affiliation(s)
- Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Baoying Xia
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Munire Abuduwaili
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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Docimo G, Cangiano A, Romano RM, Pignatelli MF, Offi C, Paglionico VA, Galdiero M, Donnarumma G, Nigro V, Esposito D, Rotondi M, Candela G, Pasquali D. The Human Microbiota in Endocrinology: Implications for Pathophysiology, Treatment, and Prognosis in Thyroid Diseases. Front Endocrinol (Lausanne) 2020; 11:586529. [PMID: 33343507 PMCID: PMC7746874 DOI: 10.3389/fendo.2020.586529] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022] Open
Abstract
The human microbiota is an integral component in the maintenance of health and of the immune system. Microbiome-wide association studies have found numerous diseases associated to dysbiosis. Studies are needed to move beyond correlations and begin to address causation. Autoimmune thyroid diseases (ATD) are one of the most common organ-specific autoimmune disorders with an increasing prevalence, higher than 5% worldwide. Most frequent manifestations of ATD are Hashimoto's thyroiditis and Graves' disease. The exact etiology of ATD remains unknown. Until now it is not clear whether bacterial infections can trigger ATD or modulate the efficacy of treatment and prognosis. The aim of our review is to characterize the microbiota and in ATD and to evaluate the impact of dysbiosis on treatment and prognosis. Moreover, variation of gut microbiome has been associated with thyroid cancer and benign nodules. Here we will characterize the microbioma in benign thyroid nodules, and papillary thyroid cancer to evaluate their implications in the pathophysiology and progression.
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Affiliation(s)
- Giovanni Docimo
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Angelo Cangiano
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Roberto Maria Romano
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Marcello Filograna Pignatelli
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Chiara Offi
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Vanda Amoresano Paglionico
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanna Donnarumma
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania ”Luigi Vanvitelli”, Naples, Italy
| | - Daniela Esposito
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mario Rotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, University of Pavia, Pavia, Italy
| | - Giancarlo Candela
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, School of Medicine, Naples, Italy
| | - Daniela Pasquali
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Soylu S, Teksoz S. EARLIER PREDICTION OF HYPOCALCEMIA BY POSTOPERATIVE SECOND HOUR PARATHYROID HORMONE LEVEL AFTER TOTAL THYROIDECTOMY. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:250-255. [PMID: 33029245 DOI: 10.4183/aeb.2020.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Thyroidectomy is becoming an ambulatory surgical procedure. By predicting hypocalcemia,duration of hospital stay might decline. We tried to determine whether measuring parathormone two hours after total thyroidectomy predicts hypocalcemia. Objective We aimed to design a protocol for early prediction of hypocalcemia by defining PTH measurement time and cut-off value of our center. Design One hundred and six patients undergoing total thyroidectomy between November 2017 and October 2018 were prospectively studied. Methods Pregnant women, patients with renal failure, parathyroid disease, previous neck operation and thyroid malignancy requiring neck dissection were excluded from the study. Parathormone (PTH) and calcium measurement was done preoperatively and in the postoperative second hour. Results Group 1 consisted of 75 normocalcemic patients while group 2 had 31 hypocalcemic patients. Mean age was 45±13.1 (age range: 18-76). Female/male ratio was 82/24. While with a 8.36 pg/mL postoperative second hour PTH, hypocalcemia can be predicted with a 51.5% sensitivity and 90.7% specificity while with a PTH decline of 40.8% hypocalcemia can be diagnosed with a 83.9% sensitivity and 52% specificity. Conclusion Postoperative second hour PTH and PTH percentage decline can predict postoperative hypocalcemia in total thyroidectomies. Preoperative Dual-energy X-ray absorptiometry (DXA) was not found useful in hypocalcemia prediction.
