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Wang P, Xue H, Zhu X, Xue S. The role of parathyroid autotransplantation for hypoparathyroidism following total thyroidectomy with bilateral central neck dissection. Front Endocrinol (Lausanne) 2024; 15:1402447. [PMID: 39022344 PMCID: PMC11251875 DOI: 10.3389/fendo.2024.1402447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
Background Hypoparathyroidism is the most common complication for patients who undergo total thyroidectomy (TT) with bilateral central lymph node dissection (BCLND). The objective of this retrospective study was to investigate the relationship between parathyroid autotransplantation (PA) and postoperative hypoparathyroidism. Materials and Methods Four hundred and sixty-five patients with papillary thyroid carcinoma (PTC) who underwent TT with BCLND (including prophylactic and therapeutic BCLND) by the same surgeon were enrolled in this retrospective study. They were divided into five groups based on the number of PAs. Group 0 was defined as no PA, while Group 1, 2, 3, and 4 were considered as 1, 2, 3, and 4 PAs during TT with BCLND, respectively. Results Transient and permanent hypoparathyroidism occurred in 83 (17.8%) and 2 (0.4%) patients who underwent TT and BCLND, respectively. The incidence of transient hypoparathyroidism increased gradually with an increase in the number of PAs. Compared with the previous group, Groups 2 and 3 had significantly more cases of transient hypoparathyroidism (p=0.03 and p=0.04, respectively). All cases of permanent hypoparathyroidism occurred in the patients without PA. Compared with Group 0, there were more removed central lymph nodes (RCLNs) in patients with one PA. Furthermore, Group 2 had more metastatic central lymph nodes(MCLNs) and RCLNs than Group 1.The number of PAs was the only identified risk factor for transient hypoparathyroidism after the multivariate logistic regression analysis. The median parathyroid hormone level recovered to the normal range within 1 month after surgery. Conclusion With an increasing number of PAs, the possibility of transient hypoparathyroidism also increases in patients with PTC who undergo TT and BCLND. Considering the rapid recovery of transient hypoparathyroidism in 1 month, two PAs during TT and BCLND could be a good choice, leading to an increase in the central lymph node yield and no permanent hypoparathyroidism. However, this conclusion should be validated in future multicenter prospective studies.
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Affiliation(s)
| | | | | | - Shuai Xue
- General Surgery Center, Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, Jilin, China
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2
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Wang B, Zhu Y, Zhou S, Lu C, Zhang A, Tian J, Li W, Ren S, Dong Y, Liu L. The effect of carbon nanoparticles vs. immune colloidal gold technique test strips on parathyroid protection in total thyroidectomy: A randomized clinical trial study. Head Neck 2024; 46:1727-1736. [PMID: 38429055 DOI: 10.1002/hed.27685] [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: 10/07/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The long-term effect of intraoperative usage of carbon nanoparticles (CN) and parathyroid hormone (PTH) test strip using immune colloidal gold technique (ICGT) is unclear. This study aims to compare the effect of intraoperative usage of CN and ICGT test strips on PG function. METHODS This randomized clinical study involved adult patients who underwent total thyroidectomy. They were randomly allocated into three groups (control, CN, and ICGT group). Clinical data were analyzed. RESULTS Each group involved 98 patients. Serum calcium and PTH concentrations at 24 h postoperatively (PTH24h) were higher in CN group. The parathyroid function recovered quicker in CN group. Use of CN increased in situ PG preservation and PTH24h. Mediation analysis indicated that 23.05% of the total effect of CN on PTH24h was attributed to PGRIS. CONCLUSION CN holds promise to improve in situ PG preservation and protect PG vasculature, thereby reducing the incidence of early hypoparathyroidism. The value of ICGT test strips for PG protection is dubious.
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Affiliation(s)
- Bochun Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yiyuan Zhu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shiguo Zhou
- Statistics Room, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Aobo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jun Tian
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wanxin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuling Ren
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanbo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liangfa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Wang Z, Zhang Q, Gao J, Cao T, Zhang Y, Qu K. Investigating the optimal parathyroid autotransplantation strategy in transareolar endoscopic thyroidectomy: A retrospective cohort study. Asian J Surg 2024; 47:886-892. [PMID: 37879989 DOI: 10.1016/j.asjsur.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND There is ongoing debate about whether intraoperative parathyroid autotransplantation effectively prevents permanent hypoparathyroidism after thyroidectomy. This study aims to examine its impact on postoperative parathyroid function and determine the best autotransplantation strategy. METHODS A retrospective analysis was conducted on 194 patients who underwent total thyroidectomy with central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC). Patients were divided into four groups based on the number of parathyroid autotransplants during surgery: Group 1 (none, n = 43), Group 2 (1 transplant, n = 60), Group 3 (2 transplants, n = 67), and Group 4 (3 transplants, n = 24). Various clinical parameters were collected and compared among the groups. RESULTS Parathyroid autotransplantation was identified as a risk factor for temporary hypoparathyroidism (OR: 1.74; 95% CI: 1.27-2.39, P = 0.001) and a protective factor for permanent hypoparathyroidism (OR: 0.27; 95% CI: 0.14-0.55, P < 0.001). At 12 months postoperative, systemic parathyroid hormone (PTH) levels increased progressively from Groups 1 to 4, with significant differences observed only between Group 1 and Group 2 (P < 0.02). Difference values in systemic PTH levels between Month 1 and Day 1 postoperative increased progressively from Groups 1 to 4, with statistically significant differences observed between adjacent groups (P < 0.02). The number of dissected positive lymph nodes increased progressively across the four groups, showing statistical differences (P < 0.02). CONCLUSION Parathyroid autotransplantation can prevent permanent hypoparathyroidism. Additionally, we recommend preserving parathyroids in situ whenever possible. If autotransplantation is required, it should involve no more than two glands.
