scholarly journals Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

2021 ◽  
Vol 10 (3) ◽  
pp. 543
Author(s):  
Antonio Sitges-Serra
Keyword(s):  
Adverse Effect ◽  
Total Thyroidectomy ◽  
Replacement Therapy ◽  
Thyroid Disorders ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism ◽  
Early Administration ◽  
Time Period ◽  
Parathyroid Function

Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy.

scholarly journals Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy

2018 ◽  
Vol 178 (1) ◽  
pp. 103-111 ◽  
Author(s):  
Inés Villarroya-Marquina ◽  
Juan Sancho ◽  
Leyre Lorente-Poch ◽  
Lander Gallego-Otaegui ◽  
Antonio Sitges-Serra
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Common Adverse Effect ◽  
Parathyroid Glands ◽  
Permanent Hypoparathyroidism ◽  
Serum Calcium Concentration ◽  
Parathyroid Function

Objective Hypocalcaemia is the most common adverse effect after total thyroidectomy. It recovers in about two-thirds of the patients within the first postoperative month. Little is known, however, about recovery of the parathyroid function (RPF) after this time period. The aim of the present study was to investigate the time to RPF in patients with protracted (>1 month) hypoparathyroidism after total thyroidectomy. Design Cohort prospective observational study. Methods Adult patients undergoing total thyroidectomy for goitre or thyroid cancer. Cases with protracted hypoparathyroidism were studied for RPF during the following months. Time to RPF and variables associated with RPF or permanent hypoparathyroidism were recorded. Results Out of 854 patients undergoing total thyroidectomy, 142 developed protracted hypoparathyroidism. Of these, 36 (4.2% of the entire cohort) developed permanent hypoparathyroidism and 106 recovered: 73 before 6 months, 21 within 6–12 months and 12 after 1 year follow-up. Variables significantly associated with RPF were the number of parathyroid glands remaining in situ (not autografted nor inadvertently resected) and a serum calcium concentration >2.25 mmol/L at one postoperative month. Late RPF (>6 months) was associated with surgery for thyroid cancer. RPF was still possible after one year in patients with four parathyroid glands preserved in situ and serum calcium concentration at one month >2.25 mmol/L. Conclusions Permanent hypoparathyroidism should not be diagnosed in patients requiring replacement therapy for more than six months, especially if the four parathyroid glands were preserved.

Late Recovery of Parathyroid Function after Total Thyroidectomy in Children and Adults: Is There a Difference?

2021 ◽  
pp. 1-9
Author(s):  
Mechteld C. de Jong ◽  
Leyre Lorente-Poch ◽  
Joan Sancho-Insenser ◽  
Virginia Rozalén García ◽  
Caroline Brain ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Young Patients ◽  
Vitamin D Supplementation ◽  
Parathyroid Function ◽  
Centre Database ◽  
Extent Of Surgery ◽  
Late Recovery

Background: Parathyroid failure after total thyroidectomy is the commonest adverse event amongst both children and adults. The phenomenon of late recovery of parathyroid function, especially in young patients with persistent hypoparathyroidism, is not well understood. This study investigated differences in rates of parathyroid recovery in children and adults and factors influencing this. Methods: A joint dual-centre database of patients who underwent a total thyroidectomy between 1998 and 2018 was searched for patients with persistent hypoparathyroidism, defined as dependence on oral calcium and vitamin D supplementation at 6 months. Demographic, surgical, pathological, and biochemical data were collected and analysed. <F00_Regular>Parathyroid Glands Remaining</F00_Regular> in Situ (PGRIS) score was calculated. Results: Out of 960 patients who had total thyroidectomy, 94 (9.8%) had persistent hypoparathyroidism at 6 months, 23 (24.5%) children with a median [range] age 10 [0–17], and 71 (75.5%) adults aged 55 [25–82] years, respectively. Both groups were comparable regarding sex, indication, extent of surgery, and PGRIS score. After a median follow-up of 20 months, the parathyroid recovery rate was identical for children and adults (11 [47.8%] vs. 34 [47.9%]; p = 0.92). Sex, extent, and indication for surgery had no effect on recovery (all p > 0.05). PGRIS score = 4 (HR = 0.48) and serum calcium >2.25 mmol/L (HR = 0.24) at 1 month were associated with a decreased risk of persistent hypoparathyroidism on multivariate analysis (p < 0.05). Conclusion: Almost half of patients recovered from persistent hypoparathyroidism after 6 months; therefore, the term persistent instead of permanent hypoparathyroidism should be used. Recovery rates of parathyroid function in children and adults were similar. Regardless of age, predictive factors for recovery were PGRIS score = 4 and a serum calcium >2.25 mmol/L at 1 month.

