Risk factors for hypoparathyroidism after thyroidectomy

doi:10.16139/j.1007-9610.2020.02.008

Abstract

Abstract:

Objective: To analyze the risk factors for hypoparathyroidism following thyroidectomy. Methods: Data of patients after thyroidectomy were collected retrospectively in Luwan Branch Ruijin Hospital Shanghai Jiao Tong University School of Medicine from January 2015 to December 2017. Demographic and surgical data with perioperative laboratory indexes were analyzed. Logistic regression was used to analyze the risk factors associated with transient (less than 6 months after surgery) and permanent (6 months after surgery) hypoparathyroidism. Results: We collected 1 381 patients with age (47.8±13.0) years old including 343 (24.84%) males and 1 038 (75.16%) females in this study. There were 456 cases (33.02%) with transient hypoparathyroidism and 21 cases (1.52%) with permanent hypoparathyroidism. Multivariate analysis showed that the risk factors associated with transient hypoparathyroidism were female(P<0.001, OR=2.049), bilateral thyroidectomy (P<0.001, OR=2.999), lymph node dissection (P=0.001, OR=1.673), operative time (P=0.043, OR=1.004), maximum diameter of resected thyroid (P=0.040, OR=1.144), preoperative serum calcium (P<0.001, OR=0.018). The risk factors associated with permanent hypoparathyroidism were bilateral thyroidectomy (P<0.046, OR=3.784) and the parathyroid hormone at the first postoperative day (P<0.001, OR=0.064). Conclusions: Female, bilateral thyroidectomy, lymph node dissection, operative time, and preoperative serum calcium were risk factors of transient hypoparathyroidism following thyroidectomy and bilateral thyroidectomy the risk factor of permanent hypoparathyroidism. Parathyroid hormone at the first postoperative day might predict permanent hypoparathyroidism.

Key words: Thyroid surgery, Hypoparathyroidism, Risk factors

CLC Number:

R736.1

WANG Maofei, YUAN Shenyi, YUAN Jianming, LIU Tao, WANG Tianxiang, WANG Mingliang. Risk factors for hypoparathyroidism after thyroidectomy[J]. Journal of Surgery Concepts & Practice, 2020, 25(02): 124-128.

Figures/Tables 4

References 11

[1]	杨雷, 王宁. 甲状腺癌流行病学研究进展[J]. 中华预防医学杂志, 2014, 48(8):744-748.
[2]	Dionigi G, Baeuzzi A, Bertocchi V, et al. Prospectives and surgical usefulness of perioperative parathyroid hormone assay in thyroid surgery[J]. Expert Rev Med Devices, 2008, 5(6):699-704. doi: 10.1586/17434440.5.6.699 URL
[3]	Toniato A, Boschin IM, Piotto A, et al. Thyroidectoma and parathyroid hormone: tracing hypocalcemia-prone patients[J]. Am J Surg, 2008, 196(2):285-288. doi: 10.1016/j.amjsurg.2007.06.036 URL
[4]	Almquist M, Ivarsson K, Nordenström E, et al. Mortality in patients with permanent hypoparathyroidism after total thyroidectomy[J]. Br J Surg, 2018, 105(10):1313-1318. doi: 10.1002/bjs.10843 pmid: 29663312
[5]	Hoback D. Hypoparathyroidism[J]. N Engl J Med, 2008, 359(4):391-403. doi: 10.1056/NEJMcp0803050 URL
[6]	Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia[J]. Br J Surg, 2014, 101(4):307-320. doi: 10.1002/bjs.9384 pmid: 24402815
[7]	李文杰, 徐海倩, 翟立斌. 甲状旁腺微血管解剖与甲状腺囊内切除技术[J]. 中国普外基础与临床杂志, 2013, 20(1):104-107.
[8]	Landry CS, Grubbs EG, Hernandez M, et al. Predictable criteria for selective, rather than routine, calcium supplementation following thyroidectomy[J]. Arch Surg, 2012, 147(4):338-344. doi: 10.1001/archsurg.2011.1406 URL
[9]	吕春晖, 陈海珍, 沈晓卉, 等. 甲状腺全切除术后甲状旁腺功能减退的相关危险因素分析[J]. 中华普通外科杂志, 2017, 32(10):863-867.
[10]	包海东, 巩鹏. 甲状腺全切除术后甲状旁腺功能减退的危险因素及诊治措施[J]. 国际外科学杂志, 2017, 44(2):81-84.
[11]	Wang W, Xia F, Meng C, et al. Prediction of permanent hypoparathyroidism by parathyroid hormone and serum calcium 24 h after thyroidectomy[J]. Am J Otolaryngol, 2018, 39(6):746-750. doi: 10.1016/j.amjoto.2018.08.005 URL

