Risk factors of hypoparathyroidism after bilateral total thyroidectomy

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

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Identification of Intermediate- to High-Risk Papillary Thyroid Carcinoma Patients Who May Be Safely Managed without the Performance of Delayed Stimulated Thyroglobulin Measurements following Total Thyroidectomy and Radioactive Iodine Therapy

International Journal of Endocrinology ◽

10.1155/2015/318916 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7

Author(s):

Kyung-Hee Kim ◽

Min-Hee Kim ◽

Ye-Jee Lim ◽

Ihn Suk Lee ◽

Ja-Seong Bae ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Total Thyroidectomy ◽

Radioactive Iodine ◽

Significant Risk ◽

Disease Status ◽

Radioactive Iodine Therapy ◽

Papillary Thyroid ◽

Independent Risk Factors

Background. The measurement of stimulated thyroglobulin (sTg) after total thyroidectomy and remnant radioactive iodine (RAI) ablation is the gold standard for monitoring disease status in patients with papillary thyroid carcinomas (PTCs). The aim of this study was to determine whether sTg measurement during follow-up can be avoided in intermediate- and high-risk PTC patients.Methods. A total of 346 patients with PTCs with an intermediate or high risk of recurrence were analysed. All of the patients underwent total thyroidectomy as well as remnant RAI ablation and sTg measurements. Preoperative and postoperative parameters were included in the analysis.Results. Among the preoperative parameters, age below 45 years and preoperative Tg above 19.4 ng/mL were significant risk factors for predicting detectable sTg during follow-up. Among the postoperative parameters, thyroid capsular invasion, lymph node metastasis, and ablative Tg above 2.9 ng/mL were independently correlated with a detectable sTg range. The combination of ablative Tg less than 2.9 ng/mL with pre- and postoperative independent risk factors for detectable sTg increased the negative predictive value for detectable sTg up to 98.5%.Conclusions. Based on pre- and postoperative parameters, a substantial proportion of patients with PTCs in the intermediate- and high-risk classes could avoid aggressive follow-up measures.

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Peer review report 2 on “Predictors and risk factors of hypoparathyroidism after total thyroidectomy”

International Journal of Surgery ◽

10.1016/j.ijsu.2016.09.034 ◽

2016 ◽

Vol 25 ◽

pp. 334

Author(s):

Kumar Alok Pathak

Keyword(s):

Risk Factors ◽

Total Thyroidectomy ◽

Peer Review

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Peer review report 1 on “Predictors and risk factors of hypoparathyroidism after total thyroidectomy”

International Journal of Surgery ◽

10.1016/j.ijsu.2016.09.035 ◽

2016 ◽

Vol 25 ◽

pp. 356

Keyword(s):

Risk Factors ◽

Total Thyroidectomy ◽

Peer Review

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Case series on the on the onset of transient hypo-parathyroidism after thyroidectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20175112 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3849

Author(s):

Kannan Rajendran ◽

S. Saravana Kumar ◽

Robinson Smile

Keyword(s):

Risk Factors ◽

Total Thyroidectomy ◽

Serum Calcium ◽

Statistical Significance ◽

Case Series ◽

Medical College ◽

Number Of Patients ◽

Common Operation ◽

Gandhi Medical College

Background: Surgery for thyroid disorders is the common operation in general surgery and total thyroidectomy is widely performed both for carcinoma as well as benign bilateral diseases of the thyroid and the most common complication is transient hypocalcaemia. A preliminary study was conducted to assess the risk factors for transient hypocalcaemia in our hospital.Methods: This was a prospective observational study conducted from February 2013 to April 2014 at the Mahatma Gandhi Medical College and Research Institute, Pondicherry and have included all patients undergone any type of thyroid surgery with a normal pre-operative serum calcium level. After initial clinical assessment, blood samples were drawn for estimation of thyroid function and serum calcium and albumin. Postoperative hypocalcemia was assessed by eliciting Chovstek’s and Troussea’s sign and biochemically estimating serum calcium and albumin at 6,24, and 24 hours intervals and 1st and 3rd months during follow-up. The risk factors involved are also studied like sex, age, type of thyroidectomy, identification of parathyroid, Identification of recurrent laryngeal nerve and their histology.Results: A total of 50 patients who underwent thyroidectomy were included in the study. The hypocalcemia occurred in 28% of patients studied showed that 66.7% of patients developed hypocalcemia at 48-72 hours. There was no statistical significance for the parameters of age or gender, benign and malignant conditions of thyroid. The analysis of type surgery performed showed a significant number of patients developing transient hypocalcaemia after near or total thyroidectomy (p-0.002).Conclusions: The present study, though consisted of a small group of patients has shown that transient hypocalcaemia after near or total thyroidectomy occurs in early post-operative days. Hence, on an average 2-5 days of hospital stay is mandatory. Near total or total thyroidectomy is a risk factor. Early diagnosis and replacement with calcium intra-venous reduce the morbidity and mortality of hypocalcaemia.

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