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Affiliation(s)
- S Soylu
- Istanbul University-Cerrahpasa - Department of General Surgery, Istanbul, Turkey
| | - S Teksoz
- Istanbul University-Cerrahpasa - Department of General Surgery, Istanbul, Turkey
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Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review. The Journal of Laryngology & Otology 2020; 134:541-552. [PMID: 32519635 DOI: 10.1017/s0022215120001024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention. METHOD Two authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019. RESULTS Sixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection. CONCLUSION Many factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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Wang X, Zhou Y, Li C, Cai Y, He T, Sun R, Tian W, Tang Z, Sheng J, Liu D, Gui C, Zeng D, Shui C, Jang J, Zhu G, Ning Y, Wang W. Surgery for retrosternal goiter: cervical approach. Gland Surg 2020; 9:392-400. [PMID: 32420264 PMCID: PMC7225497 DOI: 10.21037/gs.2020.03.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 03/05/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Retrosternal goiter refers to when the thyroid gland extends from the neck to the substernal portion, descending below the thoracic inlet into the mediastinum. It is typically accompanied by compressive symptoms, and most patients need to undergo surgery. This retrospective study set out to analyze the surgical approach to retrosternal goiter and to evaluate perioperative complications, with the aim of recommending best surgical technique. METHODS We carried out retrospective analysis of 115 patients with retrosternal goiter treated at our center between May 4, 2011 and March 19, 2019. We analyzed patient characteristics, surgical methods, and perioperative complications using SPSS. RESULTS Of the 115 patients in our study, 112 underwent thyroidectomy by cervical approach, with only 3 requiring an extracervical approach. The median age of the patients was 52.3 years, and the majority were female (81.74%). Most of the patients (73.91%) experienced no symptoms but were diagnosed with tracheal compression during surgery or preoperative imaging examination. Ninety-eight (85.22%) of our patients underwent preoperative evaluation of their condition by CT imaging. No obvious surgical contraindications were found before thyroid function tests. The mean operation time was 115.11 min, and the average amount of bleeding during surgery was 54.43 mL. The mean postoperative hospital stay was 5.38 days. In 109 cases (94.78%), the goiter was found to be benign, and malignancy was diagnosed in 6 patients (5.22%). Of the 112 patients who were treated with the cervical approach, 7 (6.25%) experienced recurrent laryngeal nerve palsy; 6 of these cases were transitory and 1 was permanent. The number of patients treated by cervical and extracervical approach who experienced transient hypocalcaemia was 23 (20.54%) and 2, respectively. Transient hypoparathyroidism affected 16 patients (14.29%) treated by cervical approach. Two patients had tracheomalacia phenomenon and one patient had pleural effusion after surgery. No cases experienced permanent hypocalcemia, permanent hypoparathyroidism, postoperative hematoma, tracheostomy, or death. CONCLUSIONS Retrosternal goiter surgery is challenging for surgeons. The best surgical approach for the patient should be based on CT scan evaluation. In our study, based on preoperative CT imaging and in-operation evaluation, 50% of the tumor volume was located below the thoracic inlet and 50% of the tumor volume was located above the thoracic inlet in almost all of the patients. Both sections could be successfully removed via a cervical incision, and no obvious complications were observed during the perioperative period. With careful planning and execution before surgery and meticulous operation during surgery, most retrosternal goiters can be safely treated by cervical approach.
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Affiliation(s)
- Xu Wang
- Department of Clinical Medicine, Chengdu Medical College, Chengdu 610041, China
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Tianqi He
- Department of Clinical Medicine, Chengdu Medical College, Chengdu 610041, China
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Wen Tian
- Department of General Surgery, The General Hospital of the People’s Liberation Army, Beijing 100853, China
| | - Zhengqi Tang
- Department of Otolaryngology Head and Neck Surgery, Zigong Third People’s Hospital, Zigong 643000, China
| | - Jianfeng Sheng
- Department of Otorhinolaryngology Head and Neck Surgery, Mianyang Third People’s Hospital, Mianyang 621000, China
| | - Dingrong Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Neijiang Second People’s Hospital, Neijiang 100191, China
| | - Chunhan Gui
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Chunyan Shui
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Jian Jang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Guiquan Zhu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Yudong Ning
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Wei Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
