Top

Langenbeck's Archives of Surgery

Published in:

01-12-2023 | Hypocalcemia | Research

Incidence and risk factors of hypoparathyroidism and hypocalcemia after hemithyroidectomy

Authors: Jae Yeong Jeong, Chang Myeon Song, Yong Bae Ji, Jung Hwan Park, Dong Sun Kim, Kyung Tae

Published in: Langenbeck's Archives of Surgery | Issue 1/2023

Abstract

Purpose

The incidence and risk factors for hypoparathyroidism after total thyroidectomy is well-known. However, the characteristics of hypoparathyroidism and hypocalcemia after hemithyroidectomy have not been investigated well. In this study, we aimed to evaluate the incidence, characteristics, and risk factors of hypoparathyroidism and hypocalcemia after hemithyroidectomy.

Method

We retrospectively analyzed the medical data of 321 patients who underwent hemithyroidectomy, with or without central neck dissection, from January 2012 to April 2019. We analyzed the serum intact parathyroid hormone (iPTH), calcium, and ionized calcium (iCa) levels serially (preoperatively and postoperatively on the operation day; days 1 and 3; and months 1, 3, 6, and 12) and evaluated risk factors for postoperative hypoparathyroidism and hypocalcemia.

Results

The mean iPTH and calcium levels decreased significantly after hemithyroidectomy on the operation day and postoperative days 1 and 3, and returned to the preoperative level at the postoperative 1-month follow-up. The mean iCa level decreased significantly on the operation day and postoperative day 1. Transient hypoparathyroidism and transient hypocalcemia occurred in 16 (5%) and 250 (78%) participants, and they recovered to normal levels postoperatively by 1 month. Eight (2.5%) patients had mild symptoms of hypocalcemia necessitating oral calcium supplementation. No permanent hypoparathyroidism or hypocalcemia was observed. Preoperatively low serum iPTH and calcium levels were associated with transient hypoparathyroidism and hypocalcemia after hemithyroidectomy.

Conclusion

Approximately 5% and 2.5% of participants showed transient hypoparathyroidism and mild symptomatic hypocalcemia after hemithyroidectomy. The risk factors for transient hypoparathyroidism and hypocalcemia include preoperative low serum iPTH and calcium levels.

Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R (2013) Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013:965212. https://doi.org/10.1155/2013/965212CrossRefPubMedPubMedCentral

Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133. https://doi.org/10.1089/thy.2015.0020CrossRefPubMedPubMedCentral

Filetti S, Durante C, Hartl D et al (2019) Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 30:1856–1883. https://doi.org/10.1093/annonc/mdz400CrossRefPubMed

Bongers PJ, Greenberg CA, Hsiao R et al (2020) Differences in long-term quality of life between hemithyroidectomy and total thyroidectomy in patients treated for low-risk differentiated thyroid carcinoma. Surgery 167:94–101. https://doi.org/10.1016/j.surg.2019.04.060CrossRefPubMed

Bourrel C, Uzzan B, Tison P, Despreaux G, Frachet B, Modigliani E, Perret GY (1993) Transient hypocalcemia after thyroidectomy. Ann Otol Rhinol Laryngol 102:496–501. https://doi.org/10.1177/000348949310200702CrossRefPubMed

Tae K, Ji YB, Song CM, Ryu J (2019) Robotic and endoscopic thyroid surgery: evolution and advances. Clin Exp Otorhinolaryngol 12:1–11. https://doi.org/10.21053/ceo.2018.00766

Lo CY, Lam KY (1998) Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study. Surgery 124:1081–6. https://doi.org/10.1067/msy.1998.92560. (discussion 1086-7)CrossRefPubMed

Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau J, Proye C (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724. https://doi.org/10.1007/s002689900459CrossRefPubMed

McHenry CR, Speroff T, Wentworth D, Murphy T (1994) Risk factors for postthyroidectomy hypocalcemia. Surgery 116:641–7 (discussion 647-8)PubMed

10.

Vasileiadis I, Charitoudis G, Vasileiadis D, Kykalos S, Karatzas T (2018) Clinicopathological characteristics of incidental parathyroidectomy after total thyroidectomy: The effect on hypocalcemia. A retrospective cohort study. Int J Surg 55:167–174. https://doi.org/10.1016/j.ijsu.2018.05.737CrossRefPubMed

11.

Kovács L, Góth MI, Vörös A, Hubina E, Szilágyi G, Szabolcs I (2000) Changes of serum calcium level following thyroid surgery–reasons and clinical implications. Exp Clin Endocrinol Diabetes 108:364–368. https://doi.org/10.1055/s-2000-8130CrossRefPubMed

12.

Palop IF, Martínez CF, Giménez MJS, Azorin Samper MC, Fuster RG (2021) Determination of calcium and parathyroid hormone levels following hemithyroidectomy. Thyroid Res 14:13. https://doi.org/10.1186/s13044-021-00104-2CrossRefPubMedPubMedCentral

13.

Bergenfelz A, Ahrén B (1993) Calcium metabolism after hemithyroidectomy. Horm Res 39:56–60. https://doi.org/10.1159/000182696CrossRefPubMed

14.

Lindblom P, Westerdahl J, Bergenfelz A (2001) Hemithyroidectomy: long-term effects on parathyroid function–preliminary report. World J Surg 25:1155–1159. https://doi.org/10.1007/BF03215864CrossRefPubMed

15.

