The impact of intraoperative elements on postoperative hypoparathyroidism in patients after total thyroidectomy

Background: To investigate the impact of the percent change of postoperative parathormone (PoPTH) level from baseline value (∆PTH) on the rate of hypocalcemia after total thyroidectomy. Methods: Assays of serum PTH and calcium (Ca) were performed preoperatively and at 24 hours postoperatively in 222 consecutive patients who underwent total thyroidectomy. Postoperative hypocalcemia was defined as serum calcium level corrected for albumin concentration (cCa) <8.5mg/dl. Patients with postoperative hypocalcemia were classified as group1 (n=100) and those with normal Ca levels as group 2 (n=122). The PoPTH levels and ∆PTH were compared between the two groups. ROC analysis was performed to determine the cut off values for PoPTH and ∆PTH. Results: The mean PoPTH level was significantly lower in group 1 compared to group 2 (18.6±15.3 pg/ml vs 32.3±15.6 pg/ml, respectively; P<0.0001). PoPTH values were within normal range in 54% of the patients with hypocalcemia and 35% of those with symptomatic hypocalcemia. PoPTH <28pg/ml or ∆PTH >45 were significantly associated with increased risk of post-thyroidectomy hypocalcemia (P=0.0001). A ∆PTH >70% ,PoPTH ≤ 15.5pg/ml and postoperative serum cCa concentrations<8.0mg/dl significantly predicted symptomatic hypocalcemia(P=0.009;P=0.006;andP=0.0001;respevtively).The sensitivities of ∆PTH,PoPTH level and postoperative serum cCa concentration to predict symptomatic hypocalcemia were 67%,64% and100, respectively. Conclusion: Although, PTH decline significantly correlate with symptomatic hypocalcemia, a considerable number of patients may experience hypocalcemic symptoms in spite of normal PoPTH levels. Analysis of serum Ca concentrations at 24 hours postoperatively help to achieve a more precise prediction of patients who bear a high risk for developing hypocalcemic symptoms.

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Impact of total thyroidectomy on quality of life at 6 months: the prospective ThyrQoL multicentre trial

Acta Endocrinologica ◽

10.1530/eje-19-0587 ◽

2020 ◽

Vol 182 (2) ◽

pp. 195-205 ◽

Cited By ~ 4

Author(s):

E Mirallié ◽

F Borel ◽

C Tresallet ◽

A Hamy ◽

M Mathonnet ◽

...

Keyword(s):

Quality Of Life ◽

Total Thyroidectomy ◽

Short Form ◽

Multivariable Analysis ◽

Vocal Cord Palsy ◽

Multicenter Trial ◽

Significant Impairment ◽

The Impact ◽

Benign Thyroid

Objective This study is to determine the impact of complications after total thyroidectomy on health-related quality of life (HR-QoL) and to identify significant predictive factors of HR-QoL changes. HR-QoL is usually impaired in patients with thyroid diseases compared to the general population. Thyroidectomy is largely performed in the case of benign thyroid benign and can be associated with long-term complications (vocal cord palsy, hypoparathyroidism). Design The prospective ThyrQoL multicenter trial (NCT02167529) included 800 patients who underwent total thyroidectomy for benign or malignant non-extensive disease in seven French referral hospitals between 2014 and 2016. Methods HR-QoL was assessed using the MOS 36-item short form health survey (SF-36) self-questionnaire with a 6-month follow-up. Results We observed a significant improvement of HR-QoL 6 months after surgery (P < 0.0001). Postoperative complications were associated with a non-significant impairment of HR-QoL. In multivariable analysis, Graves’ disease was associated with a significant improvement of HR-QoL (OR = 2.39 [1.49; 3.84]) and thyroid malignant disease with an impairment of HR-QoL (OR = 1.44 [0.99; 2.08]) after thyroidectomy. Conclusion We observed a significant improvement of HR-QoL 6 months after total thyroid surgery for benign thyroid disease.

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The Step Wise Effect of Vessel Ligation Method on Intra and Postoperative Hypoparathyroidism in the Total Thyroidectomy

Bagcilar Medical Bulletin ◽

10.4274/bmb.galenos.2020.06.025 ◽

2020 ◽

Vol 5 (4) ◽

pp. 166-172

Author(s):

Gülçin Ercan ◽

Meltem Küçükyılmaz ◽

Hakan Yiğitbaş ◽

Nadir Adnan Hacım ◽

Serhat Meriç ◽

...

Keyword(s):

Total Thyroidectomy ◽

Postoperative Hypoparathyroidism ◽

Ligation Method ◽

Vessel Ligation

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The impact of operative duration and intraoperative fluid dynamics on postoperative hypocalcemia after total thyroidectomy: a prospective non-randomized study

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-02013-8 ◽

2020 ◽

Author(s):

Poongkodi Karunakaran ◽

Deepak Thomas Abraham ◽

Geetha Devadas ◽

Srinivasan Ramalingam ◽

Sudhapresanna Balu ◽

...

Keyword(s):

Fluid Dynamics ◽

Total Thyroidectomy ◽

Randomized Study ◽

Postoperative Hypocalcemia ◽

Operative Duration ◽

The Impact

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The Impact of Single Parathyroid Gland Autotransplantation During Thyroid Surgery on Postoperative Hypoparathyroidism: A Multicenter Study

Transplantation Proceedings ◽

10.1016/j.transproceed.2006.10.192 ◽

2007 ◽

Vol 39 (1) ◽

pp. 225-230 ◽

Cited By ~ 37

Author(s):

M. Testini ◽

L. Rosato ◽

N. Avenia ◽

F. Basile ◽

P. Portincasa ◽

...