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Mo K, Shang J, Wang K, Gu J, Wang P, Nie X, Wang W. Parathyroid Hormone Reduction Predicts Transient Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective Study. Int J Endocrinol 2020; 2020:7189857. [PMID: 32802056 PMCID: PMC7416261 DOI: 10.1155/2020/7189857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/21/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We performed this study to investigate the risk factors for postoperative hypocalcemia after total thyroidectomy with central lymph node dissection (CLND). Study Design. This was a single-center prospective study based on 176 consecutive patients who underwent total thyroidectomy for papillary thyroid carcinoma. Setting. Patients were recruited between January 2016 and June 2018. Subjects and Methods. Patients who underwent bilateral (n = 155, bilateral group) and ipsilateral CLND (n = 21) after total thyroidectomy were included. The preoperative and postoperative parathyroid hormone (PTH) and calcium levels were detected. The risk factors for transient hypocalcemia were identified using logistic regression analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Fifty-one (28.98%) patients developed transient hypocalcemia, and 2 patients (1.14%) developed permanent hypoparathyroidism. There was no difference in the gender ratio or the morbidity of hypocalcemia between the patients who underwent bilateral and ipsilateral CLND. On postoperative day 1, PTH decrease was a risk factor for transient hypocalcemia in the whole cohort (β = 0.043, OR = 1.044, 95% CI 1.023-1.065, p < 0.001), bilateral group (β = 0.042, OR = 1.043, 95% CI 1.022-1.064, p < 0.001), and female patients (β = 0.049, OR = 1.050, 95% CI 1.026-1.075, p < 0.001). Tumor diameter was a risk factor for transient hypocalcemia in female patients (β = 0.499, OR = 1.647, 95% CI 1.003-2.704, p=0.049). The ROC curve analysis illustrated that 65.58%, 71.00%, and 71.00% PTH level reduction had high accuracy in predicting transient hypocalcemia in the whole cohort, bilateral group, and female patients, respectively (AUC = 0.986, 0.987, and 0.987). CONCLUSION Asymptomatic female patients with bilateral CLND and a 71.00% PTH level reduction were at a high risk of transient hypocalcemia.
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Affiliation(s)
- Kangnan Mo
- Department of Head and Neck Surgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
- Department of Head and Neck Surgery, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
| | - Jinbiao Shang
- Department of Head and Neck Surgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
- Department of Head and Neck Surgery, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
| | - Kejing Wang
- Department of Head and Neck Surgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
- Department of Head and Neck Surgery, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
| | - Jialei Gu
- Department of Head and Neck Surgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
- Department of Head and Neck Surgery, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
| | - Peng Wang
- Department of Head and Neck Surgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
- Department of Head and Neck Surgery, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
| | - Xilin Nie
- Department of Head and Neck Surgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
- Department of Head and Neck Surgery, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
| | - Wendong Wang
- Department of Head and Neck Surgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
- Department of Head and Neck Surgery, Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, No. 1 Banshan Road (East), Gongshu, Hangzhou 310022, China
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Bove A, Dei Rocini C, Di Renzo RM, Farrukh M, Palone G, Chiarini S, Staniscia T. Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy. Int J Endocrinol 2020; 2020:8875257. [PMID: 33101410 PMCID: PMC7569460 DOI: 10.1155/2020/8875257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Total thyroidectomy (TT) is recommended in the treatment of malignant and benignant thyroid diseases, and, to date, transient hypocalcemia is the most frequent complication after the procedure. We prospectively evaluated the role of vitamin D deficiency as a predictor of postoperative hypocalcemia. METHODS This is a prospective cohort study which was conducted between January 2016 and April 2019. A total of 177 consecutive patients (141 (79.7%) women and 36 (20.3%) men) who underwent TT were included in the current study. Hypocalcemia occurred when serum calcium levels were below 8.0 mg/dL or 1.10 mmol/L. Patients were divided into two groups (Group 1, normocalcemic; Group 2, hypocalcemic) and were assessed taking into consideration preoperative serum 25-hydroxy vitamin D (25-OHD) levels, preoperative serum calcium levels, thyroid hormone levels, sex, body mass index (BMI), and smoking habits. Vitamin D deficiency was defined as 25-OHD levels <25 ng/mL. RESULTS The incidence of postoperative asymptomatic and symptomatic hypocalcemia in the two groups was 19.8% and 15.8%, respectively. Preoperative 25-OHD level was significantly different between Group 1 and Group 2 (31.5 ± 15.0 ng/mL vs 18.7 ± 9.8 ng/mL,p=0.017). Logistic regression analysis revealed that preoperative vitamin D deficiency was a significant predictive factor of postoperative hypocalcemia (p=0.012), and, specifically, the risk of hypocalcemia increased 15-fold in patients with a preoperative vitamin D level <25 ng/mL (odds ratio [OR], 14.8). CONCLUSIONS Postoperative hypocalcemia is significantly associated with low preoperative levels of serum 25-OHD. Our studies demonstrate that vitamin D deficiency (<25 ng/mL) is an independent predictive factor of postoperative hypocalcemia.
