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Endocrine

pp 1–11 | Cite as

Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis

  • Juan J. DíezEmail author
  • Emma Anda
  • Julia Sastre
  • Begoña Pérez Corral
  • Cristina Álvarez-Escolá
  • Laura Manjón
  • Miguel Paja
  • Marcel Sambo
  • Piedad Santiago Fernández
  • Concepción Blanco Carrera
  • Juan C Galofré
  • Elena Navarro
  • Carles Zafón
  • Eva Sanz
  • Amelia Oleaga
  • Orosia Bandrés
  • Sergio Donnay
  • Ana Megía
  • María Picallo
  • Cecilia Sánchez Ragnarsson
  • Gloria Baena-Nieto
  • José Carlos Fernández García
  • Beatriz Lecumberri
  • Manel Sahún de la Vega
  • Ana R. Romero-Lluch
  • Pedro Iglesias
Original Article

Abstract

Purpose

The prevalence of postoperative hypoparathyroidism has been studied in registries and in surgical series with highly variable and imprecise results. However, the frequency of this hormonal deficiency in the clinical practice of endocrinologists is not known with accuracy. We aimed to assess the prevalence and risk factors of hypoparathyroidism in patients undergoing total thyroidectomy in Spain.

Methods

We designed a retrospective, multicentre and nation-wide protocol including all patients with total thyroidectomy who were seen in the endocrinology clinic of the participant centers from January to March 2018. Prevalence of hypoparathyroidism was evaluated at discharge of surgery, 3–6 months after surgery, 12 months after surgery and at last visit. Twenty hospitals participated in the study.

Results

Of 1792 patients undergoing total thyroidectomy, 866 (48.3%) developed postoperative hypoparathyroidism at discharge of surgery. Most of them recover parathyroid function over time. Prevalence of hypoparathyroidism at 3–6 months, 12 months and at last visit was 22.9%, 16.7% and 14.5%, respectively. The risk of developing definitive hypoparathyroidism was related to the presence of parathyroid tissue at histology, lymph node dissection, and two-stage thyroidectomy. Patients with thyroid cancer, with higher postoperative calcium levels and treated by expert surgical teams exhibited lower risk of developing permanent hypoparathyroidism.

Conclusions

Although most patients with postsurgical hypoparathyroidism recover parathyroid function, the prevalence of permanent disease in clinical practice is non negligible (14.5%). Postoperative calcium, extent and timing of surgery, the presence of cancer, expert surgical team, and parathyroid tissue at histology are predictors of permanent hypoparathyroidism.