Cavicchi O, Piccin O, Caliceti U, De Cataldis A, Pasquali R, Ceroni AR (2007) Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol Head Neck Surg 137:654–658. https://doi.org/10.1016/j.otohns.2007.03.001CrossRefPubMed

16.

Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B (2008) Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg 143:132–7. https://doi.org/10.1001/archsurg.2007.55. (discussion 138)CrossRefPubMed

17.

Coimbra C, Monteiro F, Oliveira P, Ribeiro L, de Almeida MG, Condé A (2017) Hypoparathyroidism following thyroidectomy: Predictive factors. Acta Otorrinolaringol Esp 68:106–111. https://doi.org/10.1016/j.otoeng.2016.06.001CrossRefPubMed

18.

Ryu J, Ryu YM, Jung YS et al (2013) Extent of thyroidectomy affects vocal and throat functions: a prospective observational study of lobectomy versus total thyroidectomy. Surgery 154:611–620. https://doi.org/10.1016/j.surg.2013.03.011CrossRefPubMed

19.

Del Rio P, Rossini M, Montana CM, Viani L, Pedrazzi G, Loderer T, Cozzani F (2019) Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 18:25. https://doi.org/10.1186/s12893-019-0483-yCrossRefPubMedPubMedCentral

20.

Wang YH, Bhandari A, Yang F et al (2017) Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer Manag Res 9:627–635. https://doi.org/10.2147/CMAR.S148090CrossRefPubMedPubMedCentral

21.

Ritter K, Elfenbein D, Schneider DF, Chen H, Sippel RS (2015) Hypoparathyroidism after total thyroidectomy: incidence and resolution. J Surg Res 197:348–353. https://doi.org/10.1016/j.jss.2015.04.059CrossRefPubMedPubMedCentral

22.

Edafe O, Prasad P, Harrison BJ, Balasubramanian SP (2014) Incidence and predictors of post-thyroidectomy hypocalcaemia in a tertiary endocrine surgical unit. Ann R Coll Surg Engl 96:219–223. https://doi.org/10.1308/003588414X13814021679753CrossRefPubMedPubMedCentral

23.

Lee NJ, Blakey JD, Bhuta S, Calcaterra TC (1999) Unintentional parathyroidectomy during thyroidectomy. Laryngoscope 109:1238–1240. https://doi.org/10.1097/00005537-199908000-00010CrossRefPubMed

24.

Chang YK, Lang BHH (2017) To identify or not to identify parathyroid glands during total thyroidectomy. Gland Surg 6:S20-S29. https://doi.org/10.21037/gs.2017.06.13.

25.

Ji YB, Song CM, Sung ES, Jeong JH, Lee CB, Tae K (2017) Postoperative hypoparathyroidism and the viability of the parathyroid glands during thyroidectomy. Clin Exp Otorhinolaryngol 10:265–271. https://doi.org/10.21053/ceo.2016.00724CrossRefPubMed

26.

Song CM, Jung JH, Ji YB, Min HJ, Ahn YH, Tae K (2014) Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy. World J Surg Oncol 12:200. https://doi.org/10.1186/1477-7819-12-200CrossRefPubMedPubMedCentral

27.

Sheahan P, Mehanna R, Basheeth N, Murphy MS (2013) Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: a prospective study. Laryngoscope 123:2324–2328. https://doi.org/10.1002/lary.23954CrossRefPubMed

28.

Del Rio P, Arcuri MF, Cataldo S, Palladino S, Sianesi M (2009) Can we use ionized calcium in the evaluation of post-thyroidectomy hypocalcemia? Minerva Endocrinol 34:289–293PubMed

29.

Promberger R, Ott J, Kober F, Karik M, Freissmuth M, Hermann M (2011) Normal parathyroid hormone levels do not exclude permanent hypoparathyroidism after thyroidectomy. Thyroid 21:145–150. https://doi.org/10.1089/thy.2010.0067CrossRefPubMed

30.

Raffaelli M, De Crea C, D’Amato G, Moscato U, Bellantone C, Carrozza C, Lombardi CP (2016) Post-thyroidectomy hypocalcemia is related to parathyroid dysfunction even in patients with normal parathyroid hormone concentrations early after surgery. Surgery 159:78–84. https://doi.org/10.1016/j.surg.2015.07.038CrossRefPubMed

Title: Incidence and risk factors of hypoparathyroidism and hypocalcemia after hemithyroidectomy
Authors: Jae Yeong Jeong
Chang Myeon Song
Yong Bae Ji
Jung Hwan Park
Dong Sun Kim
Kyung Tae
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Hypocalcemia
Hypoparathyroidism
Hemithyroidectomy
Hemithyroidectomy
Thyroidectomy
Thyroidectomy
Neck Dissection
Published in: Langenbeck's Archives of Surgery / Issue 1/2023
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-023-03038-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence and risk factors of hypoparathyroidism and hypocalcemia after hemithyroidectomy

Abstract

Purpose

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Brazilian guide to nutrition in bariatric and metabolic surgery

Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend

Risk factors and outcomes for cholangitis after hepatic resection

Subserosal vascular density predicts oncological features of T2 gallbladder cancer

Transanal full-thickness excision for rectal neoplasm: is it advisable to leave the defect open?

Effects of extremely low-pressure pneumoperitoneum on postoperative recovery after single site robot-assisted cholecystectomy: a randomized controlled trial