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Affiliation(s)
- A. Bove
- Department of Medicine, Dentistry and Biotechnology, University “G. D'Annunzio”, Via dei Vestini, 66100 Chieti, Italy
| | - C. Dei Rocini
- Department of Medicine, Dentistry and Biotechnology, University “G. D'Annunzio”, Via dei Vestini, 66100 Chieti, Italy
| | - R. M. Di Renzo
- Department of Medicine, Dentistry and Biotechnology, University “G. D'Annunzio”, Via dei Vestini, 66100 Chieti, Italy
| | - M. Farrukh
- Department of Medicine, Dentistry and Biotechnology, University “G. D'Annunzio”, Via dei Vestini, 66100 Chieti, Italy
| | - G. Palone
- Department of Medicine, Dentistry and Biotechnology, University “G. D'Annunzio”, Via dei Vestini, 66100 Chieti, Italy
| | - S. Chiarini
- Department of Medicine and Ageing Sciences, University “G. D'Annunzio”, Chieti-Pescara, Italy
| | - T. Staniscia
- Department of Medicine and Ageing Sciences, University “G. D'Annunzio”, Chieti-Pescara, Italy
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Saad RK, Boueiz NG, Akiki VC, Fuleihan GAEH. Rate of drop in serum calcium as a predictor of hypocalcemic symptoms post total thyroidectomy. Osteoporos Int 2019; 30:2495-2504. [PMID: 31463588 DOI: 10.1007/s00198-019-05040-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/30/2019] [Indexed: 12/28/2022]
Abstract
UNLABELLED The rate of drop in serum calcium post total thyroidectomy is a predictor of hypocalcemic symptoms in adults, after adjusting for other significant covariates. INTRODUCTION Test the hypothesis that rate of drop in calcium is a significant and independent predictor of post-operative hypocalcemic symptoms post total thyroidectomy. METHODS A retrospective chart review (electronic and hard copy) for 429 patients who underwent total thyroidectomy from January 2011 to December 2016. We collected information on demographics, clinical characteristics, information on surgical intervention, histopathology reports, clinical course, biochemistries, treatments and discharge instructions. RESULTS Sixty-one patients (14%) developed post-operative hypocalcemic symptoms. The rate of calcium drop, younger age, female gender, and lower body mass index, and the presence of parathyroid tissue in resected specimen all correlated significantly with the development of symptoms. The rate of drop in serum calcium and the post-operative serum calcium level remained the only significant predictors of symptom development, after adjustment for other significant co-variates. Using a receiver operating characteristics curve, a cutoff rate of calcium drop > 0.083 mg/dl/h, that is 1 mg/dl over 12 h, has a sensitivity of 71% and specificity of 73% for detecting hypocalcemic symptoms. CONCLUSION The rate of drop of serum calcium post total thyroidectomy significantly and independently correlated with the development of hypocalcemic symptoms. Patients with a rate of drop < 1 mg/dl/12 h may be considered for earlier discharge and less aggressive management peri-operatively.
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Affiliation(s)
- R K Saad
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut-Medical Center, Bliss Street, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
| | - N G Boueiz
- Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
| | - V C Akiki
- Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
| | - G A E-H Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut-Medical Center, Bliss Street, Beirut, Lebanon.
- Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon.
