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Reinke R, Udholm S, Christiansen CF, Almquist M, Londero S, Rejnmark L, Rasmussen TB, Rolighed L. Hypoparathyroidism and mortality after total thyroidectomy: A nationwide matched cohort study. Clin Endocrinol (Oxf) 2024; 100:408-415. [PMID: 38375986 DOI: 10.1111/cen.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Total thyroidectomy (TT) carries a risk of hypoparathyroidism (hypoPT). Recently, hypoPT has been associated with higher overall mortality rates. We aimed to evaluate the frequency of hypoPT and mortality in patients undergoing TT in Denmark covering 20 years. DESIGN Retrospective Cohort study. PATIENTS AND MEASUREMENTS Using population-based registries, we identified all Danish individuals who had undergone TT between January 1998 and December 2017. We included a comparison cohort by randomly selecting 10 citizens for each patient, matched on sex and birth year. HypoPT was defined as treatment with active vitamin D after 12 months postoperatively. We used cumulative incidence to calculate risks and Cox regression to compare the rate of mortality between patients and the comparison cohort. We evaluated patients in different comorbidity groups using the Charlson Comorbidity Index and by different indications for surgery. RESULTS 7912 patients underwent TT in the period. The prevalence of hypoPT in the study period was 16.6%, 12 months postoperatively. After adjusting for potential confounders the risk of death due to any causes (hazard ratio; 95% confidence intervals) following TT was significantly increased (1.34; 1.15-1.56) for patients who developed hypoPT. However, subgroup analysis revealed mortality was only increased in malignancy cases (2.48; 1.99-3.10) whereas mortality was not increased when surgery was due to benign indications such as goitre (0.88; 0.68-1.15) or thyrotoxicosis (0.86; 0.57-1.28). CONCLUSIONS The use of active vitamin D for hypoPT was prevalent one year after TT. Patients with hypoPT did not have an increased risk of mortality following TT unless the indication was due to malignancy.
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Affiliation(s)
- Rasmus Reinke
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology and Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Martin Almquist
- Department of Surgery, Lund University Hospital, Lund, Sweden
| | - Stefano Londero
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Holm M, Vestergaard P, Poulsen MM, Rasmussen ÅK, Feldt-Rasmussen U, Bay M, Rolighed L, Londero S, Pedersen HB, Hahn CH, Rask KB, Nielsen HH, Gaustadnes M, Rossing MC, Hermann AP, Godballe C, Mathiesen JS. Primary Hyperparathyroidism in Multiple Endocrine Neoplasia Type 2A in Denmark 1930–2021: A Nationwide Population-Based Retrospective Study. Cancers (Basel) 2023; 15:2125. [PMID: 37046785 PMCID: PMC10093219 DOI: 10.3390/cancers15072125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Studies of primary hyperparathyroidism (PHPT) in multiple endocrine neoplasia type 2A (MEN 2A) shows divergence in frequency, disease definition, reporting of clinical characteristics and traces of selection bias. This is a nationwide population-based retrospective study of PHPT in MEN 2A, suggesting a representative frequency, with complete reporting and a strict PHPT definition. The Danish MEN 2A cohort 1930-2021 was used. Of 204 MEN 2A cases, 16 had PHPT, resulting in a frequency of 8% (CI, 5-12). Age-related penetrance at 50 years was 8% (CI, 4-15). PHPT was seen in the American Thyroid Association moderate (ATA-MOD) and high (ATA-H) risk groups in 62% and 38% of carriers, respectively. Median age at PHPT diagnosis was 45 years (range, 21-79). A total of 75% were asymptomatic and 25% were symptomatic. Thirteen underwent parathyroid surgery, resulting in a cure of 69%, persistence in 8% and recurrence in 23%. In this first study with a clear PHPT definition and no selection bias, we found a lower frequency of PHPT and age-related penetrance, but a higher age at PHPT diagnosis than often cited. This might be affected by the Danish RET p.Cys611Tyr founder effect. Our study corroborates that PHPT in MEN 2A is often mild, asymptomatic and is associated with both ATA-MOD and ATA-H variants. Likelihood of cure is high, but recurrence is not infrequent and can occur decades after surgery.
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Affiliation(s)
- Magnus Holm
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.); (M.B.); (C.G.)
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, 9100 Aalborg, Denmark;
| | - Morten Møller Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Åse Krogh Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (Å.K.R.); (U.F.-R.); (M.C.R.)
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (Å.K.R.); (U.F.-R.); (M.C.R.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mette Bay
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.); (M.B.); (C.G.)
| | - Lars Rolighed
- Department of ORL Head & Neck Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark; (L.R.); (S.L.)
| | - Stefano Londero
- Department of ORL Head & Neck Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark; (L.R.); (S.L.)
| | | | - Christoffer Holst Hahn
- Department of ORL Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (C.H.H.); (K.B.R.)
| | - Klara Bay Rask
- Department of ORL Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (C.H.H.); (K.B.R.)
| | - Heidi Hvid Nielsen
- Department of Clinical Biochemistry, Zealand University Hospital, 4000 Roskilde, Denmark;
| | - Mette Gaustadnes
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Maria Caroline Rossing
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (Å.K.R.); (U.F.-R.); (M.C.R.)
- Center for Genomic Medicine, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | | | - Christian Godballe
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.); (M.B.); (C.G.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Jes Sloth Mathiesen
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.); (M.B.); (C.G.)
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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