scholarly journals Effect of autotransplantation of a parathyroid gland on hypoparathyroidism after total thyroidectomy

2018 ◽  
Vol 7 (2) ◽  
pp. 286-294 ◽  
Author(s):  
Anping Su ◽  
Yanping Gong ◽  
Wenshuang Wu ◽  
Rixiang Gong ◽  
Zhihui Li ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Parathyroid Gland ◽  
Central Neck Dissection ◽  
Parathyroid Glands ◽  
Central Neck ◽  
Permanent Hypoparathyroidism ◽  
Papillary Thyroid ◽  
Transient Hypoparathyroidism

Background The effect of parathyroid autotransplantation on hypoparathyroidism is not fully understood. The purpose of the study was to determine the effect of autotransplantation of a parathyroid gland on the incidence of hypoparathyroidism and recovery of parathyroid function at 6 months after total thyroidectomy with central neck dissection for papillary thyroid carcinoma. Methods All patients with autotransplantation of a parathyroid gland (no inadvertent parathyroidectomy) (group A), in situ preservation of all parathyroid glands (no autotransplantation and inadvertent parathyroidectomy) (group B) or inadvertent removal of a parathyroid gland (no autotransplantation) (group C) who underwent first-time total thyroidectomy with central neck dissection for papillary thyroid carcinoma between January 2013 and June 2016 were included retrospectively. Results Of the 702 patients, 383, 297 and 22 were respectively included in the groups A, B and C. The overall rates of transient and permanent hypoparathyroidism were 37.6% and 1.0%. The incidence of transient hypoparathyroidism was 43.9, 29.0 and 45.5% (A vs B, P = 0.000; A vs C, P = 1.000), and the incidence of permanent hypoparathyroidism was 1.0, 0.7 and 4.5% (P > 0.05). The recovery rates of serum parathyroid hormone levels were 71.4, 72.2 and 66.0% at 6-month follow-up (P > 0.05). Conclusion Autotransplantation of a parathyroid gland does not affect the incidence of permanent hypoparathyroidism, but increases the risk of transient hypoparathyroidism when the rest of parathyroid glands are preserved in situ. At least 2 parathyroid glands should be preserved during total thyroidectomy with central neck dissection to prevent permanent hypoparathyroidism.

Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism

2019 ◽  
Vol 66 (3) ◽  
pp. 195-201
Author(s):  
Pablo Calvo Espino ◽  
José Ángel Rivera Bautista ◽  
Mariano Artés Caselles ◽  
Javier Serrano González ◽  
Arturo García Pavía ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Serum Levels ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism

scholarly journals Measurement of serum intact parathyroid hormone concentration 1 day after total thyroidectomy to assess risk of permanent hypoparathyroidism

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092719
Author(s):  
Jianwei Zheng ◽  
Shuyan Cai ◽  
Huimin Song ◽  
Yunlei Wang ◽  
Xiaofeng Han ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism ◽  
Clinical Value ◽  
Predictive Risk Factor ◽  
Patients At Risk ◽  
Ipth Concentration

Objective This study was performed to assess the clinical value of measuring the intact parathyroid hormone (iPTH) concentration 1 day after total thyroidectomy to estimate the occurrence of permanent hypoparathyroidism (pHPP). Methods Data of 546 patients who underwent total thyroidectomy from February 2008 to December 2018 were retrospectively analyzed. Calcium and iPTH concentrations were collected preoperatively and at 1 day and 6 months postoperatively. Logistic regression was used to analyze the correlation between clinical indexes and postoperative pHPP. Results Of the 546 patients, 22 (4.03%) developed pHPP. Multivariate analysis showed that the iPTH and serum calcium concentrations measured 1 day after surgery were independent predictors of the risk of pHPP. An iPTH concentration of 5.51 pg/mL measured 1 day postoperatively was used as the cut-off value, and the area under the curve was 0.956. The risk of pHPP was identified with a sensitivity of 100%, specificity of 85.1%, positive predictive value of 22%, and negative predictive value of 100%. Conclusions The iPTH concentration measured 1 day after total thyroidectomy is closely related to the occurrence of pHPP postoperatively and is an independent predictive risk factor. The postoperative iPTH concentration can be helpful in identifying patients at risk for developing pHPP.