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Affiliation(s)
- Zesheng Wang
- Department of General Surgery, Gansu Provincial Central Hospital, Lanzhou, 730050, China; The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Qi Zhang
- Department of General Surgery, Gansu Provincial Central Hospital, Lanzhou, 730050, China
| | - Jinwei Gao
- Department of General Surgery, Gansu Provincial People's Hospital, Lanzhou, 730000, China
| | - Tingbao Cao
- Department of General Surgery, Gansu Provincial Central Hospital, Lanzhou, 730050, China
| | - Yupeng Zhang
- Department of General Surgery, Gansu Provincial Central Hospital, Lanzhou, 730050, China
| | - Kunpeng Qu
- Department of General Surgery, Gansu Provincial Central Hospital, Lanzhou, 730050, China.
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Sheetal K, Sooria ND, Nikisha GN. Impact of Clinico Pathological and Surgical Related Risk Factor in Post Operative Hypoparathyroidism in Total Thyroidectomy Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:3402-3409. [PMID: 37974793 PMCID: PMC10645958 DOI: 10.1007/s12070-023-03949-1] [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: 05/21/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Multiple risk factors have been predicted in post operative hypoparathyroidism in total thyroidectomy patients but none have been clearly defined. Present study aims at evaluating the clinic pathological and surgical impact factors in predicting the risk of post operative hypoparathyroidism in thyroidectomy patients. The study was done in Karpaga Vinayaga Institute of Medical Science and Research Centre where Retrospective prospective cohort study who underwent and undergoing total thyroidectomy with or without central neck dissection for both benign and malignant thyroid disorders during 2014 to 2022 was analyzed. The study has analyzed the various risk factors from clinic pathological and surgical skills of identifying the Inferior thyroid artery at its origin and tracing the branches to the parathyroid gland and evaluating the incidence of hypocalcemia in both study and control groups. Two groups were analyzed during the period 2014 to 2022. The study group was included patients with thyroidectomy where ITA were identified and traced up to the parathyroid gland. They were further classified into category A where both sides ITA were identified and saved, category B where only one side was preserved. In control group, the surgery was done only on basis of capsular dissection and peripheral ligation of vessels close to the gland. Total study participants in our study was 416. The overall prevalence of hypocalcemia in our study was 11.4%. The age, gender and pathological variants were comparable between the two groups. Female preponderance (76%) was seen among both the groups. Among total study subjects who underwent total thyroidectomy 44.8% were having multi nodular goitre, 7.3% toxic goitre, 9.8% follicular adenoma, 30.2% papillary carcinoma and 7.9% follicular carcinoma. In our study benign and malignant thyroid disorders had no significant difference. Prevalence of hypocalcemia among control group 14.5% vs study group 3.8%. We found incidence of hypocalcaemia was comparitively lesser among patients with thyroidectomy alone, than those with unilateral or bilateral CND. Prevalence of hypocalcemia among control group was 33% (45/133) and study group 7% (12/153), when thyroidectomy alone was done. However, with neck dissection in bilateral CND, incidence was 41% (23/56) in study group and 61% (11/18) in control group. In unilateral CND, study and control group had 31% (10/32) and 54% (13/24) which was found to be statistically significant. Parathyroid auto transplantation among the control group (29%) compared to the study group (16%). Bilateral neck dissection and gross extrathyroidal extension and cases with PTG inadvertent removal posed significant risk factors for hypoparathyroidism. The prevalence of immediate hypocalcemia among Cat A, Cat B and control group were 14%, 20.3% and 37.5% respectively and was statistically significant (P < .0001). Symptomatic and Biochemical hypocalcemia at the end of 1 week among Cat A, Cat B, and control group was 8%, 12%, and 33.6, & 12.9%, 21% and 30% respectively. Whereas transient hypocalcemia reported among these groups was 1.6%, 5% and 14.6%. Permanent hypocalcemia was < 1% in study group and 4% among control group. We observed that permanent hypocalcemia was high among patients with bilateral neck dissection and auto transplanted PTG. There was no significant statistical difference in hypocalcemia (transient or permanent) among study and control group, but the incidence of hypocalcemia had significantly reduced in both study groups when unilateral or bilateral identification of ITA was done compared to control group. Our hypothesis in this study aims at preserving the branches of ITA supplying PTG distally has greater functional preservation of the parathyroid than conventional technique. This technique also helps us maintaining the plane and capsular dissection if done properly. By trying to preserve the ITA surgeons may acquire better meticulous dissection skills and understanding the anatomical variation of vessels around PTG more precisely which improve the surgical outcome in preventing both transient and permanent hypocalcaemia.