Keywords

Thyroidectomy Hypoparathyroidism Hypocalcemia Thyroid surgery Prevalence Risk factors 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    J. Bollerslev, L. Rejnmark, C. Marcocci, D.M. Shoback, A. Sitges-Serra, W. van Biesen, O.M. Dekkers, European Society of Endocrinology, European society of endocrinology clinical guideline: treatment of chronic hypoparathyroidism in adults. Eur. J. Endocrinol. 173, G1–G20 (2015)CrossRefGoogle Scholar
  2. 2.
    M.L. Brandi, J.P. Bilezikian, D. Shoback, R. Bouillon, B.L. Clarke, R.V. Thakker, A.A. Khan, J.T. Potts Jr., Management of hypoparathyroidism: Summary statement and guidelines. J. Clin. Endocrinol. Metab. 101, 2273–2283 (2016)CrossRefGoogle Scholar
  3. 3.
    B.L. Clarke, E.M. Brown, M.T. Collins, H. Jüppner, P. Lakatos, M.A. Levine, M.M. Mannstadt, J.P. Bilezikian, A.F. Romanischen, R.V. Thakker, Epidemiology and diagnosis of hypoparathyroidism. J. Clin. Endocrinol. Metab. 101, 2284–2299 (2016)CrossRefGoogle Scholar
  4. 4.
    B.L. Clarke, C. Leibson, J. Emerson, J.E. Ransom, H. Lagast, Co-morbid medical conditions associated with prevalent hypoparathyroidism: a population-based study (abstract SA0170). J. Bone Min. Res. 26, S182 (2011)CrossRefGoogle Scholar
  5. 5.
    L. Underbjerg, T. Sikjaer, L. Mosekilde, L. Rejnmark, Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J. Bone Miner. Res. 28, 2277–2285 (2013)CrossRefGoogle Scholar
  6. 6.
    L. Underbjerg, T. Sikjaer, L. Mosekilde, L. Rejnmark, The epidemiology of nonsurgical hypoparathyroidism in Denmark: A nationwide case finding study. J. Bone Miner. Res. 30, 1738–1744 (2015)CrossRefGoogle Scholar
  7. 7.
    B.C. Stack Jr, D.N. Bimston, D.L. Bodenner, E.M. Brett, H. Dralle, L.A. Orloff, J. Pallota, S.K. Snyder, R.J. Wong, G.W. Randolph, American Association of Clinical Endocrinologists and American College of Endocrinology disease state clinical review: postoperative hypoparathyroidism - Definitions and management. Endocr. Pract. 21, 674–685 (2015)CrossRefGoogle Scholar
  8. 8.
    P. Iglesias, J.J. Díez, Endocrine complications of surgical treatment of thyroid cancer: an update. Exp. Clin. Endocrinol. Diabetes 125, 497–505 (2017)CrossRefGoogle Scholar
  9. 9.
    Y.S. Lee, K.H. Nam, W.Y. Chung, H.S. Chang, C.S. Park, Postoperative complications of thyroid cancer in a single center experience. J. Korean Med. Sci. 25, 541–545 (2010)CrossRefGoogle Scholar
  10. 10.
    L. Youngwirth, J. Benavidez, R. Sippel, H. Chen, Parathyroid hormone deficiency after total thyroidectomy: incidence and time. J. Surg. Res. 163, 69–71 (2010)CrossRefGoogle Scholar
  11. 11.
    M.I. Khan, S.G. Waguespack, M.I. Hu, Medical management of postsurgical hypoparathyroidism. Endocr. Pract. 17, 18–25 (2011)CrossRefGoogle Scholar
  12. 12.
    D. Giordano, R. Valcavi, G.B. Thompson, C. Pedroni, L. Renna, P. Gradoni, V. Barbieri, Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 22, 911–917 (2012)CrossRefGoogle Scholar
  13. 13.
    S.H. Paek, Y.M. Lee, S.Y. Min, S.W. Kim, K.W. Chung, Y.K. Youn, Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer. World J. Surg. 37, 94–101 (2013).CrossRefGoogle Scholar
  14. 14.
    A. Puzziello, L. Rosato, N. Innaro, G. Orlando, N. Avenia, G. Perigli, P.G. Calò, M. De Palma, Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine 47, 537–542 (2014)CrossRefGoogle Scholar
  15. 15.
    O. Edafe, R. Antakia, N. Laskar, L. Uttley, S.P. Balasubramanian, Systematic review and meta-analysis of predictors of post-thyroidectomy hipocalcemia. Br. J. Surg. 101, 307–320 (2014)CrossRefGoogle Scholar
  16. 16.
    K. Ritter, D. Elfenbein, D.F. Schneider, D.F. Schneider, H. Chen, R.S. Sippel, Hypoparathyroidism after total thyroidectomy: incidence and resolution. J. Surg. Res. 197, 348–353 (2015)CrossRefGoogle Scholar
  17. 17.
    X. Wang, T. Xing, T. Wei, J. Zhu, Completion thyroidectomy and total thyroidectomy for differentiated thyroid cancer: comparison and prediction of postoperative hypoparathyroidism. J. Surg. Oncol. 113, 522–525 (2016)CrossRefGoogle Scholar
  18. 18.
    S.A. Hundahl, B. Cady, M.P. Cunningham, I. Mazzaferri, R.F. McKee, J. Rosai, J.P. Shah, A.M. Fremgen, A.K. Stewart, S. Hölzer, Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer 89, 202–217 (2000)CrossRefGoogle Scholar
  19. 19.