scholarly journals Late Recovery of Parathyroid Function after Total Thyroidectomy: A Case-Control Study

2021 ◽  
Author(s):  
Juan José Díez ◽  
Emma Anda ◽  
Julia Sastre ◽  
Begoña Pérez Corral ◽  
Cristina Álvarez-Escolá ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Replacement Therapy ◽  
Clinical Characteristics ◽  
Case Control Study ◽  
Case Control ◽  
Parathyroid Function ◽  
Postoperative Hypoparathyroidism ◽  
Late Recovery ◽  
Control Study

AbstractThe clinical characteristics of patients with postoperative hypoparathyroidism who recover parathyroid function more than 12 months after surgery have not been studied. We aimed to evaluate whether the intensity of replacement therapy with calcium and calcitriol is related to the late recovery of parathyroid function. We compared the demographic, surgical, pathological, and analytical features of two groups of patients: cases, i. e., late recovery patients (those who recover parathyroid function>1 year after thyroidectomy, n=40), and controls, i. e., patients with permanent hypoparathyroidism (n=260). Replacement therapy with calcium and calcitriol was evaluated at discharge of surgery, 3–6 months, 12 months, and last visit. No significant differences were found in clinical, surgical, pathological, or analytical characteristics between cases and controls. The proportion of cases who required treatment with calcium plus calcitriol at 12 months was significantly lower than that found in controls (p<0.001). Furthermore, daily calcium and calcitriol doses in controls were significantly higher than those in cases at 3–6 months (p=0.014 and p=0.004, respectively) and at 12 months (p<0.001 and p=0.043, respectively). In several models of logistic regression analysis therapy with calcium and calcitriol at 12 months was negatively related to late recovery of parathyroid function. Although delayed recuperation of parathyroid function after total thyroidectomy is uncommon (13%), follow-up beyond 12 months is necessary in patients with postoperative hypoparathyroidism, especially in those whose needs of treatment with Ca and calcitriol are reducing over time.

scholarly journals Thyroid autotransplantation following total thyroidectomy in benign thyroid disorders: a new technique to avoid postoperative hypothyroidism

2019 ◽  
Vol 6 (7) ◽  
pp. 2267
Author(s):  
Ahmed Mohamed Gamal ◽  
Nagm Eldin Abu Elnaga ◽  
Mahmoud Thabet Ayoub ◽  
Abdel Radi Abdel Salam Farghally
Keyword(s):  
Hormone Replacement Therapy ◽  
Total Thyroidectomy ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Thyroid Tissue ◽  
Thyroid Disorders ◽  
Thyroid Function Tests ◽  
Thyroid Scan ◽  
Benign Thyroid Disorders ◽  
Benign Thyroid

Background: Although total thyroidectomy has become the operation of choice in treatment of BMNG, it leads to permanent hypothyroidism which lead the patient to take a lifelong exogenous hormone replacement therapy, which involves daily administration of levothyroxine at a dose that must be in close follow-up in terms of thyroid hormone levels. In addition, reaching euthyroid status using hormone replacement therapy can be affected in  presence of other medical problems that interfere with absorption of the drug as mal-absorption syndrome. When all these are considered, there is a necessity of a novel method to avoid the occurrence of postoperative hypothyroidism.Methods: A case series prospective study carried out over 30 patients with benign thyroid disorders for whom total thyroidectomy is indicated to evaluate the capacity of auto-implanted thyroid tissue in achieving an euthyroid state without any need for life-long hormone replacement therapy. Postoperative Assessment consists of repeated thyroid function tests and thyroid scan with complementary SPECT/CT.Results: significant gradual increase in serum levels of T3 and T4 with corresponding decrease in TSH levels returning to normal levels 6-9 months postoperatively. Thyroid scan with complementary SPECT/CT was done for 15 patients to evaluate the functional capacity of the thyroid implant.  Among the 15 patients, 13 patients have functioning thyroid implant (success percent: 6.6%). whereas 2 patients show non functioning thyroid implant (failure percent: 13.3%).Conclusions: Thyroid Auto-transplantation following total thyroidectomy in benign thyroid disorders is an effective method to prevent postoperative hypothyroidism.