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Affiliation(s)
- K. Sheetal
- Karpaga Vinayaga Institute of Medical Science and Research Center, Chengalpattu, Tamil Nadu India
| | - N. Deva Sooria
- Karpaga Vinayaga Institute of Medical Science and Research Center, Chengalpattu, Tamil Nadu India
| | - G. N. Nikisha
- Karpaga Vinayaga Institute of Medical Science and Research Center, Chengalpattu, Tamil Nadu India
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Yang J, Han Y, Min Y, Chen C, Chen J, Xiang K, Liao J, Feng Y, Hu D, Yin G. Prophylactic central neck dissection for cN0 papillary thyroid carcinoma: is there any difference between western countries and China? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1176512. [PMID: 37576962 PMCID: PMC10413573 DOI: 10.3389/fendo.2023.1176512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Recommendations for the performance of prophylactic central neck dissection (pCND) in patients with clinically node-uninvolved (cN0) papillary thyroid carcinoma (PTC) are not the same. This meta-analysis set out to compare the effectiveness of pCND with total thyroidectomy (TT) in different countries and regions, mainly between western countries and China. Methods The electronic databases PubMed, EMBASE, and Cochrane Library were searched for studies published until August 2022. The incidence rate of cervical lymph node metastases (LNMs), locoregional recurrences (LRRs), and postoperative complications were pooled by a random-effects model. Subgroup analyses based on different countries and regions were performed. Results Eighteen studies involving 5,346 patients were analyzed. In the subgroup of western countries, patients undergoing pCND with TT had a significantly lower LRR rate [69/1,804, 3.82% vs. 139/2,541, 5.47%; odds ratio (OR) = 0.56; 95% CI 0.37-0.85] and a higher rate of temporary hypoparathyroidism (HPT) (316/1,279, 24.71% vs. 194/1,467, 13.22%; OR = 2.23; 95% CI 1.61-3.08) than that of the TT alone group, while no statistically significant difference was found in the rate of permanent HPT and temporary and permanent recurrent laryngeal nerve (RLN) injury. In the Chinese subgroup, the pCND with TT group had a significantly higher incidence rate of both temporary HPT (87/374, 23.26% vs. 36/324, 11.11%; OR = 2.24; 95% CI 1.32-3.81) and permanent HPT (21/374, 5.61% vs. 4/324, 1.23%; OR = 3.58; 95% CI = 1.24-10.37) than that of the TT alone group, while no significant difference was detected in the rate of LRR and temporary and permanent RLN injury. Conclusion Compared with the TT alone for cN0 PTC patients, pCND with TT had a significantly lower LRR rate while having a higher temporary HPT rate in Europe, America, and Australia; however, it showed no significant difference in decreasing LRR rate while having a significantly raised rate of temporary and permanent HPT in China. More population-based results are required to advocate precision medicine in PTC. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022358546.
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Affiliation(s)
- Jiaxin Yang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuling Han
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Min
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jialin Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiahu Liao
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Feng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Frey S, Van Den Heede K, Triponez F, Bizard JP, Godiris-Petit G, Pattou F. Prevention of hypocalcemia and hypoparathyroidism after total thyroidectomy. Recommendations of the Francophone Association of Endocrine Surgery (AFCE) with the French Society of Endocrinology (SFE) and the French Society of Nuclear Medicine (SFMN). J Visc Surg 2023:S1878-7886(23)00084-X. [PMID: 37211443 DOI: 10.1016/j.jviscsurg.2023.05.004] [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: 05/23/2023]
Abstract
Postoperative hypoparathyroidism, resulting from removal and/or devascularization of one or more parathyroid glands, is a feared complication of total thyroidectomy. Two forms, which are distinguished by their frequency, their time to onset and their duration as well as by their presentation, must be individualized: early postoperative hypocalcemia, often secondary to early hypoparathyroidism is a frequent and often transient situation occurring within the first days after surgery; permanent hypoparathyroidism, which is rarer, manifests when parathyroid function remains impaired for more than six months after surgery. Because of their severity, these conditions must be known and ideally prevented during total thyroidectomy. The objective of this article is to provide surgeons with practical recommendations for the prevention, diagnosis, and treatment of hypoparathyroidism after total thyroidectomy. These recommendations, which are the fruit of a medico-surgical consensus, were developed by the Francophone Association of Endocrine Surgery (AFCE), the French Society of Endocrinology (SFE) and the French Society of Nuclear Medicine and Molecular Imaging. (SFMN). The content, grade and level of evidence for each recommendation was decided after consultation within a panel of experts, based on an analysis of recent literature.
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Affiliation(s)
- Samuel Frey
- Digestif Cancer, Digestive and Endocrine Surgery, Institute of Digestive Tract Diseases, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - Klaas Van Den Heede
- Visceral and Endocrine General Surgery Department, Pitié-Salpêtrière Hospital, Pierre-et-Marie-Curie-Sorbonne University (Paris 6), 75013 Paris, France
| | - Frédéric Triponez
- Thoracic and Endocrine Surgery, University Hospitals (HUG), Faculty of Medicine of Geneva, 1211 Genève, Switzerland
| | - Jean-Pierre Bizard
- Endocrine and Visceral Surgery, Hospital of Arras-lès-Bonnettes Hospital, 62000 Arras, France
| | - Gaëlle Godiris-Petit
- Visceral and Endocrine General Surgery Department, Pitié-Salpêtrière Hospital, Pierre-et-Marie-Curie-Sorbonne University (Paris 6), 75013 Paris, France
| | - François Pattou
- General and Endocrine Surgery, University Hospital of Lille, 59000 Lille, France.