    R. Asari, C. Passler, K. Kaczirek, C. Scheuba, B. Niederle, Hypoparathyroidism after total thyroidectomy: a prospective study. Arch. Surg. 143, 132–137 (2008).CrossRefGoogle Scholar
  20. 20.
    A. Bergenfelz, S. Jansson, A. Kristofferson, H. Martenson, E. Reihnér, G. Wallin, I. Lausen, Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3660 patients. Lange. Arch. Surg. 393, 667–673 (2008)CrossRefGoogle Scholar
  21. 21.
    J.J. Jeong, S.W. Kang, J.S. Yun, T.Y. Sung, S.C. Lee, Y.S. Lee, K.H. Nam, H.S. Chang, W.Y. Chung, C.S. Park, Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. J. Surg. Oncol. 100, 477–480 (2009)CrossRefGoogle Scholar
  22. 22.
    D. Shoback, Clinical practice. Hypoparathyroidism. N. Engl. J. Med. 359, 391–403 (2008)CrossRefGoogle Scholar
  23. 23.
    L.A. Orloff, S.M. Wiseman, V.J. Bernet, T.J. Faheylll, A.R. Shaha, M.L. Shindo, S.K. Snyder, B.C. Stack Jr, J.B. Sunwoo, M.B. Wang, American Thyroid Association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults. Thyroid 28, 830–841 (2018)CrossRefGoogle Scholar
  24. 24.
    S.M. Kim, H.K. Kim, K.J. Kim, H.J. Chang, B.W. Kim, Y.S. Lee, H.S. Chang, C.S. Park, Recovery from permanent hypoparathyroidism after total thyroidectomy. Thyroid 25, 830–833 (2015)CrossRefGoogle Scholar
  25. 25.
    I. Villarroya-Marquina, J. Sancho, L. Lorente-Poch, L. Gallego-Otaegui, A. Sitges-Serra, Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy. Eur. J. Endocrinol. 178, 103–111 (2018)CrossRefGoogle Scholar
  26. 26.
    J. Powers, K. Joy, A. Ruscio, H. Lagast, Prevalence and incidence of hypoparathyroidism in the United States using a large claims database. J. Bone Miner. Res. 28, 2570–2576 (2013)CrossRefGoogle Scholar
  27. 27.
    A. Sitges-Serra, S. Ruiz, M. Girvent, H. Manjón, J.P. Dueñas, J.J. Sancho, Outcome of protracted hypoparathyroidism after total thyroidectomy. Br. J. Surg. 97, 1687–1695 (2010)CrossRefGoogle Scholar
  28. 28.
    L. Lorente-Poch, J.J. Sancho, J.L. Muñoz-Nova, P. Sánchez-Velázquez, A. Sitges-Serra, Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 4, 82–90 (2015)PubMedPubMedCentralGoogle Scholar
  29. 29.
    O. Thomusch, A. Machens, C. Sekulla, J. Ukkat, M. Brauckhoff, H. Dralle, The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133, 180–185 (2003)CrossRefGoogle Scholar
  30. 30.
    Y. Erbil, A. Bozbora, N. Ozbey, H. Issever, F. Aral, S. Ozarmagan, S. Tezelman, Predictive value of age and serum parathormone and vitamin D3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch. Surg. 142, 1182–1187 (2007)CrossRefGoogle Scholar
  31. 31.
    P. Hallgrimsson, E. Nordenström, M. Almquist, A.O. Bergenfelz, Risk factors for medically treated hypocalcemia after surgery for Graves’ disease: a Swedish multicenter study of 1157 patients. World J. Surg. 36, 1933–1942 (2012)CrossRefGoogle Scholar
  32. 32.
    L. Lorente-Poch, J.J. Sancho, S. Ruiz, A. Sitges-Serra, Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br. J. Surg. 102, 359–367 (2015)CrossRefGoogle Scholar
  33. 33.
    B.H. Lang, P.C. Yih, K.K. Ng, A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J. Surg. 36, 1300–1306 (2012)CrossRefGoogle Scholar
  34. 34.
    C.Y. Lo, Parathyroid autotransplantation during thyroidectomy. ANZ J. Surg. 72, 902–907 (2002)CrossRefGoogle Scholar
  35. 35.
    J.A. Pereira, J. Jimeno, J. Miquel, M. Iglesias, A. Munné, J.J. Sancho, A. Sitges-Serra, Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 138, 1095–1100 (2005).CrossRefGoogle Scholar
  36. 36.
    J.A. Olson Jr, M.K. DeBenedetti, D.S. Baumann, S.A. Wells Jr, Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann. Surg. 223, 472–478 (1996).CrossRefGoogle Scholar
  37. 37.
    C.Y. Lo, S.C. Tam, Parathyroid autotransplantation during thyroidectomy: documentation of graft function. Arch. Surg. 136, 1381–1385 (2001)CrossRefGoogle Scholar
  38. 38.
    M. Almquist, P. Hallgrimsson, E. Nordenström, A. Bergenfelz, Prediction of permanent hypoparathyroidism after total thyroidectomy. World J. Surg. 38, 2613–2620 (2014)CrossRefGoogle Scholar
  39. 39.
    F. Pattou, F. Combemale, S. Fabre, B. Carnaille, M. Decoulx, J.L. Wemeau, A. Racadot, C. Prove, Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J. Surg. 22, 718–724 (1998)CrossRefGoogle Scholar
  40. 40.
    U. Ohman, P.O. Granberg, B. Lindell, Function of the parathyroid glands after total thyroidectomy. Surg. Gynecol. Obstet. 146, 773–778 (1978)PubMedGoogle Scholar