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Wang W, Meng C, Ouyang Q, Xie J, Li X. Magnesemia: an independent risk factor of hypocalcemia after thyroidectomy. Cancer Manag Res 2019; 11:8135-8144. [PMID: 31564973 PMCID: PMC6731956 DOI: 10.2147/cmar.s218179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/07/2019] [Indexed: 01/02/2023] Open
Abstract
Background This study was designed to investigate the impact of serum magnesium (Mg) levels on hypocalcemia after thyroidectomy. Patients and methods In total, 242 patients with differentiated thyroid cancer were retrospectively analyzed. Results Multivariate regression analysis showed hypomagnesemia was an independent risk factor for hypocalcemia (P<0.001). While Mg in low levels (0.66 mmol/L ≤ Po-Mg ≤0.74 mmol/L) increased the risk of hypocalcemia, postoperative serum Ca (Po-Ca) levels were significantly lower in patients with hypomagnesemia than in patients with normomagnesemia (P=0.01), and the former patients suffered significant decreases in serum Ca (P=0.02). Compared to patients with a mild decline of serum Mg after surgery (ΔMg <0.17), serum Ca decline significantly increased (P<0.001) in patients with a severe decline of serum Mg (ΔMg ≥0.17), while the change in amounts of parathyroid hormone (PTH) after surgery was similar between the two groups (P>0.05). In patients with normal Po-Ca levels, hypomagnesemia increased the risk of symptoms related to hypocalcemia by 4.478 times (OR =5.478, 95% CI 1.724–17.403). Conclusion Hypomagnesemia, or even a low serum Mg level within the normal range, can increase the risk of hypocalcemia. After excluding the potential effects of PTH on serum magnesium and calcium, serum Mg reduction is one of the most important factors that influences postoperative serum Ca reduction. What’s more, hypomagnesemia is closely linked with symptoms.
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Affiliation(s)
- Wenlong Wang
- Division of Thyroid, General Surgery Department, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Chaoyang Meng
- Division of Thyroid, General Surgery Department, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Qianhui Ouyang
- Division of Thyroid, General Surgery Department, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Jing Xie
- Division of Thyroid, General Surgery Department, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Xinying Li
- Division of Thyroid, General Surgery Department, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
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Canu GL, Medas F, Longheu A, Boi F, Docimo G, Erdas E, Calò PG. Correlation between iPTH Levels on the First Postoperative Day After Total Thyroidectomy and Permanent Hypoparathyroidism: Our Experience. Open Med (Wars) 2019; 14:437-442. [PMID: 31231683 PMCID: PMC6572408 DOI: 10.1515/med-2019-0047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
Permanent hypoparathyroidism is the most common long-term complication after thyroidectomy. We evaluated whether iPTH concentrations on the first postoperative day may be a good predictor of this complication. Patients undergoing thyroidectomy in our Unit between January 2017 and February 2018 who developed postsurgical hypoparathyroidism were analysed. According to iPTH values on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into 2 groups: Group A (iPTH < 6.3 pg/mL, undetectable), Group B (iPTH ≥ 6.3 pg/mL). Seventy-five patients were included in this study: 64 in Group A and 11 in Group B. Permanent hypoparathyroidism occurred in 14 (21.88%) patients in Group A, while none developed this complication in Group B. When iPTH was < 6.3 pg/mL, the sensitivity for the prediction of permanent hypoparathyroidism was 100%, the specificity was 18.03%, the positive predictive value was 21.88% and the negative predictive value was 100%. No patient with iPTH ≥ 6.3 pg/mL on the first postoperative day developed permanent hypoparathyroidism. On the other hand, iPTH concentrations < 6.3 pg/mL have not proved to be a strong predictor of this condition. However, this cut-off value can be useful to identify patients at risk of developing this complication.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Alessandro Longheu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Francesco Boi
- Department of Medical Sciences, University of Cagliari, Endocrinology Unit, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Giovanni Docimo
- Department of General Surgery, General and Endocrine Surgical Unit, Second University of Naples, 80131, Naples, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato (CA), Italy
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Prete FP, Marzaioli R, Lattarulo S, Paradies D, Barile G, d’Addetta MV, Tomasicchio G, Gurrado A, Pezzolla A. Transaxillary robotic-assisted thyroid surgery: technique and results of a preliminary experience on the Da Vinci Xi platform. BMC Surg 2019; 18:19. [PMID: 31074396 PMCID: PMC7402570 DOI: 10.1186/s12893-019-0473-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Robotic thyroidectomy by transaxillary approach (RATS) is regarded as a feasible and safe alternative procedure in selected patients with benign disease or thyroid cancer of low risk, facilitating thyroidectomy with respect to conventional endoscopic approach and offering improved cosmetic results. The Da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) presents technical advantages over its previous generations, including overhead docking, more