Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients
<p>Regression of postoperative hypoparathyroidism in a series of 496 patients after bilateral thyroid surgery.</p> "> Figure 2
<p>Regression of postoperative hypoparathyroidism in patients undergoing follow-up by endocrine surgeons (Group A) and other physicians (Group B) (<b>a</b>); regression in patients with hypoparathyroidism lasting more than 6 months after surgery (<b>b</b>).</p> "> Figure 3
<p>Regression of postoperative hypoparathyroidism according to the dose of calcium/active vitamin D treatment at discharge.</p> ">
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Demographic, Anamnestic, and Biochemical Data
2.2. Surgical Data
2.3. Pathological Data
2.4. Follow-Up Data
2.5. Statistics
3. Results
3.1. Risk and Protective Factor of Immediate HypoPTH
3.2. Risk and Protective Factors of Permanent HypoPTH
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Univariate Logistic Regression Analysis | Stepwise Logistic Regression Analysis | ||||||||
---|---|---|---|---|---|---|---|---|---|
HypoPTH− n = 1423 | HypoPTH+ n = 542 | Odds Ratio | 95% CI | p Value | Odds Ratio | 95% CI | p Value | ||
Age at surgery (years) * | 53.14 (14.92) | 50.60 (15.98) | 0.989 | 0.983–0.996 | 0.001 | - | - | - | |
Gender | Female n = 1522 | 1088 (71.2) | 434 (28.5) | 1.240 | 0.970–1.58 | 0.087 | - | - | - |
Male n = 443 | 335 (75.6) | 108 (24.4) | |||||||
Arterial Hypertension | Yes n = 553 | 411 (74.3) | 142 (25.7) | 0.874 | 0.699–1.090 | 0.237 | - | - | - |
No n = 1412 | 1012 (71.7) | 400 (28.3) | |||||||
Body mass index (Kg/m2) ° | 25.06 (5.70) | 24.15 (3.96) | 0.978 | 0.953–1.000 | 0.091 | - | - | - | |
Diabetes and Glucose intolerance | Yes n = 126 | 92 (73.0) | 34 (27.0) | 0.968 | 0.645–1.450 | 0.877 | - | - | - |
No n = 1839 | 1331 (72.4) | 508 (27.6) | |||||||
Preoperative Vitamin D | Decreased n = 256 | 189 (73.8) | 67 (26.2) | 1.290 | 0.822–2.030 | 0.266 | - | - | - |
Normal n = 140 | 96 (68.6) | 44 (31.4) | |||||||
Standardized preoperative PTH ° | 0.77 (0.38) | 0.65 (0.36) | 0.293 | 0.172–0.498 | <0.001 | 3.190 | 1.860–5.470 | <0.001 | |
Preoperative serum total albumin-corrected calcium levels (mmol/L) * | 2.33 (0.12) | 2.33 (0.13) | 1.350 | 0.587–3.090 | 0.482 | - | - | - | |
Hyperthyroidism | Yes n = 503 | 380 (75.5) | 123 (24.5) | 0.806 | 0.638–1.020 | 0.069 | - | - | - |
No n = 1462 | 1043 (71.3) | 419 (28.7) | |||||||
Laboratory Autoimmune Thyroiditis | Yes n = 766 | 556 (72.6) | 210 (27.4) | 0.971 | 0.787–1.200 | 0.787 | - | - | - |
No n = 993 | 715 (72.0) | 278 (28.0) | |||||||
Surgery duration (minutes) ° | 75 (25) | 80 (30) | 1.000 | 1.000–1.010 | 0.002 | 1.010 | 1.000–1.021 | 0.032 | |
