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Ning K, Yu Y, Zheng X, Luo Z, Jiao Z, Liu X, Wang Y, Liang Y, Zhang Z, Ye X, Wu W, Bu J, Chen Q, Cheng F, Liu L, Jiang M, Yang A, Wu T, Yang Z. Risk factors of transient and permanent hypoparathyroidism after thyroidectomy: a systematic review and meta-analysis. Int J Surg 2024; 110:5047-5062. [PMID: 38652139 PMCID: PMC11326036 DOI: 10.1097/js9.0000000000001475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/31/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Postoperative hypoparathyroidism (hypoPT) is a common complication following thyroid surgery. However, current research findings on the risk factors for post-thyroid surgery hypoPT are not entirely consistent, and the same risk factors may have different impacts on transient and permanent hypoPT. Therefore, there is a need for a comprehensive study to summarize and explore the risk factors for both transient and permanent hypoPT after thyroid surgery. MATERIALS AND METHODS Two databases (PubMed and Embase) were searched from inception to 2024. The Newcastle-Ottawa Scale was used to rate study quality. Pooled odds ratios were used to calculate the relationship of each risk factor with transient and permanent hypoPT. Subgroup analyses were conducted for hypoPT with different definition-time (6 or 12 months). Publication bias was assessed using Begg's test and Egger's test. RESULTS A total of 19 risk factors from the 93 studies were included in the analysis. Among them, sex and parathyroid autotransplantation were the most frequently reported risk factors. Meta-analysis demonstrated that sex (female vs. male), cN stage, central neck dissection, lateral neck dissection, extent of central neck dissection (bilateral vs. unilateral), surgery [total thyroidectomy (TT) vs. lobectomy], surgery type (TT vs. sub-TT), incidental parathyroidectomy, and pathology (cancer vs. benign) were significantly associated with transient and permanent hypoPT. Preoperative calcium and parathyroid autotransplantation were only identified as risk factors for transient hypoPT, while preoperative PTH was a protective factor. Additionally, node metastasis and parathyroid in specimen were associated with permanent hypoPT. CONCLUSION The highest risk of hypoPT occurs in female thyroid cancer patients with lymph node metastasis undergoing TT combined with neck dissection. The key to preventing postoperative hypoPT lies in the selection of surgical approach and intraoperative protection.
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Affiliation(s)
- Kang Ning
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center
| | - Yongchao Yu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center
| | - Xinyi Zheng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Zhenyu Luo
- Clinical Medical College, Southwest Medical University
| | - Zan Jiao
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center
| | - Xinyu Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Yiyao Wang
- Faculty of Nursing, Southwest Medical University, Luzhou, People's Republic of China
| | - Yarong Liang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Zhuoqi Zhang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Xianglin Ye
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Weirui Wu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Jian Bu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Qiaorong Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Fuxiang Cheng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Lizhen Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou
| | - Mingjie Jiang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center
| | - Ankui Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center
| | - Tong Wu
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center
| | - Zhongyuan Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center
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van Dijk SPJ, van Driel MHE, van Kinschot CMJ, Engel MFM, Franssen GJH, van Noord C, Visser WE, Verhoef C, Peeters RP, van Ginhoven TM. Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia-Related Complications: A Meta-Analysis. Otolaryngol Head Neck Surg 2024; 170:359-372. [PMID: 38013484 DOI: 10.1002/ohn.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/12/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE The aim of this Meta-analysis is to evaluate the impact of different treatment strategies for early postoperative hypoparathyroidism on hypocalcemia-related complications and long-term hypoparathyroidism. DATA SOURCES Embase.com, MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched to September 20, 2022. REVIEW METHODS Articles reporting on adult patients who underwent total thyroidectomy which specified a treatment strategy for postthyroidectomy hypoparathyroidism were included. Random effect models were applied to obtain pooled proportions and 95% confidence intervals. Primary outcome was the occurrence of major hypocalcemia-related complications. Secondary outcome was long-term hypoparathyroidism. RESULTS Sixty-six studies comprising 67 treatment protocols and 51,096 patients were included in this Meta-analysis. In 8 protocols (3806 patients), routine calcium and/or active vitamin D medication was given to all patients directly after thyroidectomy. In 49 protocols (44,012 patients), calcium and/or active vitamin D medication was only given to patients with biochemically proven postthyroidectomy hypoparathyroidism. In 10 protocols (3278 patients), calcium and/or active vitamin D supplementation was only initiated in case of clinical symptoms of hypocalcemia. No patient had a major complication due to postoperative hypocalcemia. The pooled proportion of long-term hypoparathyroidism was 2.4% (95% confidence interval, 1.9-3.0). There was no significant difference in the incidence of long-term hypoparathyroidism between the 3 supplementation groups. CONCLUSIONS All treatment strategies for postoperative hypocalcemia prevent major complications of hypocalcemia. The early postoperative treatment protocol for postthyroidectomy hypoparathyroidism does not seem to influence recovery of parathyroid function in the long term.