项目	一过性甲状旁腺功能减退组(n=456)	对照组 (n=925)	χ²值	t值	P值
性别男女	76（16.67） 380（83.33）	267（28.86） 658（71.14）	15.889	/	<0.001
年龄（岁）	48.3±12.9	47.7±13.0	/	0.06	0.508
手术时间（min）	92.0±36.6	80.2±34.6	/	4.805	<0.001
甲状腺切除单侧双侧	148（32.46） 308（67.54）	571（61.73） 354（38.27）	68.728	/	<0.001
淋巴结清扫无有	216（47.37） 240（52.63）	570（61.62） 355（38.38）	16.792	/	<0.001
切除肿瘤最大径（mm）	17.7±12.8	18.7±14.1	/	1.046	0.296
切除甲状腺最大径（cm）	4.79±1.32	4.51±1.12	/	-3.397	0.001
术前血钙（mmol/L）	2.39±0.08	2.41±0.08	/	3.810	<0.001
术前PTH（pg/L）	35.5±17.6	35.3±15.4	/	-0.141	0.888

因素	P值	OR值（95%CI）
女性	<0.001	2.049（1.414~2.970）
双侧甲状腺切除	<0.001	2.999（2.209~4.072）
淋巴结清扫	0.001	1.673（1.226~2.282）
手术时间（min）	0.043	1.004（1.000~1.009）
切除甲状腺最大径（cm）	0.040	1.144（1.006~1.300）
术前血钙（mmol/L）	<0.001	0.018（0.003~0.132）

项目	长期甲状旁腺功能减退组(n=21)	对照组 (n=1 360)	χ²值	t值	P值
性别			0.389	/	0.389
男女	4 (19.05%) 17 (80.95%)	339 (24.93%) 1021 (75.07%)
年龄（岁）	47.0±13.8	47.9±12.9	/	-0.325	0.745
手术时间（min）	73.8±28.4	84.3±35.8	/	-1.340	0.181
甲状腺切除			6.847	/	0.009
单侧双侧	5 (23.81%) 16 (16.19%)	714 (52.5%) 646 (47.5%)
淋巴结清扫			1.727	/	0.189
无有	9 (42.86%) 12 (57.14%)	777 (57.13%) 583 (42.87%)
切除肿瘤最大径（mm）	13.0±8.6	18.5±13.7	/	-2.838	0.009
切除甲状腺最大径（cm）	4.74±0.77	4.60±1.21	/	-3.397	0.001
术前血钙（mmol/L）	2.42±0.09	2.40±0.08	/	0.841	0.041
术前PTH（pg/L）	26.7±15.1	35.6±16.1	/	-2.504	0.012
术后第1天血钙（mmol/L）	2.23±0.16	2.29±0.13	/	-1.934	0.053
术后第1天PTH（pg/L）	4.47±4.72	17.9±11.8	/	-5.218	<0.001

因素	P值	OR（95%CI）
双侧甲状腺切除	0.046	3.784（1.002~14.007）
切除肿瘤最大径（mm）	0.063
切除甲状腺最大径（cm）	0.735
术前血钙（mmol/L）	0.631
术前PTH（pg/L）	0.110
术后第1天PTH（pg/L）	<0.001	0.064（0.018~0.228）