  41. 41.
    R. Bergamaschi, G. Becouarn, J. Ronceray, J.P. Arnaud, Morbidity of thyroid surgery. Am. J. Surg. 176, 71–75 (1998)CrossRefGoogle Scholar
  42. 42.
    O. Thomusch, A. Machens, C. Sekulla, J. Ukkat, H. Lippert, I. Gastinger, H. Dralle, Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J. Surg. 24, 1335–1341 (2000)CrossRefGoogle Scholar
  43. 43.
    W.K. Cheah, C. Arici, P.H. Ituarte, A.E. Siperstein, Q.Y. Duh, O.H. Clark, Complications of neck dissection for thyroid cancer. World J. Surg. 26, 1013–1016 (2002)CrossRefGoogle Scholar
  44. 44.
    J.F. Henry, L. Gramatica, A. Denizot, A. Kvachenyuk, M. Puccini, T. Defechereux, Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Lange. Arch. Surg. 383, 167–169 (1998)Google Scholar
  45. 45.
    M. Hermann, J. Ott, R. Promberger, F. Kober, M. Karik, M. Freissmuth, Kinetics of serum parathyroid hormone during and after thyroid surgery. Br. J. Surg. 95, 1480–1487 (2008)CrossRefGoogle Scholar
  46. 46.
    A. Sitges-Serra, J. Gómez, M. Barczynski, L. Lorente-Poch, M. Iacobone, J. Sancho, A nomogram to predict the likelihood of permanent hypoparathyroidism after total thyroidectomy based on delayed serum calcium and iPTH measurements. Gland Surg. 6(Suppl 1), S11–S19 (2017)CrossRefGoogle Scholar
  47. 47.
    O. Cavicchi, O. Piccin, U. Caliceti, A. De Cataldis, R. Pasquali, A.R. Ceroni, Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol. Head. Neck Surg. 137, 654–658 (2007)CrossRefGoogle Scholar
  48. 48.
    I. Nawrot, A. Pragacz, K. Pragacz, W. Grzesiuk, M. Barczynski, Total thyroidectomy is associated with increased prevalence of permanent hypoparathyroidism. Med. Sci. Monit. 20, 1675–1681 (2014)CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  • Juan J. Díez
    • 1
    • 20
    Email author
  • Emma Anda
    • 2
  • Julia Sastre
    • 3
  • Begoña Pérez Corral
    • 4
  • Cristina Álvarez-Escolá
    • 5
  • Laura Manjón
    • 6
  • Miguel Paja
    • 7
  • Marcel Sambo
    • 8
  • Piedad Santiago Fernández
    • 9
  • Concepción Blanco Carrera
    • 10
  • Juan C Galofré
    • 11
  • Elena Navarro
    • 12
  • Carles Zafón
    • 13
  • Eva Sanz
    • 13
  • Amelia Oleaga
    • 7
  • Orosia Bandrés
    • 14
  • Sergio Donnay
    • 15
  • Ana Megía
    • 16
  • María Picallo
    • 8
  • Cecilia Sánchez Ragnarsson
    • 6
  • Gloria Baena-Nieto
    • 17
  • José Carlos Fernández García
    • 18
  • Beatriz Lecumberri
    • 5
  • Manel Sahún de la Vega
    • 19
  • Ana R. Romero-Lluch
    • 12
  • Pedro Iglesias
    • 1
    • 20
  1. 1.Department of EndocrinologyHospital Universitario Ramón y CajalMadridSpain
  2. 2.Department of EndocrinologyComplejo Hospitalario de NavarraPamplonaSpain
  3. 3.Department of EndocrinologyComplejo Hospitalario de ToledoToledoSpain
  4. 4.Department of EndocrinologyComplejo Asistencial Universitario de LeónLeónSpain
  5. 5.Department of EndocrinologyHospital Universitario La PazMadridSpain
  6. 6.Department of EndocrinologyHospital Universitario Central de AsturiasOviedoSpain
  7. 7.Department of EndocrinologyHospital Universitario de BasurtoBilbaoSpain
  8. 8.Department of EndocrinologyHospital Universitario Gregorio MarañónMadridSpain
  9. 9.Department of EndocrinologyComplejo Hospitalario de JaénJaénSpain
  10. 10.Department of EndocrinologyHospital Universitario Príncipe de Asturias, Alcalá de HenaresMadridSpain
  11. 11.Department of EndocrinologyClínica Universidad de NavarraPamplonaSpain
  12. 12.Department of EndocrinologyHospital Universitario Virgen del RocíoSevillaSpain
  13. 13.Department of EndocrinologyHospital Universitari Vall d’HebronBarcelonaSpain
  14. 14.Department of EndocrinologyHospital Royo VillanovaZaragozaSpain
  15. 15.Department of EndocrinologyFundación Hospital de Alcorcón, AlcorcónMadridSpain
  16. 16.Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPVUniversitat Rovira i Virgili, CiberdemTarragonaSpain
  17. 17.Department of EndocrinologyHospital de Jerez, Jerez de la FronteraCádizSpain
  18. 18.Department of EndocrinologyHospital Virgen de la VictoriaMálagaSpain
  19. 19.Department of EndocrinologyHospital Moisès Broggi, Sant Joan DespíBarcelonaSpain
  20. 20.Department of EndocrinologyHospital Universitario Puerta de Hierro MajadahondaMadridSpain

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