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Affiliation(s)
- Sam P J van Dijk
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M H Elise van Driel
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Caroline M J van Kinschot
- Department of Internal Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten F M Engel
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gaston J H Franssen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
| | - W Edward Visser
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tessa M van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Yang H, Tao L. Lymph Node Posterior to the Right Recurrent Laryngeal Nerve Metastasis in Right Lobe T1a Papillary Thyroid Carcinoma: A Retrospective Cohort Study. Cancer Control 2023; 30:10732748221149819. [PMID: 36747345 PMCID: PMC9905024 DOI: 10.1177/10732748221149819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES This study analyzed the incidence and predictors of lymph node posterior to the right recurrent laryngeal nerve metastasis in T1a papillary thyroid carcinoma of the right lobe. METHODS This was a retrospective cohort study. Patients were selected from those who had received surgical treatment for primary papillary thyroid carcinoma between January 2019 and December 2020. The association between clinicopathologic variables and lymph node posterior to the right recurrent laryngeal nerve metastasis was assessed using univariate and multivariate analyses. Postoperative complications were also described. RESULTS Lymph node posterior to the right recurrent laryngeal nerve metastasis was present in 6.0% of the 402 study patients. It was the most likely to occur when there were other lymph node metastases, particularly in the lymph node anterior to the recurrent laryngeal nerve. Independent predictors for lymph node posterior to the right recurrent laryngeal nerve metastasis were a tumor size of ≥5.0 mm, a lower pole location, and lymph node anterior to the right recurrent laryngeal nerve metastasis. The rate of persistent vocal cord paralysis was .5%, and no patient developed permanent hypoparathyroidism. CONCLUSIONS Although lymph node posterior to the right recurrent laryngeal nerve metastases of the right lobe T1a papillary thyroid carcinoma is uncommon, the possibility of metastasis should be investigated when there is a positive lymph node anterior to the right recurrent laryngeal nerve in a tumor >5.0 mm in size located in the lower pole. Lymph node posterior to the right recurrent laryngeal nerve dissection is recommended for such tumors.
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Affiliation(s)
- Huijie Yang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China,Huijie Yang, Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, China.
| | - Li Tao
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Nagel K, Hendricks A, Lenschow C, Meir M, Hahner S, Fassnacht M, Wiegering A, Germer CT, Schlegel N. Definition and diagnosis of postsurgical hypoparathyroidism after thyroid surgery: meta-analysis. BJS Open 2022; 6:6683841. [PMID: 36050906 PMCID: PMC9437325 DOI: 10.1093/bjsopen/zrac102] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Postsurgical hypoparathyroidism (PH) is the most frequent complication after thyroid surgery. The aim of this systematic review and meta-analysis is to summarize a unifying definition of PH and to elucidate the best possible approach for early detection of PH. Methods A systematic review of the literature according to the PICO framework using Embase, PUBMED and the Cochrane library was carried out on 1 December 2021 followed by analysis for risk of bias, data extraction and meta-analysis. All studies addressing the definition of postoperative hypoparathyroidism and/or diagnostic approaches for early detection and diagnosis were included. Case reports, commentaries, non-English articles, book chapters and pilot studies and reviews were excluded. Results From 13 704 articles, 188 articles were eligible for inclusion and further analysis. These articles provided heterogeneous definitions of PH. Meta-analysis revealed that postoperative measurements of parathormone (PTH) levels have a higher sensitivity and specificity than intraoperative PTH measurements to predict PH after thyroid surgery. None of the timeframes analysed after surgery within the first postoperative day (POD1) was superior to predict the onset of PH. PTH levels of less than 15 pg/ml and less than 10 pg/ml are both reliable threshold levels to predict the postoperative onset of PH. A relative reduction of mean(s.d.) PTH levels from pre- to postoperative values of 73 (standard deviation 11) per cent may also be predictive for the development of PH. The estimation of calcium levels on POD1 are recommended. Conclusion PH is best defined as an undetectable or inappropriately low postoperative PTH level in the context of hypocalcaemia with or without hypocalcaemic symptoms. PTH levels should be measured after surgery within 24 h. Both threshold levels below 10 and 15 pg/ml or relative loss of PTH before/after thyroid surgery are reliable to predict the onset of PH.