INCIDENCE, RISK FACTORS, AND CLINICAL IMPLICATIONS OF DELAYED HYPOPARATHYROIDISM ON POSTOPERATIVE DAY TWO FOLLOWING TOTAL THYROIDECTOMY FOR PAPILLARY THYROID CARCINOMA

2020 ◽  
Vol 26 (7) ◽  
pp. 768-776
Author(s):  
Seung Taek Lim ◽  
Ye Won Jeon ◽  
Hongki Gwak ◽  
Young Jin Suh
Keyword(s):  
Risk Factors ◽  
Parathyroid Hormone ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Significant Risk ◽  
Clinical Implications ◽  
Intact Parathyroid Hormone ◽  
Permanent Hypoparathyroidism ◽  
Papillary Thyroid

Objective: This study aimed to investigate the incidence rates, risk factors, and clinical implications of delayed hypoparathyroidism on postoperative day 2 (POD-2) after total thyroidectomy in patients with papillary thyroid carcinoma. Methods: This study included 410 patients with normal serum intact parathyroid hormone (iPTH) and calcium levels on postoperative day 1 (POD-1) who were classified into 2 groups according to the presence or absence of delayed hypoparathyroidism on POD-2. Results: Of the 410 patients, 98 experienced delayed hypoparathyroidism on POD-2 (23.9%). The significant risk factors for delayed hypoparathyroidism on POD-2 included female gender, age older than 45 years, central lymph node dissection, increased number of excised lymph nodes, and low POD-1 versus preoperative iPTH ratios. Additionally, delayed hypoparathyroidism on POD-2 was found to be a significant risk factor for hypocalcemia on POD-2 and permanent hypoparathyroidism. Conclusion: Prophylactic calcium supplementation and long-term surveillance for permanent hypoparathyroidism should be considered in patients with risk factors for delayed hypoparathyroidism on POD-2. Abbreviations: CI = confidence interval; iPTH = intact parathyroid hormone; OR = odds ratio; POD-1 = postoperative day 1; POD-2 = postoperative day 2; PTC = papillary thyroid carcinoma; ROC = receiver operating characteristic

Parathyroid Autotransplantation in Patients Undergoing a Total Thyroidectomy: A Review of 261 Patients

1994 ◽  
Vol 111 (3P1) ◽  
pp. 258-264 ◽  
Author(s):  
Regina P. Walker ◽  
Edward Paloyan ◽  
Timothy F. Kelley ◽  
Chellam Gopalsami ◽  
Harriet Jarosz
Keyword(s):  
Vitamin D ◽  
Total Thyroidectomy ◽  
Blood Supply ◽  
Frozen Section ◽  
Parathyroid Tissue ◽  
Vitamin D Supplementation ◽  
Parathyroid Glands ◽  
Parathyroid Autotransplantation ◽  
Parathyroid Function

Parathyroid autotransplantation was first described in 1907 by Halsted. However, this simple and effective method of preserving parathyroid function has been used with increasing frequency only during the past 25 years. Beginning in the late 1960s, our group has transplanted normal parathyroid tissue into the ipsilateral sternocleidomastoid muscle whenever these glands could not be preserved in situ with adequate blood supply. In addition, if the blood supply of all four parathyroid glands appeared compromised, cryopreservation of parathyroid tissue was performed in case the autotransplanted tissue did not function after surgery. Since 1970, 393 patients underwent a total thyroidectomy. Parathyroid glands that could not be saved in situ were biopsied to confirm their identity by frozen section and then autotransplanted. Of the 393 patients who underwent a total thyroidectomy, 261 patients required transplantation of one or more glands. Among those 261 patients who underwent selective parathyroid autotransplantation, 33 (13%) required temporary calcium and vitamin D supplementation. Of these 33 patients, 2 (less than 1%) had permanent hypoparathyroidism and are receiving long-term vitamin D therapy.

scholarly journals Selective Parathyroid Autotransplantation During Total Thyroidectomy for Papillary Thyroid Carcinoma: A Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuxuan Qiu ◽  
Zhichao Xing ◽  
Yuanfan Qian ◽  
Yuan Fei ◽  
Yan Luo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Central Neck Dissection ◽  
Permanent Hypoparathyroidism ◽  
Papillary Thyroid ◽  
Parathyroid Autotransplantation ◽  
Long Run ◽  
Parathyroid Function

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 (&gt;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 &lt; 0.0001; OR, 2.983; 95% CI, 2.336–3.810; P &lt; 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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