Lymph-nodal dissection | Yes n = 503 | 316 (62.8) | 187 (37.2) | 1.850 | 1.490–2.290 | <0.001 | 1.550 | 1.090–2.190 | 0.015 |
No n = 1462 | 1107 (75.7) | 355 (24.3) | |||||||
PGRIS | ≤2 n = 61 | 19 (31.1) | 42 (68.9) | 0.162 | 0.093–0.281 | <0.001 | 5.050 | 2.340–10.900 | <0.001 |
>2 n = 1889 | 1390 (73.6) | 499 (26.4) | |||||||
Parathyroid reimplantation | Yes n = 92 | 49 (53.3) | 43 (46.7) | 2.420 | 1.580–3.690 | <0.001 | - | - | - |
No n = 1873 | 1374 (73.4) | 499 (26.6) | |||||||
Reoperations | Yes n = 36 | 30 (83.3) | 6 (16.7) | 0.520 | 0.215–1.260 | 0.146 | - | - | - |
No n = 1929 | 1393 (72.2) | 536 (27.8) | |||||||
Histological diagnosis | Benign n = 1122 | 840 (74.9) | 282 (25.1) | 1.330 | 1.090–1.620 | 0.005 | - | - | - |
Malignant n = 843 | 583 (69.2) | 260 (30.8) | |||||||
Histological Autoimmune Thyroiditis | Yes n = 357 | 234 (65.5) | 123 (34.5) | 1.480 | 1.160–1.890 | 0.002 | - | - | - |
No n = 1594 | 1176 (73.8) | 418 (26.2) | |||||||
Thyroid weight (grams) ° | 31.00 (44.40) | 33.00 (42.25) | 1.000 | 0.999–1.000 | 0.311 | - | - | - |
Univariate Cox Proportional Regression Analysis | Stepwise Cox Proportional Regression Analysis | ||||||||
---|---|---|---|---|---|---|---|---|---|
Regressed HypoPTH n = 443 | Persistent HypoPTH n = 53 | Hazard Ratio | 95% CI | p Value | Hazard Ratio | 95% CI | p Value | ||
Age at surgery (years) * | 50.77 (16.01) | 48.73 (16.53) | 1.005 | 0.999–1.011 | 0.113 | - | - | - | |
Gender | Female n = 404 | 363 (89.9) | 41 (10.1) | 0.960 | 0.754–1.224 | 0.744 | - | - | - |
Male n = 92 | 80 (87.0) | 12 (13.0) | |||||||
Arterial Hypertension | Yes n = 126 | 117 (92.9) | 9 (7.1) | 1.178 | 0.954–1.456 | 0.128 | - | - | - |
No n = 370 | 326 (88.1) | 44 (11.9) | |||||||
Body mass index (Kg/m2) ° | 24.19 (6.07) | 23.31 (5.82) | 1.009 | 0.986–1.033 | 0.456 | - | - | - | |
Diabetes and Glucose intolerance | Yes n = 32 | 29 (90.6) | 3 (9.4) | 1.001 | 0.687–1.460 | 0.994 | - | - | - |
No n = 464 | 414 (89.2) | 50 (10.8) | |||||||
Preoperative Vitamin D | Decreased n = 65 | 55 (84.6) | 10 (15.4) | 1.315 | 0.871–1.986 | 0.192 | - | - | - |
Normal n = 42 | 40 (95.2) | 2 (4.8) | |||||||
Standardized preoperative PTH ° | 0.66 (0.38) | 0.61 (0.32) | 0.960 | 0.608–1.517 | 0.862 | - | - | - | |
Hyperthyroidism | Yes n = 109 | 100 (91.7) | 9 (8.3) | 0.999 | 0.800–1.249 | 0.995 | - | - | - |
No n = 387 | 343 (88.6) | 44 (11.4) | |||||||
Laboratory Autoimmune Thyroiditis | Yes n = 187 | 163 (87.2) | 24 (12.8) | 0.873 | 0.715–1.066 | 0.182 | - | - | - |
No n = 259 | 236 (91.1) | 23 (8.9) | |||||||
Surgery duration (minutes) ° | 80 (30) | 85 (35) | 0.997 | 0.994–1.000 | 0.047 | - | - | - | |
Lymph-nodal dissection | Yes n = 171 | 145 (84.8) | 26 (15.2) | 0.768 | 0.628–0.938 | 0.010 | - | - | - |
No n = 325 | 298 (91.7) | 27 (8.3) | |||||||