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Zhang Q, Qu KP, Wang ZS, Gao JW, Zhang YP, Cao WJ. Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma. Front Oncol 2022; 12:942488. [PMID: 35992841 PMCID: PMC9386417 DOI: 10.3389/fonc.2022.942488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to examine the effect of selective inferior parathyroid gland autotransplantation on central lymph node dissection(CLND) and incidence of postoperative hypoparathyroidism in patients undergoing endoscopic radical resection of thyroid carcinoma. Methods The data of 310 patients undergoing endoscopic radical resection of thyroid carcinoma will be retrospectively analyzed. The patients will be divided into the experimental group and the control group according to whether they combined with parathyroid autotransplantation. Statistics of the incidence rate of postoperative hypoparathyroidism, the concentration of PTH and Calcium in the systemic circulation at different time points in the two groups, the concentration of PTH in the cubital fossa vein in the transplantation region in the experimental group, and the number of central lymph nodes and positive lymph nodes dissection will be carried out. Results The incidence rate of temporary and permanent hypoparathyroidism in the experimental group was 33.75% and 0.625%, respectively, and in the control group was 22% and 5%, respectively; its difference was statistically significant (X2 = 10.255, P=0.006). Parathyroid autotransplantation increased incidence of transient hypoparathyroidism (OR, 1.806; Cl, 1.088-2.998; P=0.022), and lower incidence of permanent hypoparathyroidism (OR, 0.112; Cl, 0.014-0.904; P=0.040). The diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism (OR, 0.769; Cl, 0.467-1.265; P=0.301) or permanent hypoparathyroidism (OR, 1.434; Cl, 0.316-6.515; P=0.641). Comparison of systemic circulation PTH, between the two groups showed that the PTH of patients in the experimental group was higher than that in the control group from 1 week to 12 months after the operation, and the difference was statistically significant (P<0.05). In the experimental group, from 1 week to 12 months after surgery, PTH concentrations was significantly higher in the cubital fossa of the transplantation side than in the contralateral side, and the differences were statistically significant (P<0.05). The mean number of central lymph node dissected per patient was significantly higher in the experimental group (7.94 ± 3.03 vs. 6.99 ± 2.86; P <0.05); The mean number of positive nodes per patient was significantly higher in the experimental group (3.16 ± 1.86 vs. 2.53 ± 1.59; P <0.05). Conclusions In endoscopic radical resection of thyroid carcinoma, parathyroid autotransplantation is more beneficial to postoperative parathyroid glands function recovery, effectively preventing postoperative permanent hypoparathyroidism and realizing more thorough CLND.
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Affiliation(s)
- Qi Zhang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Kun-Peng Qu
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
- *Correspondence: Kun-Peng Qu,
| | - Ze-Sheng Wang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jing-Wei Gao
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yu-Peng Zhang
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Wei-Jia Cao
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
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Wang B, Liu Z, Wu J, Liu Y, Wang P, Liu H, Wang H, Wang T, Wang J, Tang Y, Zhang J. Bioelectrical impedance spectroscopy can assist to identify the parathyroid gland during thyroid surgery. Front Endocrinol (Lausanne) 2022; 13:963520. [PMID: 36187105 PMCID: PMC9521317 DOI: 10.3389/fendo.2022.963520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to explore the effectiveness of bioelectrical impedance spectroscopy in the identification of parathyroid glands during thyroid surgeries. METHOD All patients who received thyroid surgeries at our department from January 2018 to February 2020 were recruited for this study. The bioelectrical impedance spectroscopy analyzer was applied to analyze on following tissues: thyroid tissues, lymph nodes, adipose tissues, and the tissues suspected to be parathyroid glands. Postoperative pathological reports were obtained as the golden standard to compare with the characteristic parameters obtained from bioelectrical impedance spectroscopy. The receiver operating characteristic curve analysis was used to assess the diagnostic value and the selection of the optimal threshold of these parameters from bioelectrical impedance spectroscopy. RESULTS A total of 512 patients were enrolled in the study and 1898 specimens were measured by the bioelectrical impedance spectroscopy analyzer. There were significant differences in the parameter of f c among parathyroid glands, thyroid tissues, lymph nodes, and adipose tissues (252.2 ± 45.8 vs 144.7 ± 26.1, 491.7 ± 87.4, 602.3 ± 57.3; P<0.001, P<0.001, P<0.001). The area under the receiver operating characteristic curves was 0.993 (95%CI: 0.989-0.996) for f c. When the diagnostic criterion of f c was set at 188.85 kHz~342.55 kHz, the sensitivity and specificity to identify parathyroid glands from lymph nodes and adipose tissues were both 100%. At this f c, the sensitivity and specificity to identify parathyroid glands from thyroid tissues were 91.1% and 99.0%, respectively. CONCLUSION In conclusion, bioelectrical impedance spectroscopy could assist to differentiate parathyroid glands from peripheral tissues during thyroid surgeries.
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Affiliation(s)
- Bin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Zaoyang Liu
- Department of General Thoracic Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Jian Wu
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
- *Correspondence: Jian Wu,
| | - Ying Liu
- Department of Ultrasound, Chengdu Third People’s Hospital, Chengdu, China
| | - Pin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Hong Liu
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Haobin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Tielin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Juan Wang
- Department of Ultrasound, Chengdu Third People’s Hospital, Chengdu, China
| | - Yan Tang
- Department of Pathology, Chengdu Third People’s Hospital, Chengdu, China
| | - Junyan Zhang
- Department of Computer Science, George Washington University, Washington, DC, United States
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Wang B, Zhu CR, Yao XM, Wu J. The Effect of Parathyroid Gland Autotransplantation on Hypoparathyroidism After Thyroid Surgery for Papillary Thyroid Carcinoma. Cancer Manag Res 2021; 13:6641-6650. [PMID: 34466034 PMCID: PMC8402957 DOI: 10.2147/cmar.s323742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose There are some controversies over the relationship between parathyroid gland autotransplantation and permanent hypoparathyroidism. This study aimed to explore the relationship between parathyroid gland autotransplantation and postoperative hypoparathyroidism. Patients and Methods We performed a retrospective analysis of patients who underwent initial thyroid surgery for papillary thyroid carcinoma from January 2014 to December 2018. Patients were divided into 4 groups according to the number of autotransplanted parathyroid glands (group 1: 0 autotransplanted parathyroid gland, group 2: 1 autotransplanted parathyroid gland, group 3: 2 autotransplanted parathyroid glands, group 4: 3 autotransplanted parathyroid glands). Clinical data were analyzed among the four groups. Results The more parathyroid glands were transplanted, the higher the incidence of immediate hypoparathyroidism was (group 1: 32.9%, group 2: 52.9%, group 3: 65.8%, group 4: 82.4%; Pgroup 1 vs group 2 < 0.001, Pgroup 2 vs group 3 = 0.012, Pgroup 3 vs group 4 = 0.17). Parathyroid gland autotransplantation did not affect the incidence of permanent hypoparathyroidism (group 1: 1.4%, group 2: 1.3%, group 3: 0.9%, group 4: 0%; Pgroup 1 vs group 2 > 0.99, Pgroup 2 vs group 3 > 0.99, Pgroup 3 vs group 4 > 0.99). Conclusion The number of autotransplanted parathyroid glands was positively associated with the incidence of postoperative immediate hypoparathyroidism. Parathyroid gland autotransplantation was not associated with permanent hypoparathyroidism.