compact robotic arms, extended range of motion, and ability for camera to be docked in any arm. This construct supports dissection in smaller spaces with less arm interference and improved view. We present an initial experience of RATS on DVSS Xi in an academic Centre in Italy. METHODS We conducted a prospective observational study, involving patients with thyroid disease and treated between April 2016 and January 2018. A modified thyroidectomy retractor (Modena retractor, CEATEC Medizintechnik, Germany) was used to lift a musculocutaneous flap and operate gasless. Instrument placement was recorded for each procedure. Each procedure description was broken down into three phases, creation of working space, machine docking with instrument positioning and endoscopic operating technique. Duration of cases was recorded. Patients selected were young women, BMI < 30, thyroid nodule < 5 cm, cytology TIR2 to TIR4 (TIR4:only nodules < 1 cm diameter). RESULTS Twelve RATS were performed within the learning curve for the robotic technique, 10 lobectomies and 2 total thyroidectomies. No patients required reintervention. Mean duration of surgery was 198.9 min for lobectomy and 210 for thyroidectomy. The same surgical team performed all procedures. No patients presented surgery-related complications, mean stay was 3 days. Decrease in operating time was observed after 8 cases along with more precise preparation of working space. Four arms were used in the first 10 procedures then only three. No recurrent laryngeal nerve dysfunction, no seroma or haematoma were recorded. One patient had transient hypocalcaemia after total thyroidectomy. CONCLUSIONS Since the early phases of a preliminary experience RATS appeared a safe alternative to open thyroidectomy. Uptake of technique was quick on Xi platform with few technical tweaks over techniques described for Si machines. Careful patient selection is crucial. TRIAL REGISTRATION Retrospectively registered on 20 july 2018 . TRIAL REGISTRATION NUMBER researchregistry4272. The Research Registry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5b517f08dbc2045aefd7f9b4/.
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Affiliation(s)
- Francesco Paolo Prete
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Rinaldo Marzaioli
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Serafina Lattarulo
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Daniele Paradies
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Graziana Barile
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
- Department of Surgical Oncology – IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Maria Vittoria d’Addetta
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Angela Gurrado
- Department of Biomedical Science and Human Oncology - Emergency, Digestive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
| | - Angela Pezzolla
- Department of Emergency and Organ Transplant - Minimally invasive and Endocrine Surgery Unit, University Medical School of Bari, Bari, Italy
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Xing T, Hu Y, Wang B, Zhu J. Role of oral calcium supplementation alone or with vitamin D in preventing post-thyroidectomy hypocalcaemia: A meta-analysis. Medicine (Baltimore) 2019; 98:e14455. [PMID: 30813146 PMCID: PMC6407934 DOI: 10.1097/md.0000000000014455] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Thyroidectomy is the main intervention for thyroid malignancies and some benign thyroid diseases. Its most common complication is hypocalcaemia, which requires oral or intravenous calcium therapy. The aim of this meta-analysis was to assess the efficacy of routine calcium supplementation with or without vitamin D in preventing hypocalcaemia post-thyroidectomy. METHODS Systematic searches of the PubMed, EMBASE, and Cochrane Library databases were performed. The qualities of the included articles were assessed using the Cochrane risk of bias tool. The studies' qualities of outcomes and strengths of evidence were evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Data analysis was performed using Review Manager 5.3, and odds ratio (ORs) with their 95% confidence intervals (CIs) were computed for dichotomous data. RESULTS Ten randomized controlled trials (RCTs) were included. The combined study recruited 1620 patients (343 men and 1277 women) who underwent total thyroidectomy alone or with neck dissection. Calcium supplementation decreased the risk of transient postoperative hypocalcaemia (OR 0.48 [95% CI, 0.31-0.74]; P < .001) but did not decrease the demand for intravenous supplementation or the rate of permanent hypocalcaemia compared to no treatment. Calcium and vitamin D supplementation significantly reduced the rate of transient hypocalcaemia and the demand for intravenous supplementation compared to either no treatment (OR 0.21 [95% CI, 0.11-0.40]; P < .001 and OR 0.26 [95% CI, 0.10-0.69]; P = .007, respectively) or calcium alone (OR 0.39 [95% CI, 0.18-0.84]; P = .02 and OR 0.18 [95% CI, 0.07-0.47]; P < .001, respectively), but did not decrease the rate of permanent hypocalcaemia. GRADE-based confidence was moderate. CONCLUSION Postoperative calcium supplementation is effective for preventing post-thyroidectomy hypocalcaemia. Calcium plus vitamin D was more effective than calcium alone in preventing postoperative hypocalcaemia and decreasing the demand for intravenous calcium supplementation. Further, well-designed RCTs with larger sample sizes are required to validate our findings.