[1]	WANG Bin, QIU Ming. Meticulous surgical techniques for endoscopic thyroid surgery [J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 197-201.
[2]	ZHU Hainan, GU Bin, XIE Feng, et al. Pre-operation evaluations in vascularized composite tissue allotransplantation　 [J]. Journal of Tissue Engineering and Reconstructive Surgery, 2022, 18(3): 265-.
[3]	LUO Zhiping, GUO Zichao, SUN Hanxing, CHENG Xi, LIU Zhuoran, ZHANG Tao, YAN Jiqi, QIU Weihua, KUANG Jie, ZHAO Ren. A prospective study on team-based learning combined with case-based learning in training thyroid surgery of medical intern [J]. Journal of Surgery Concepts & Practice, 2022, 27(05): 448-452.
[4]	ZHENG Yuzhen, ZHENG Yanjun, ZHOU Yi, QI Xing, CHEN Weiwei, SHI Wen, ZHOU Weijun, YANG Zhitao, CHEN Ying, MAO Enqiang, CHEN Erzhen. The clinical retrospective analysis of 674 hospitalized patients diagnosed with sepsis in a general hospital [J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(04): 278-282.
[5]	HUANG Xiaomin, ZHANG Qianying, YANG Li, CUI Yan, XU Tian, WANG Ziqiu, WANG Zhaohui, REN Hong, ZHANG Chunyan. A cross-sectional study of falls in peritoneal dialysis patients [J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(03): 248-252.
[6]	DING Yanfei, XIN Xiaorong, ZHOU Yufen, XIE Ling, GU Leilei, WU Yunlin, CHEN Ping. Analysis of risk factors for delayed healing of peptic ulcer in patients with upper gastrointestinal bleeding [J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 312-316.
[7]	BIAN Xiujuan, BAO Zhiyao, CHEN Hong, CHENG Luxiao, SHI Baoping. Analysis of risk factors for mortality in patients with bloodstream infection of Carbapenem-resistant Klebsiella pneumonia [J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(01): 73-77.
[8]	LIANG Yali, ZHAO Haigang, XIANG Guangyu. The stress-induced hyperglycemia ratio in the prognosis prediction of patients with acute ischemic stroke one year after thrombolytic therapy [J]. Journal of Diagnostics Concepts & Practice, 2021, 20(06): 562-566.
[9]	DENG Weiping, YANG Zhao, LIU Jianrong. Risk factor analysis of hematoma volume of cerebral hemorrhage in different location [J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(05): 331-336.
[10]	LI Yanxiu, ZHU Enze, ZHOU Chunlei, LIU Yun, ZUO Xiangrong, LI Jinghang, CAO Quan. Relationship between vasopressin and prognosis in the patients with critical condition [J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(03): 183-187.
[11]	ZHANG Guixiang, CHEN Gang, LI Zhengzheng, CHEN Yi, DU Xiao, CHENG Zhong. Relationship between metabolic risk factors and serum markers of bone metabolism in patients with metabolic and bariatric surgery [J]. Journal of Surgery Concepts & Practice, 2020, 25(06): 493-497.
[12]	GAO Haoji, SUN Hanxing, HUANG Haiyan, YING Xiayang, LIU Zhuoran, LI Rui, KUANG Jie, YAN Jiqi. Analysis of feasibiliaty of robotic assisted male thyroidectomy [J]. Journal of Surgery Concepts & Practice, 2020, 25(06): 503-506.
[13]	GUO Ying, XU Huijie, ZHENG Lei, ZHANG Shiyu, LEI Ming, YAN Jiqi, CHEN Xi, YANG Weiping. Analysis of risk factors for hypoparathyroidism in patients after thyroidectomy [J]. Journal of Surgery Concepts & Practice, 2020, 25(06): 507-511.
[14]	LIN Yuxuan, ZHAO Yanhua, WANG Xiaojing. Risk factors for hypoxia during performing gastroscopy with propofol sedation [J]. Journal of Diagnostics Concepts & Practice, 2020, 19(06): 594-599.
[15]	DU Xuan,QIAO Xinjun,YAN Zhiwang,MIAO Shihong,LI Runqi,WANG Ying. Analysis of Risk Factors for Disseminated Intravascular Coagulation after Operation of Multiple Fractures [J]. Journal of Tissue Engineering and Reconstructive Surgery, 2019, 15(4): 248-251.