Vol 73, No 1 (2022)
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Published online: 2022-02-08

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Intact parathyroid hormone value on the first postoperative day following total thyroidectomy as a predictor of permanent hypoparathyroidism: a retrospective analysis on 426 consecutive patients

Gian Luigi Canu1, Fabio Medas1, Federico Cappellacci1, Cristina Soddu1, Giorgio Romano2, Enrico Erdas1, Pietro Giorgio Calò1
Pubmed: 35156703
Endokrynol Pol 2022;73(1):48-55.

Abstract

Introduction: Hypoparathyroidism represents a common complication following total thyroidectomy. To date, there is still no reliable and immediate postoperative parameter to establish which patients with postsurgical hypoparathyroidism will develop permanent hypoparathyroidism.

The main purpose of the present study was to assess whether the intact parathyroid hormone (iPTH) value on the first postoperative day is a good predictor of permanent hypoparathyroidism.

Material and methods: Patients undergoing thyroidectomy in our unit between March 2018 and January 2020 were analysed. According to the iPTH value on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into two groups: Group A (iPTH ≥ 4.6 pg/mL) and Group B (iPTH < 4.6 pg/mL, undetectable).

Results: In total 426 patients were included: 364 in Group A and 62 in Group B. Permanent hypoparathyroidism occurred in 3 (0.82%) patients from Group A and in 26 (41.94%) from Group B (p < 0.001). When iPTH levels were < 4.6 pg/mL on the first postoperative day the sensitivity for the prediction of permanent hypoparathyroidism was 89.66%, the specificity was 90.93%, the positive predictive value (PPV) was 41.94%, the negative predicitive value (NPV) was 99.18% and the accuracy was 90.85%.

Conclusions: An iPTH value < 4.6 pg/mL on the first postoperative day following total thyroidectomy has proven to be a good parameter for early identification of patients at high risk for permanent hypoparathyroidism. Moreover, we want to underline that in our experience no patient with an iPTH level > 6.5 pg/mL developed this complication.

 