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Affiliation(s)
| | - Yiyi Hu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chendu
| | - Bin Wang
- Department of Thyroid Surgery
- The Third People' s Hospital of Chengdu, China
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Determination of risk factors causing hypocalcaemia after thyroid surgery. Asian J Surg 2019; 42:883-889. [PMID: 30685145 DOI: 10.1016/j.asjsur.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/04/2018] [Accepted: 12/18/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The most common complication after thyroid surgery is hypocalcaemia and it sometimes leads to problems that are difficult to correct in patients. The present study was aimed to determine the risk factors causing the development of hypocalcaemia after thyroid surgery. METHODS 818 adult patients were included in the study. The data were recorded by examining the hospital automation system and patient files retrospectively. Patients' demographic characteristics, radiological imaging findings, serum biochemical parameters, extent of the performed surgery, histopathological diagnoses were recorded. RESULTS The rate of hypocalcaemia was 28.4% (1.7% permanent). In multivariate analysis: the female gender (p = 0.002), heavier thyroid gland (p = 0.084), substernal location (p = 0.004) and cervical lymph nodes dissection (CLND) (p < 0.001) were found to be significantly. Malignant thyroid pathology (p = 0.006) and total thyroidectomy (p = 0.025) increased the risk of hypocalcaemia significantly in univariate analysis. However, this increase in risk was not found to be statistically significant in regression analysis. Significant statistical result was not found on postoperative hypocalcaemia in terms of advanced age, hyperthyroidism and re-operation. The duration of hospitalization was higher in patients with postoperative hypocalcaemia (m = 2 days) (p < 0.001). CONCLUSION In our analyses CLND, female gender, substernal location and heavier thyroid gland was found to be the independent risk factors in the development of postoperative hypocalcaemia. The development of postoperative hypocalcaemia may be predicted and measures may be taken to prevent clinical findings.
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Margolick J, Chen W, Wiseman SM. Systematic Review and Meta-Analysis of Unplanned Reoperations, Emergency Department Visits and Hospital Readmission After Thyroidectomy. Thyroid 2018; 28:624-638. [PMID: 29587583 DOI: 10.1089/thy.2017.0543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Unplanned reoperation, emergency department (ED) visits, and hospital readmission following thyroid operations usually arise due to complications and are a source of frustration for both surgeons and patients. With the aim of providing insight important for the development of patient quality care improvement initiatives, the primary objective of this review was to evaluate the available literature systematically in order to determine the contemporary rates of reoperation, readmission, and ED visits following thyroid operations. A secondary study objective was to determine if there were any practices that showed promise in reducing the occurrence of these undesirable postoperative events. METHODS This systematic review was conducted in accordance with the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses protocols. Twenty-two studies were included in the systematic review. Meta-analysis was performed to obtain the weighted-pooled summary estimates of rates of reoperations, ED visits, and unplanned hospital readmission. Jackknife sensitivity analyses were performed for each data set. Finally, in order to detect the risk of publication bias and the small-study effect, funnel plot analysis was performed. RESULTS The pooled rate estimate for reoperation was very low (0.6% [confidence interval (CI) 0.3-1.1%]). This was subject to publication bias because smaller studies tended to report lower rates of reoperation. The pooled rate of ED visits was 8.1% [CI 6.5-9.8%], while the pooled rate of hospital readmission from 19 studies was 2.7% [CI 2.1-3.4%]. Neck hematoma was the most common reason for reoperation, while postoperative hypocalcemia was the most common reason for hospital readmission. CONCLUSIONS ED visits and hospital readmission after thyroidectomy are common, and there are several practices that can reduce their occurrence. Routine postoperative calcium and vitamin D supplementation may reduce rates of postoperative hypocalcemia, and avoiding postoperative hypertension may decrease the risk of neck hematoma development and the need for reoperation. Older age, thyroid cancer, dependent functional status, higher ASA score, diabetes, chronic obstructive pulmonary disease, steroid use, hemodialysis, and recent weight loss increase the risk of hospital readmission after thyroid surgery. By further identifying risk factors for reoperation, ED visits, and readmission, this review may assist practitioners in optimizing perioperative care and therefore reducing patient morbidity and mortality after thyroid operations.