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Affiliation(s)
- Bin Wang
- Department of Thyroid and Breast Surgery, Chengdu Third People's Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Chun-Rong Zhu
- Department of Chemistry, School of Basic Medical Science, North Sichuan Medical College, Nanchong, Sichuan Province, People's Republic of China
| | - Xin-Min Yao
- Department of Thyroid and Breast Surgery, Chengdu Third People's Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Jian Wu
- Department of Thyroid and Breast Surgery, Chengdu Third People's Hospital, Chengdu, Sichuan Province, People's Republic of China
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10
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Qiu Y, Xing Z, Fei Y, Qian Y, Luo Y, Su A. Role of the 2018 American Thyroid Association statement on postoperative hypoparathyroidism: a 5-year retrospective study. BMC Surg 2021; 21:334. [PMID: 34474672 PMCID: PMC8414735 DOI: 10.1186/s12893-021-01333-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/28/2021] [Indexed: 02/08/2023] Open
Abstract
Background Definitions of postoperative hypoparathyroidism (hypoPT) have never reached consent until the American Thyroid Association (ATA) statement was released, with new characteristics and challenges. Methods Patients with papillary thyroid carcinoma who underwent primary total thyroidectomy between January 2013 and June 2018 were retrospectively enrolled. Symptoms of hypocalcemia and their frequency were stringently followed. Patients were divided into groups according to the ATA statement. Incidence of postoperative hypoPT and serum parathyroid hormone levels accompanied by calcium levels, from 1-day to at least 24-month follow-up.
Results A total of 1749 patients were included: 458 (26.2%) had transient and 63 (3.6%) had permanent hypoPT. Transient hypoPT was found in 363 (20.7%) patients with biochemical hypoPT, 72 (4.1%) with clinical hypoPT, and 23 (1.3%) with relative hypoPT; permanent hypoPT was detected in 8 (0.5%) patients with biochemical hypoPT, 55 (3.1%) with clinical hypoPT, and none with relative hypoPT. Female sex, age ≥ 55 years, unintentional parathyroid gland resection, and autotransplantation of ≥ 2 parathyroid glands were independent risk factors for transient biochemical hypoPT. Age ≥ 55 years, bilateral central neck dissection, and isthmus tumor location were independent risk factors for transient clinical hypoPT. A postoperative 1-day percentage of parathyroid hormone (PTH) reduction of > 51.1% was an independent risk factor for relative hypoPT (odds ratio, 4.892; 95% confidence interval, 1.653–14.480; P = 0.004). No independent risk factor for permanent hypoPT was found. Conclusion ATA diagnostic criteria for postoperative hypoPT are of great value in differentiating patients by hypocalcemia symptoms and choosing corresponding clinical assistance; however, they may underestimate the actual incidence.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.,Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China
| | - Yuan Fei
- Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China
| | - Yuanfan Qian
- Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Anping Su
- Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China.
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11
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Development and validation of a population-based model for predicting the regional lymph node metastasis in adolescent differentiated thyroid carcinoma. Oral Oncol 2021; 121:105507. [PMID: 34450454 DOI: 10.1016/j.oraloncology.2021.105507] [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] [Received: 03/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adolescent differentiated thyroid carcinoma (DTC) is a rare type of thyroid cancer that represents a special entity of all endocrine-related cancer. This study aims to establish the first nomogram for predicting the regional (central and lateral) lymph node metastasis (LNM) in the adolescent population for better surgical management. METHOD We retrospectively reviewed the clinicopathology characteristics of adolescent patients with DTC in the Surveillance, Epidemiology, and End Results database between 2010 and 2015. RESULTS A total of 1,930 adolescent patients between the ages of 10 and 24 years from the SEER database were enrolled in this study. Six predictive factors including age, race, histology, multifocality, extrathyroidal invasion (EI) and tumor size were identified to be significantly associated with the regional LNM via univariate and multivariate logistic regression analyses. These indicators were used to construct a nomogram for predicting the regional LNM in adolescent patients with DTC. Moreover, a satisfied predictive ability of the model was determined with a C-index of 0.794, supported by an internal validation group with a C-index of 0.776. The Decision Curve Analysis and calibration curve further conducted a great agreement in our model. CONCLUSION The first predictive model containing multiple factors has been successfully established with good discrimination for predicting the regional LNM in adolescent patients with DTC. This nomogram could effectively help surgeons to make better individualized surgical decision intraoperatively, especially in terms of whether cervical lymph node dissection (LND) is warranted.
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12
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Koimtzis GD, Stefanopoulos L, Giannoulis K, Papavramidis TS. What are the real rates of temporary hypoparathyroidism following thyroidectomy? It is a matter of definition: a systematic review. Endocrine 2021; 73:1-7. [PMID: 33651345 DOI: 10.1007/s12020-021-02663-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Post-operative hypoparathyroidism is the most encountered complication of thyroid surgery and is classified as temporary or permanent. However, its incidence varies greatly in the literature ranging from 0.5% to 65%. This can be mainly attributed to the different definition of hypoparathyroidism used in each study and especially to the different time cutoff applied to distinguish temporary from permanent hypoparathyroidism. METHODS We conducted a systematic literature search in PubMed, Scopus, Cochrane and GoogleScholar databases, as well as grey literature. Ultimately, 45 articles with 23,164 patients in total were included in this review. These articles used either the cutoff of six or twelve post-operative months to distinguish temporary from permanent hypoparathyroidism. RESULTS The overall incidence of permanent hypoparathyroidism diagnosed at 6 months post-operatively was 4.11% and 4.08% at 12 months post-operatively. There was no statistically significant difference between the two groups (p = 0.92). CONCLUSIONS We suggest that adhering to the current guidelines that recommend diagnosing temporary hypoparathyroidism when recovery is made within 6 months after surgery is important when conducting future research in order to narrow the gap that exists currently in the literature, as well as when deciding to put patients on long-term calcium supplements.