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Affiliation(s)
- Kathrin Nagel
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg , Würzburg , Germany
| | - Anne Hendricks
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg , Würzburg , Germany
| | - Christina Lenschow
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg , Würzburg , Germany
| | - Michael Meir
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg , Würzburg , Germany
| | - Stefanie Hahner
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg , Würzburg , Germany
| | - Martin Fassnacht
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg , Würzburg , Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg , Würzburg , Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg , Würzburg , Germany
| | - Nicolas Schlegel
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg , Würzburg , Germany
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Lu D, Tang E, Yin S, Zhu J, Mo H, Yi Z, Chai F, Sun Y, Li Y, Yin T, Yang Z, Zhang F. Factors in the occurrence and restoration of hypoparathyroidism after total thyroidectomy for thyroid cancer patients with intraoperative parathyroid autotransplantation. Front Endocrinol (Lausanne) 2022; 13:963070. [PMID: 35937810 PMCID: PMC9353036 DOI: 10.3389/fendo.2022.963070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Postoperative hypoparathyroidism (POH) is the most common and important complication for thyroid cancer patients who undergo total thyroidectomy. Intraoperative parathyroid autotransplantation has been demonstrated to be essential in maintaining functional parathyroid tissue, and it has clinical significance in identifying essential factors of serum parathyroid hormone (PTH) levels for patients with parathyroid autotransplantation. This retrospective cohort study aimed to comprehensively investigate influential factors in the occurrence and restoration of POH for patients who underwent total thyroidectomy with intraoperative parathyroid autotransplantation (TTIPA). METHOD This study was conducted in a tertiary referral hospital, with a total of 525 patients who underwent TTIPA. The postoperative serum PTH levels were collected after six months, and demographic characteristics, clinical features and associated operative information were analyzed. RESULTS A total of 66.48% (349/525) of patients who underwent TTIPA were diagnosed with POH. Multivariate logistic regression indicated that Hashimoto's thyroiditis (OR=1.93, 95% CI: 1.09-3.42), P=0.024), the number of transplanted parathyroid glands (OR=2.70, 95% CI: 1.91-3.83, P<0.001) and postoperative blood glucose levels (OR=1.36, 95% CI: 1.06-1.74, P=0.016) were risk factors for POH, and endoscopic surgery (OR=0.39, 95% CI: 0.22-0.68, P=0.001) was a protective factor for POH. Multivariate Cox regression indicated that PTG autotransplantation patients with same-side central lymph node dissection (CLND) (HR=0.50; 95% CI: 0.34-0.73, P<0.001) demonstrated a longer time for increases PTH, and female patients (HR=1.35, 95% CI: 1.00-1.81, P=0.047) were more prone to PTH increases. Additionally, PTG autotransplantation with same-side CLND (HR=0.56, 95% CI: 0.38-0.82, P=0.003) patients had a longer time to PTH restoration, and patients with endoscopic surgery (HR=1.54, 95% CI: 1.04-2.28, P=0.029) were more likely to recover within six months. CONCLUSION High postoperative fasting blood glucose levels, a large number of transplanted PTGs, open surgery and Hashimoto's thyroiditis are risk factors for postoperative POH in TTIPA patients. Elevated PTH levels occur earlier in female patients and patients without CLND on the transplant side. PTH returns to normal earlier in patients without CLND and endoscopic surgery on the transplant side.
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Affiliation(s)
- Dengwei Lu
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
| | - Enjie Tang
- Epidemiology Department, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Supeng Yin
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Junping Zhu
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Hongbiao Mo
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Ziying Yi
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Fan Chai
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Yizeng Sun
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Yao Li
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Tingjie Yin
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
| | - Zeyu Yang
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
- *Correspondence: Fan Zhang, ; Zeyu Yang,
| | - Fan Zhang
- Breast and Thyroid Surgical Department, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicinel, Chongqing Medical University, Chongqing, China
- *Correspondence: Fan Zhang, ; Zeyu Yang,
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