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References

  1. Puzziello A, Rosato L, Innaro N, et al. Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multicenter study comprising 2,631 patients. Endocrine. 2014; 47(2): 537–542.
  2. Bilezikian JP, Khan A, Potts JT, et al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research. J Bone Miner Res. 2011; 26(10): 2317–2337.
  3. Asari R, Passler C, Kaczirek K, et al. Hypoparathyroidism after total thyroidectomy: a prospective study. Arch Surg. 2008; 143(2): 132–7; discussion 138.
  4. Pattou F, Combemale F, Fabre S, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 1998; 22(7): 718–724.
  5. Zheng J, Song H, Cai S, et al. Evaluation of clinical significance and risk factors of incidental parathyroidectomy due to thyroidectomy: A single-center retrospective clinical study. Medicine (Baltimore). 2017; 96(39): e8175.
  6. Coimbra C, Monteiro F, Oliveira P, et al. Hypoparathyroidism following thyroidectomy: Predictive factors. Acta Otorrinolaringol Esp. 2017; 68(2): 106–111.
  7. Kakava K, Tournis S, Papadakis G, et al. Postsurgical Hypoparathyroidism: A Systematic Review. In Vivo. 2016; 30(3): 171–179.
  8. Cho JN, Park WS, Min SY. Predictors and risk factors of hypoparathyroidism after total thyroidectomy. Int J Surg. 2016; 34: 47–52.
  9. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid. 2018; 28(7): 830–841.
  10. Díez JJ, Anda E, Sastre J, et al. Permanent postoperative hypoparathyroidism: an analysis of prevalence and predictive factors for adequacy of control in a cohort of 260 patients. Gland Surg. 2020; 9(5): 1380–1388.
  11. Bollerslev J, Rejnmark L, Marcocci C, et al. European Society of Endocrinology. European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol. 2015; 173(2): G1–20.
  12. Brandi ML, Bilezikian JP, Shoback D, et al. Management of Hypoparathyroidism: Summary Statement and Guidelines. J Clin Endocrinol Metab. 2016; 101(6): 2273–2283.
  13. Stack BC, Bimston DN, Bodenner DL, et al. American Association Of Clinical Endocrinologists And American College Of Endocrinology disease state clinical review: postoperative hypoparathyroidism — definitions and management. Endocr Pract. 2015; 21(6): 674–685.
  14. Lorente-Poch L, Sancho JJ, Carballo L, et al. Clinical profile and long-term follow-up of 32 patients with postoperative permanent hypoparathyroidism. Gland Surg. 2017; 6(Suppl 1): S3–SS10.
  15. Mitchell DM, Regan S, Cooley MR, et al. Long-term follow-up of patients with hypoparathyroidism. J Clin Endocrinol Metab. 2012; 97(12): 4507–4514.
  16. Rastogi R, Beauchamp NJ, Ladenson PW. Calcification of the basal ganglia in chronic hypoparathyroidism. J Clin Endocrinol Metab. 2003; 88(4): 1476–1477.
  17. Kinirons MJ, Glasgow JF. The chronology of dentinal defects related to medical findings in hypoparathyroidism. J Dent. 1985; 13(4): 346–349.
  18. Lorente-Poch L, Sancho JJ, Muñoz-Nova JL, et al. Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 2015; 4(1): 82–90.
  19. Khan MI, Waguespack SG, Hu MI. Medical management of postsurgical hypoparathyroidism. Endocr Pract. 2011; 17 Suppl 1: 18–25.
  20. Reid IR, Bristow SM, Bolland MJ. Calcium supplements: benefits and risks. J Intern Med. 2015; 278(4): 354–368.
  21. Polistena A, Di Lorenzo P, Sanguinetti A, et al. Medicolegal implications of surgical errors and complications in neck surgery: A review based on the Italian current legislation. Open Med (Wars). 2016; 11(1): 298–306.
  22. Lorente-Poch L, Sancho JJ, Ruiz S, et al. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015; 102(4): 359–367.
  23. Wang JB, Sun HL, Song CY, et al. Association between decreased serum parathyroid hormone after total thyroidectomy and persistent hypoparathyroidism. Med Sci Monit. 2015; 21: 1223–1231.
  24. Qasaimeh GR, Al Nemri S, Al Omari AK. Incidental extirpation of the parathyroid glands at thyroid surgery: risk factors and post-operative hypocalcemia. Eur Arch Otorhinolaryngol. 2011; 268(7): 1047–1051.
  25. Sitges-Serra A, Gallego-Otaegui L, Suárez S, et al. Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma. Surgery. 2017; 161(3): 712–719.
  26. Imga NN, Atas H, Torgutalp M, et al. Stratifying the risk factors for hypoparathyroidism after total thyroidectomy. A single Center study. Ann Ital Chir. 2019; 90: 21–30.
  27. Youssef T, Gaballah G, Abd-Elaal E, et al. Assessment of risk factors of incidental parathyroidectomy during thyroid surgery: a prospective study. Int J Surg. 2010; 8(3): 207–211.
  28. Almquist M, Hallgrimsson P, Nordenström E, et al. Prediction of permanent hypoparathyroidism after total thyroidectomy. World J Surg. 2014; 38(10): 2613–2620.
  29. Roh JL, Kim JM, Park CIl. Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol. 2011; 18(8): 2245–2250.
  30. Hallgrimsson P, Nordenström E, Bergenfelz A, et al. Hypocalcaemia after total thyroidectomy for Graves' disease and for benign atoxic multinodular goitre. Langenbecks Arch Surg. 2012; 397(7): 1133–1137.
  31. Medas F, Erdas E, Canu GL, et al. Does hyperthyroidism worsen prognosis of thyroid carcinoma? A retrospective analysis on 2820 consecutive thyroidectomies. J Otolaryngol Head Neck Surg. 2018; 47(1): 6.
  32. Calò PG, Conzo G, Raffaelli M, et al. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study. Eur J Surg Oncol. 2017; 43(1): 126–132.
  33. Pesce CE, Shiue Z, Tsai HL, et al. Postoperative hypocalcemia after thyroidectomy for Graves' disease. Thyroid. 2010; 20(11): 1279–1283.
  34. Canu GL, Medas F, Longheu A, et al. Correlation between iPTH Levels on the First Postoperative Day After Total Thyroidectomy and Permanent Hypoparathyroidism: Our Experience. Open Med (Wars). 2019; 14: 437–442.
  35. Wang W, Xia F, Meng C, et al. Prediction of permanent hypoparathyroidism by parathyroid hormone and serum calcium 24 h after thyroidectomy. Am J Otolaryngol. 2018; 39(6): 746–750.
  36. Calvo Espino P, Rivera Bautista JÁ, Artés Caselles M, et al. Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism. Endocrinol Diabetes Nutr (Engl Ed). 2019; 66(3): 195–201.
  37. Kim H, Yu H, Bae I, et al. Prediction of Transient and Permanent Hypoparathyroidism after Total Thyroidectomy Using the Postoperative Serum Parathyroid Hormone Test: When Is the Best Time to Check? J Endocrin Surg. 2017; 17(3): 104.
  38. Julián MT, Balibrea JM, Granada ML, et al. Intact parathyroid hormone measurement at 24 hours after thyroid surgery as predictor of parathyroid function at long term. Am J Surg. 2013; 206(5): 783–789.
  39. Godlewska P, Benke M, Stachlewska-Nasfeter E, et al. Risk factors of permanent hypoparathyroidism after total thyroidectomy and central neck dissection for papillary thyroid cancer: a prospective study. Endokrynol Pol. 2020; 71(2): 126–133.
  40. Zheng J, Cai S, Song H, et al. Measurement of serum intact parathyroid hormone concentration 1 day after total thyroidectomy to assess risk of permanent hypoparathyroidism. J Int Med Res. 2020; 48(6): 300060520927199.
  41. Lončar I, Dulfer RR, Massolt ET, et al. Postoperative parathyroid hormone levels as a predictor for persistent hypoparathyroidism. Eur J Endocrinol. 2020; 183(2): 149–159.
  42. Canu GL, Medas F, Conzo G, et al. Is prophylactic central neck dissection justified in patients with cN0 differentiated thyroid carcinoma? An overview of the most recent literature and latest guidelines. Ann Ital Chir. 2020; 91: 451–457.
  43. Medas F, Tuveri M, Canu GL, et al. Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases. Updates Surg. 2019; 71(4): 705–710.
  44. Calò PG, Pisano G, Medas F, et al. Risk factors in reoperative thyroid surgery for recurrent goitre: our experience. G Chir. 2012; 33(10): 335–338.
  45. Suffat LP, Mondini G, Demaria F, et al. A proposal for thyroid surgery: criteria to identify the references of endocrine surgery. Updates Surg. 2017; 69(4): 431–434.
  46. Adam MA, Thomas S, Youngwirth L, et al. Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Ann Surg. 2017; 265(2): 402–407.