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Affiliation(s)
- Georgios D Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Heath Park Way, Cardiff, CF14 4XW, UK.
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Kleanthis Giannoulis
- 1st Surgical Department, Papageorgiou General Hospital of Thessaloniki, Taskou Papageorgiou, 54631, Thessaloniki, Greece
| | - Theodosios S Papavramidis
- 1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 1st St. Kiriakidi Street, 54621, Thessaloniki, Greece
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13
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Qiu Y, Xing Z, Qian Y, Fei Y, Luo Y, Su A. Selective Parathyroid Autotransplantation During Total Thyroidectomy for Papillary Thyroid Carcinoma: A Cohort Study. Front Surg 2021; 8:683041. [PMID: 34262932 PMCID: PMC8274712 DOI: 10.3389/fsurg.2021.683041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/07/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: The relationship between the selective parathyroid gland (PG) autotransplantation and hypoparathyroidism is still not completely clear. The aim was to ascertain whether the number of autotransplanted PGs affected the incidence of hypoparathyroidism and recovery of parathyroid function in the long-term for patients with papillary thyroid carcinoma (PTC). Methods: A retrospective cohort study included all patients with PTC who had underwent primary total thyroidectomy with central neck dissection between January 2013 and December 2017. The patients were divided into three groups (0, 1, and 2 PGs autotransplanted, respectively). Results: Of the 2,477 patients, 634 (25.6%) received no PG autotransplantation, 1,078 (43.5%) and 765 (30.9%) were autotransplanted 1 and 2 PGs, respectively, and the incidence of permanent hypoparathyroidism (>1 year) was 1.7%, 0.7%, and 0.4% (P = 0.0228). Both 1 or 2 PGs autotransplanted increased the incidence of transient biochemical hypoparathyroidism (odds ratio [OR], 1.567; 95% confidence interval [CI], 1.258-1.953; P < 0.0001; OR, 2.983; 95% CI, 2.336-3.810; P < 0.0001, respectively) but reduced the incidence of permanent hypoparathyroidism (OR, 0.373; 95% CI, 0.145-0.958; P = 0.0404; OR, 0.144; 95% CI, 0.037-0.560; P = 0.0052, respectively). Both 1 or 2 PGs autotransplanted did not independently influence the occurrence of hypocalcemia symptoms. Conclusion: Selective parathyroid autotransplantation is less likely to lead to post-operative symptomatic hypocalcemia, although it could lead to a transient decrease in parathyroid hormone. However, in the long run, it is still an effective strategy to preserve parathyroid function.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.,Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanfan Qian
- 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
| | - Yan Luo
- Department of Ultrasound, 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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14
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Sun R, Sheng J, Zhou Y, Zhou Y, Cai Y, Shui C, Zeng D, Jiang J, Li R, Wang X, Zhu J, Li C. Relationship between the extent of central node dissection and parathyroid function preservation in thyroid cancer surgery. Gland Surg 2021; 10:1093-1103. [PMID: 33842253 DOI: 10.21037/gs-21-121] [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 The risk and effect of hypocalcemia following surgery of different magnitudes remains unclear. Thus, we assessed whether different extents of central lymph node dissection (CLND) and status of preserved parathyroid glands can influence parathyroid function in differentiated thyroid carcinoma (DTC) patients with initial surgical resection. Methods Participants were categorized into 6 groups based on the extent of the surgical procedures, number of parathyroid glands preserved in situ, and parathyroid autotransplantation. The frequencies of hypocalcemia, serum calcium (Ca) levels, and parathyroid hormone (PTH) levels among the different groups were analyzed. Results The prevalence of hypocalcemia, number and status of parathyroid glands preserved in situ, and parathyroid autotransplantation were inversely related to extensive CLND (r=-0.18; P<0.05). The decrease of serum Ca and PTH was most severe on postoperative days (POD) 1-7. The incidence of hypocalcemia was higher in Group C than in Group B and A (P<0.05). The average postoperative serum Ca and PTH levels in Group C were significantly lower than group A on POD 1-7 (P<0.05). The incidence of hypocalcemia was obviously increased in Group D compared to Groups E and F (P<0.05). The mean serum Ca and PTH levels in Group D were significantly lower than in Group F (P<0.05), and the same results could be observed between Groups D and E (P<0.05). However, through parathyroid autotransplantation, there was no significant difference that could be found between Groups E and F on POD 1-7 (P>0.05). Conclusions With the expansion of CLND scope, postoperative parathyroid function will be affected, increasing the risk of postoperative hypocalcemia. When at least 1-2 parathyroid glands were reserved in situ plus at least 1 parathyroid gland autotransplantation, there was little effect on postoperative parathyroid function.