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Affiliation(s)
- Joseph Margolick
- 1 Department of Surgery, University of British Columbia and St. Paul's Hospital , Vancouver, Canada
| | - Wenjia Chen
- 2 Department of Pharmaceutical Science, University of British Columbia , Vancouver, Canada
| | - Sam M Wiseman
- 1 Department of Surgery, University of British Columbia and St. Paul's Hospital , Vancouver, Canada
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Su A, Gong Y, Wu W, Gong R, Li Z, Zhu J. Effect of autotransplantation of a parathyroid gland on hypoparathyroidism after total thyroidectomy. Endocr Connect 2018; 7:286-294. [PMID: 29301864 PMCID: PMC8111321 DOI: 10.1530/ec-17-0313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 01/04/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The effect of parathyroid autotransplantation on hypoparathyroidism is not fully understood. The purpose of the study was to determine the effect of autotransplantation of a parathyroid gland on the incidence of hypoparathyroidism and recovery of parathyroid function at 6 months after total thyroidectomy with central neck dissection for papillary thyroid carcinoma. METHODS All patients with autotransplantation of a parathyroid gland (no inadvertent parathyroidectomy) (group A), in situ preservation of all parathyroid glands (no autotransplantation and inadvertent parathyroidectomy) (group B) or inadvertent removal of a parathyroid gland (no autotransplantation) (group C) who underwent first-time total thyroidectomy with central neck dissection for papillary thyroid carcinoma between January 2013 and June 2016 were included retrospectively. RESULTS Of the 702 patients, 383, 297 and 22 were respectively included in the groups A, B and C. The overall rates of transient and permanent hypoparathyroidism were 37.6% and 1.0%. The incidence of transient hypoparathyroidism was 43.9, 29.0 and 45.5% (A vs B, P = 0.000; A vs C, P = 1.000), and the incidence of permanent hypoparathyroidism was 1.0, 0.7 and 4.5% (P > 0.05). The recovery rates of serum parathyroid hormone levels were 71.4, 72.2 and 66.0% at 6-month follow-up (P > 0.05). CONCLUSION Autotransplantation of a parathyroid gland does not affect the incidence of permanent hypoparathyroidism, but increases the risk of transient hypoparathyroidism when the rest of parathyroid glands are preserved in situ. At least 2 parathyroid glands should be preserved during total thyroidectomy with central neck dissection to prevent permanent hypoparathyroidism.
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Affiliation(s)
- Anping Su
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanping Gong
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenshuang Wu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rixiang Gong
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihui Li
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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Margolick J, Wiseman SM. Risk of major complications following thyroidectomy and parathyroidectomy: Utility of the NSQIP surgical risk calculator. Am J Surg 2018; 215:936-941. [PMID: 29370884 DOI: 10.1016/j.amjsurg.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/27/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The primary objective of this study was to determine rates of reoperation, ED visits, and hospital readmission after thyroid and parathyroid surgery at a tertiary hospital. A secondary objective was to determine if scores from the American College of Surgeons Surgical Risk Calculator (ACS SRC) predicted these events. METHODS We retrospectively reviewed the records of patients undergoing parathyroid and thyroid surgery between 2011 and 2014. Patients who underwent an unplanned reoperation, returned to the ED, or were readmitted to hospital were evaluated using the ACS SRC. RESULTS 436 patients underwent thyroid and parathyroid operations. Rates of re-operations, ED visits and hospital readmissions after thyroid and parathyroid surgery were: 3.4%, 0.6% and 3.0% and 2.2%, 0% and 1.4%, respectively. 71% of patients who experienced post-operative complications scored below average on the ACS SRC, 17% scored above average and 12% scored average risk. CONCLUSIONS The SRC did not predict re-operation, ED visits, or hospital readmission after thyroid or parathyroid operations.
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Affiliation(s)
- Joseph Margolick
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada.
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