Outcome of protracted hypoparathyroidism after total thyroidectomy

• Published in: British journal of surgery Vol. 97; no. 11; pp. 1687 - 1695
• Main Authors: Sitges-Serra, A., Ruiz, S., Girvent, M., Manjón, H., Dueñas, J. P., Sancho, J. J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.11.2010; Wiley
• Subjects: Biological and medical sciences; Calcitriol; Calcium - metabolism; Endocrinopathies; Epidemiologic Methods; Female; General aspects; Goiter - surgery; Humans; Hypocalcemia - etiology; Hypocalcemia - physiopathology; Hypoparathyroidism - etiology; Hypoparathyroidism - physiopathology; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Glands - physiopathology; Parathyroid Glands - transplantation; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Recovery of Function; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of endocrine glands; Thyroid Neoplasms - surgery; Thyroidectomy - adverse effects; Treatment Outcome; Endocrinopathy; Medicine; Prognosis; Treatment; Parathyroid diseases; Surgery; Hypoparathyroidism; Evolution; Thyroidectomy
• DOI: 10.1002/bjs.7219
• ISSN: 0007-1323

Background: Although the variables that influence the development of post‐thyroidectomy hypocalcaemia are now better understood, the risk factors and long‐term outcome of persistent hypoparathyroidism (HPP) are poorly defined. A retrospective review of a prospective protocol for the management of post‐thyroidectomy hypocalcaemia was performed. Methods: Patients with a serum calcium level below 8 mg/dl (2 mmol/l) 24 h after total thyroidectomy were prescribed oral calcium with or without calcitriol and followed for at least 1 year. Protracted HPP was defined as an intact parathyroid hormone (iPTH) level below 13 pg/ml and need for calcium medication at 1 month after thyroidectomy. Results: Of 442 patients (343 with goitre, 99 with carcinoma) undergoing total thyroidectomy, 222 (50·2 per cent) developed postoperative hypocalcaemia. Eleven patients were lost to follow‐up. Parathyroid function recovered in 131 patients within 1 month and 80 developed protracted HPP, which was associated with lymphadenectomy, fewer than three glands left in situ and incidental parathyroidectomy. Parathyroid function recovered within 1 year in 78 per cent of patients with protracted HPP. Factors associated with late recovery of parathyroid function were higher serum calcium and low but detectable iPTH levels 1 month after surgery. These factors were associated with higher calcitriol and calcium dosages at hospital discharge. Parathyroid autotransplantation did not protect against permanent HPP. Conclusion: Higher serum calcium levels at 1 month after total thyroidectomy are associated with recovery of parathyroid function. It is hypothesized that intensive medical treatment of hypocalcaemia—‘parathyroid splinting’—may improve the outcome of patients with protracted HPP. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Medical treatment important for outcome