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Affiliation(s)
- Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianfeng Sheng
- Department of Otorhinolaryngology Head and Neck Surgery, Mianyang Third People's Hospital, Mianyang, China
| | - Yue Zhou
- Department of Radiotherapy, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunyan Shui
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jian Jiang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xu Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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15
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Liu RH, Razavi CR, Chang HY, Tufano RP, Eisele DW, Gourin CG, Russell JO. Association of Hypocalcemia and Magnesium Disorders With Thyroidectomy in Commercially Insured Patients. JAMA Otolaryngol Head Neck Surg 2021; 146:237-246. [PMID: 31917427 DOI: 10.1001/jamaoto.2019.4193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Hypocalcemia is a common complication of total thyroidectomy. Objectives To identify factors associated with hypocalcemia after total thyroidectomy and to explore the association between hypocalcemia, magnesium disorders, and costs of care. Design, Setting, and Participants A retrospective cross-sectional analysis was performed using data from the MarketScan Commercial Claim and Encounters database on 126 766 commercially insured patients younger than 65 years undergoing total thyroidectomy between January 1, 2010, and December 31, 2012. Statistical analysis was performed from January 1, 2016, to May 30, 2019. Main Outcomes and Measures Short- and long-term hypocalcemia and the costs of care were examined using multivariable regression modeling. Results Among the 126 766 patients in the study (81.6% women; mean age, 46.5 years [range, 18-64 years]), postoperative hypocalcemia was present in 19.1% of patients in the initial 30-day postoperative period and in 4.4% of patients at 1 year. Magnesium disorders were present in 2.1% of patients at the time of surgery. Short- and long-term hypocalcemia were significantly more likely in women (short-term: odds ratio [OR], 1.39 [95% CI, 1.29-1.50]; long-term: OR, 1.69 [95% CI, 1.52-1.89]), those younger than 40 years (short-term: OR for ages 40-64 years, 0.83 [95% CI, 0.78-0.87]; long-term: OR for ages 40-64 years, 0.73 [95% CI, 0.67-0.79]), those with a diagnosis of thyroiditis (short-term: OR, 1.48 [95% CI, 1.16-1.89]; long-term: OR, 1.60 [95% CI, 1.13-2.26]) or cancer (short-term: OR, 1.32 [95% CI, 1.05-1.67]; long-term: OR, 1.17 [95% CI, 0.83-1.63]), vitamin D deficiency (short-term: OR, 1.96 [95% CI, 1.74-2.21]; long-term: OR, 3.72 [95% CI, 3.30-4.18]), concurrent lateral neck dissection (short-term: OR, 1.51 [95% CI, 1.37-1.66]; long-term: OR, 1.95 [95% CI, 1.69-2.26]), concurrent central neck dissection (short-term: OR, 1.15 [95% CI, 1.07-1.24]; long-term: OR, 1.25 [95% CI, 1.12-1.40]), intraoperative parathyroid (short-term: OR, 1.58 [95% CI, 1.46-1.71]; and long-term: OR, 2.05 [95% CI, 1.82-2.31]) or recurrent laryngeal nerve injury (short-term: OR, 1.49 [95% CI, 1.27-1.74]; long-term: OR, 2.04 [95% CI, 1.64-2.54]), and magnesium disorders (short-term: OR, 8.40 [95% CI, 7.21-9.79]; long-term: OR, 25.23 [95% CI, 19.80-32.17]). Compared with the initial postoperative period, the odds of hypocalcemia decreased by 90.0% (OR, 0.10 [95% CI, 0.09-0.11]) at 6 months and 93.0% (OR, 0.07 [95% CI, 0.06-0.08]) at 1 year. After controlling for all other variables, magnesium disorders were associated with the highest odds of short- and long-term postoperative hypocalcemia. Hypocalcemia ($3392) and magnesium disorders ($14 314) were associated with increased mean incremental 1-year costs of care. Conclusions and Relevance Hypocalcemia is common after total thyroidectomy but resolves in most patients by 1 year. Magnesium disorders are significantly independently associated with short- and long-term hypocalcemia and are associated with greater costs of care. These data suggest a potentially modifiable target to reduce the incidence and cost of long-term hypocalcemia at patient and systemic levels.
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Affiliation(s)
- Rui Han Liu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christopher R Razavi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Hsien-Yen Chang
- Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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16
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Qiu Y, Xing Z, Xiang Q, Yang Q, Su A, Luo Y. Duration of Parathyroid Function Recovery in Patients With Protracted Hypoparathyroidism After Total Thyroidectomy for Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:665190. [PMID: 33953701 PMCID: PMC8090861 DOI: 10.3389/fendo.2021.665190] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/01/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of the present study is to investigate the time to recovery of parathyroid function in patients with protracted hypoparathyroidism at 1 month after total thyroidectomy of papillary thyroid carcinoma. MATERIALS AND METHODS Adult patients who underwent total thyroidectomy for papillary thyroid cancer were included. Cases of long-term hypoparathyroidism were studied for recovery of parathyroid function during the follow-up. The duration of recovery and associated variables were recorded. RESULTS Out of the 964 patients, 128 (13.28%) developed protracted hypoparathyroidism and of these, 23 (2.39%) developed permanent hypoparathyroidism and 105 (10.89%) recovered: 86 (8.92%) before 6 months, 11 (1.14%) within 6 and 12 months and 8 (0.83%) after 1 year follow-up. Variables significantly associated with the time to parathyroid function recovery were number of autotransplanted parathyroid glands (HR, 1.399; 95% CI, 1.060 - 1.846; P = 0.018), serum calcium concentration >2.07 mmol/L (Hazard ratio [HR], 1.628; 95% confidence interval [CI], 1.009 - 2.628; P = 0.046) and PTH level > 1.2 pmol/L (HR, 1.702; 95% CI, 1.083 - 2.628; P = 0.021) at 1 month postoperatively. CONCLUSION Permanent hypoparathyroidism should not be diagnosed easily by time, since up to one-fifth of the patients will experience recovery after a period of 6 months and a few patients even beyond one year. The number of autotransplanted parathyroid glands is positively associated with the time to parathyroid function recovery.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Xiang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Qianru Yang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yan Luo, ; Anping Su,