Keyword(s):

Parathyroid Gland ◽

Multicenter Study ◽

Thyroid Surgery ◽

Postoperative Hypoparathyroidism ◽

The Impact

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288 Impact of Trainee Surgeons Performing Thyroid Procedure on Patient Safety

British Journal of Surgery ◽

10.1093/bjs/znab259.536 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Nessa ◽

S Aspinall

Keyword(s):

Patient Safety ◽

Total Thyroidectomy ◽

Predictive Factors ◽

Postoperative Bleeding ◽

Multivariable Analysis ◽

Vocal Cord Palsy ◽

Primary Operator ◽

Nodal Dissection ◽

Multivariable Analyses ◽

The Impact

Abstract Introduction Impact of trainee surgeons performing thyroid procedure on patient safety Aim The primary aim was to evaluate the impact of trainee as the principal operator on patient safety in thyroid surgery. Method The data was extracted from a single consultant’s data from 2009 to 2020 in the British Association of Endocrine and Thyroid Surgeons (BAETS) National audit. Multivariable analysis of predictive factors (including trainee primary operator) for temporary and permanent hypocalcaemia was performed. Results There were 507 thyroid cases. After excluding cases with missing data in variables analysed 378 (74.5%) cases were analysed. Vocal cord palsy occurred in 5/378 (1.3%), postoperative bleeding 3/378 (0.8%), temporary hypocalcaemia 68/378 (18.0%) and permanent hypocalcaemia 20/378 (5.3%). Predictive factors analysed included hyperthyroidism 117/378 (31%), retrosternal goitre 33/378 (8%), reoperation, 43/378 (11%), total thyroidectomy 184/378 (49%), nodal dissection 21/378 (6%) and trainee principal operator 15/378 (4%). Multivariable analyses of temporary and permanent hypocalcaemia found only two variables significantly affected incidence of temporary hypocalcaemia were total thyroidectomy (OR 7.82, 95% CI 3.41-17.92, p < 0.001) and nodal dissection (OR 3.53, 95% CI 1.20-10.38, p = 0.02), and for permanent hypocalcaemia these were reoperation (OR 5.05, 95% CI 1.09-23.25, p = 0.04) and total thyroidectomy (OR 5.76, 95% CI 1.35-24.54, p = 0.018). Conclusions There was no evidence that trainee principal operator adversely affected the outcome of thyroidectomy; it is worth noting that only 4% of operations were done by trainees and so this study would support trainees undertaking more thyroidectomies as principal surgeon.

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Measurement of serum intact parathyroid hormone (iPTH) at the end of total thyroidectomy: A reliable parameter for hypocalcemia?

British Journal of Surgery ◽

10.1093/bjs/znab202.033 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

A Lalos ◽

K Linke ◽

M von Flüe ◽

B Kern

Keyword(s):

Parathyroid Hormone ◽

Total Thyroidectomy ◽

Clinical Symptoms ◽

Parathyroid Tissue ◽

Postoperative Management ◽

Parathyroid Glands ◽

Intact Parathyroid Hormone ◽

Postoperative Hypoparathyroidism ◽

Symptomatic Hypocalcemia ◽

The Mean

Abstract Objective Total thyroidectomy represents the gold standard surgical procedure for patients with malignant thyroid disease. Over the past decades, the total thyroidectomy gradually replaced the subtotal thyroidectomy for benign thyroid disorders as well. Postoperative hypocalcemia remains the most frequent complication. The close proximity of parathyroid glands to the thyroid capsule leads often to devascularization or adventitious removal of parathyroid tissue. Clinical symptoms like paresthesia, tingling, muscle cramps or seizures often occur. Combined measurement of intact parathyroid hormone (iPTH) and calcium after the operation are used worldwide to predict postoperative hypoparathyroidism. The purpose of this study was to find out the incidence of decreased iPTH at the end of surgery and its reliability in predicting hypocalcemia. Methods We performed a retrospective analysis of 534 patients who underwent total thyroidectomy at our institution between 2000 and 2019. Medical records were reviewed to analyze the patient characteristics, indication of the procedure, laboratory and histological results, postoperative management and complications. The iPTH was measured before and at the end of the surgery, while the calcium was measured at the first postoperative day. The iPTH assay at our hospital has a normal range between 15.0 and 80.0 pg/ml. Meanwhile hypocalcemia was defined as a calcium measurement < 2.2 mmol/l. Results The mean age of the patients was 55.34 years. The female to male ratio was 4.6:1. The mean preoperative iPTH of our cohort was 48.35 pg/ml, while the postoperative iPTH was 31.74 pg/ml, indicating a mean reduction of 35.75%. A total of 174 patients (32.6%) had a iPTH < 15.0 pg/ml at the end of the surgery, indicating a reduction of 75.6%. 22 of these 174 patients (12.6%) developed clinical symptoms of hypocalcemia. In contrast only 3 patients (0.08%) with normal iPTH developed symptoms. Whole parathyroid glands were identified in 95/534 (17.8%), whereas from the 174 patients with iPTH < 15.0 pg/ml, 56 (32.2%) had at least one parathyroid gland in the operative specimens. Conclusion Measurement of iPTH at the end of total thyroidectomy is a good predictor to detect patient who are at risk for developing symptomatic hypocalcemia and calcium substitution can be started at the same day. A normal iPTH almost excludes symptomatic hypocalcemia.

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