Evaluation of hypoparathyroidism following laryngectomy

• Published in: Annals of the Royal College of Surgeons of England Vol. 105; no. 1; pp. 62 - 67
• Main Authors: Edafe, O, Tan, E T, Jackson, R, Sionis, S, Balasubramanian, S P, Beasley, N
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2023; Royal College of Surgeons
• Subjects: Dietary supplements; Dissection; Endocrine system; Female; Head & neck cancer; Humans; Hypocalcemia; Hypocalcemia - epidemiology; Hypocalcemia - etiology; Hypocalcemia - prevention & control; Hypoparathyroidism - epidemiology; Hypoparathyroidism - etiology; Laryngectomy - adverse effects; Otolaryngology; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Radiation therapy; Retrospective Studies; Risk Factors; Systematic review; Teaching hospitals; Thyroid gland; Thyroidectomy; Thyroidectomy - adverse effects; Thyroidectomy - methods; Variables; Vitamin D; Hypocalcaemia; Laryngectomy; Thyroidectomy; Hypoparathyroidism
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2021.0276

Hypoparathyroidism is a recognised complication following laryngectomy; it is associated with significant short-and long-term morbidity. This study aimed to further characterise this condition, identify risk factors and describe preventative and management strategies in a large cohort. This was a retrospective study at a tertiary referral centre for head and neck cancers. All consecutive patients who had total laryngectomy over an eight-year period were included. A total of 140 patients were included. Rates of transient and long-term hypoparathyroidism were 14.3% and 10.1%, respectively. The following factors were significantly associated with transient post-surgical hypocalcaemia or hypoparathyroidism: total thyroidectomy (relative risk, RR, 4.33; 95% confidence interval, CI, 1.86-10.10), oesophagectomy (RR 6.05; 95% CI 2.92-12.53) and female sex (RR 3.23; 95% CI 1.45-7.19). In addition, total thyroidectomy (RR 5.89; 95% CI 1.94-17.86), central neck dissection (RR 3.97; 95% CI 1.42-11.10), oesophagectomy (RR 9.38; 95% CI 4.13-21.3), pharyngectomy (RR 7.14; 95% CI 2.08-24.39) and female sex (RR 5.52; 95% CI 1.95-15.63) were risk factors for long-term hypoparathyroidism. There was variability in the use of preventative measures, monitoring and management of hypocalcaemia and hypoparathyroidism following total laryngectomy. Transient hypocalcaemia and long-term hypoparathyroidism occur in a significant proportion of patients after laryngectomy. A standard protocol is required to improve care.