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yan Luo, ; Anping Su,
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Ponce de León-Ballesteros G, Velázquez-Fernández D, Hernández-Calderón FJ, Bonilla-Ramírez C, Pérez-Soto RH, Pantoja JP, Sierra M, Herrera MF. Hypoparathyroidism After Total Thyroidectomy: Importance of the Intraoperative Management of the Parathyroid Glands. World J Surg 2019; 43:1728-1735. [PMID: 30919027 DOI: 10.1007/s00268-019-04987-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Total thyroidectomy is the most common surgical procedure for the treatment of thyroid diseases. Postoperative hypocalcemia/hypoparathyroidism is the most frequent complication after total thyroidectomy. The aim of this study was to evaluate the rate of postoperative hypocalcemia and permanent hypoparathyroidism after total thyroidectomy in order to identify potential risk factors and to evaluate the impact of parathyroid autotransplantation. PATIENTS AND METHODS We performed a retrospective analysis of 1018 patients who underwent total thyroidectomy at our institution between 2000 and 2016. Medical records were reviewed to analyze patient features, clinical presentation, management and postoperative complications. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Statistical significance was set at p ≤ 0.05. RESULTS Mean ± SD age was 46.79 ± 15.9 years; 112 (11.7%) were males and 844 (88.3%) females. A total of 642 (67.2%) patients underwent surgery for malignant disease. The rate of postoperative hypocalcemia, transient, protracted and permanent hypoparathyroidism was 32.8%, 14.43%, 18.4% and 3.9%, respectively. Permanent hypoparathyroidism was significantly associated with the number of parathyroid glands remaining in situ (4 glands: 2.5%, 3 glands: 3.8%, 1-2 glands: 13.3%; p ˂ 0.0001) [OR for 1-2 glands in situ = 5.32, CI 95% 2.61-10.82]. Other risk factors related to permanent hypoparathyroidism were obesity (OR 3.56, CI 95% 1.79-7.07), concomitant level VI lymph node dissection (OR 3.04, CI 95% 1.46-6.37) and incidental parathyroidectomy without autotransplantation (OR 3.6, CI 95% 1.85-7.02). CONCLUSIONS Identification and in situ preservation of at least three parathyroid glands were associated with a lower rate of postoperative hypocalcemia (30.4%) and permanent postoperative hypoparathyroidism (2.79%).
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Affiliation(s)
- Guillermo Ponce de León-Ballesteros
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - David Velázquez-Fernández
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - F Javier Hernández-Calderón
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Carlos Bonilla-Ramírez
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Rafael H Pérez-Soto
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Juan Pablo Pantoja
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Mauricio Sierra
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico
| | - Miguel F Herrera
- Service of Endocrine and Advanced Laparoscopic Surgery/Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Vasco de Quiroga 15, Seccion XVI, Tlalpan, 14000, Mexico City, Mexico.
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18
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Wang B, Zhu CR, Liu H, Wu J. The effectiveness of parathyroid gland autotransplantation in preserving parathyroid function during thyroid surgery for thyroid neoplasms: A meta-analysis. PLoS One 2019; 14:e0221173. [PMID: 31412080 PMCID: PMC6693848 DOI: 10.1371/journal.pone.0221173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022] Open
Abstract
Objective We conducted this meta-analysis to assess the effectiveness of parathyroid gland autotransplantation in preserving parathyroid function during thyroid surgery for thyroid neoplasms. Methods We conducted a search by using PubMed, Embase, and the Cochrane Library electronic databases for studies that were published up to January 2019. The reference lists of the retrieved articles were also reviewed. Two authors independently assessed the methodological quality and extracted the data. A random-effects model was used to calculate the overall combined risk estimates. Publication bias was evaluated with a funnel plot using Egger’s and Begg’s tests. Results A total of 25 independent studies involving 10,531 participants were included in the meta-analysis. Compared with patients who did not undergo parathyroid gland autotransplantation, the overall pooled relative risks for patients who underwent parathyroid gland autotransplantation were 1.75 (95% CI: 1.51–2.02, p<0.001) for postoperative hypoparathyroidism, 1.72 (95% CI: 1.45–2.05, p<0.001) for protracted hypoparathyroidism, 1.06 (95% CI: 0.44–2.58, p = 0.894) and 0.71 (95% CI: 0.22–2.29, p = 0.561) for biochemical hypoparathyroidism and biochemical hypocalcemia at 6 months postoperatively, respectively, and 1.89 (95% CI: 1.33–2.69, p<0.001) and 0.22 (95% CI: 0.09–0.52, p = 0.001) for biochemical hypoparathyroidism and biochemical hypocalcemia at 12 months postoperatively, respectively. The pooled relative risks for patients who underwent one parathyroid gland autotransplantation and patients who underwent two or more parathyroid gland autotransplantations were 1.71 (95% CI: 1.25–2.35, p = 0.001) and 2.22 (95% CI: 1.43–3.45, p<0.001) for postoperative hypoparathyroidism, 1.09 (95% CI: 0.59–2.01, p = 0.781) and 0.55 (95% CI: 0.16–1.87, p = 0.341) for hypoparathyroidism at 6 months postoperatively compared with those of patients who did not undergo parathyroid gland autotransplantation. Conclusions Parathyroid gland autotransplantation is significantly associated with increased risk of postoperative and protracted hypoparathyroidism, and the number of autoplastic parathyroid glands is positively correlated with the incidence of postoperative hypoparathyroidism.
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Affiliation(s)
- Bin Wang
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Chun-Rong Zhu
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- Department of Chemistry, School of Basic Medical Science, North Sichuan Medical College, Nanchong, China
| | - Hong Liu
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jian Wu
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
- * E-mail:
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Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma. Surg Endosc 2019; 34:268-274. [DOI: 10.1007/s00464-019-06762-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/18/2019] [Indexed: 11/25/2022]
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