PGRIS | ≤2 n = 40 | 34 (85.0) | 6 (15.0) | 1.105 | 0.779–1.569 | 0.575 | - | - | - |
>2 n = 455 | 408 (89.7) | 47 (10.3) | |||||||
Parathyroid glands reimplantation | Yes n = 38 | 35 (92.1) | 3 (7.9) | 0.991 | 0.702–1.400 | 0.961 | - | - | - |
No n = 458 | 408 (89.0) | 50 (11.0) | |||||||
Reoperations | Yes n = 6 | 5 (83.3) | 1 (16.7) | 0.917 | 0.380–2.214 | 0.847 | - | - | - |
No n = 490 | 438 (89.4) | 52 (10.6) | |||||||
Histological diagnosis | Benign n = 254 | 234 (92.1) | 20 (7.9) | 0.796 | 0.660–0.960 | 0.017 | - | - | - |
Malignant n = 242 | 209 (86.4) | 33 (13.6) | |||||||
Histological Autoimmune Thyroiditis | Yes n = 114 | 103 (90.4) | 11 (9.6) | 1.002 | 0.804–1.250 | 0.984 | - | - | - |
No n = 381 | 339 (89.0) | 42 (11.0) | |||||||
Thyroid weight (grams) ° | 32.50 (43.00) | 34.00 (24.00) | 1.000 | 0.999–1.001 | 0.690 | - | - | - | |
1st POD PTH levels (pg/mL) ° | 6.0 (3.6) | 4.4 (1.4) | 1.218 | 1.160–1.279 | <0.001 | - | - | - | |
1st POD serum total albumin-corrected calcium levels (mmol/L) * | 2.02 (0.15) | 1.94 (0.14) | 5.362 | 2.870–10.020 | <0.001 | - | - | - | |
1st POD serum ionized calcium levels (mmol/L) ° | 1.06 (0.07) | 1.03 (0.09) | 154.800 | 32.250–743.300 | <0.001 | - | - | - | |
1st POD phosphorus levels (mmol/L) ° | 1.46 (0.25) | 1.48 (0.27) | 0.739 | 0.514–1.062 | 0.102 | - | - | - | |
Calcium intravenous administration in 1st or 2nd POD | Yes n = 34 | 24 (70.6) | 10 (29.4) | 0.548 | 0.362–0.828 | 0.004 | - | - | - |
No n = 462 | 419 (90.7) | 43 (9.3) | |||||||
Calcium/Vitamin D treatment at discharge | Low dose n = 149 | 148 (99.3) | 1 (0.7) | 0.512 | 0.450–0.582 | <0.001 | 0.656 | 0.580–0.743 | <0.001 |
Medium dose n = 147 | 135 (91.8) | 12 (8.2) | |||||||
High dose n = 200 | 160 (80.0) | 40 (20.0) | |||||||
Physicians performing the follow-up | Group A n = 362 | 353 (97.5) | 9 (2.5) | 2.949 | 2.313–3.760 | <0.001 | 2.470 | 1.919–3.178 | <0.001 |
Group B n = 134 | 90 (67.2) | 44 (32.8) | |||||||
RadioIodine therapy | Yes n = 158 | 134 (84.8) | 24 (15.2) | 0.810 | 0.661–0.994 | 0.043 | |||
No n = 338 | 309 (91.4) | 29 (8.6) |
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Dughiero, S.; Torresan, F.; Censi, S.; Mian, C.; Carrillo Lizarazo, J.L.; Iacobone, M. Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients. Cancers 2024, 16, 2867. https://doi.org/10.3390/cancers16162867
Dughiero S, Torresan F, Censi S, Mian C, Carrillo Lizarazo JL, Iacobone M. Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients. Cancers. 2024; 16(16):2867. https://doi.org/10.3390/cancers16162867
Chicago/Turabian StyleDughiero, Silvia, Francesca Torresan, Simona Censi, Caterina Mian, José Luis Carrillo Lizarazo, and Maurizio Iacobone. 2024. "Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients" Cancers 16, no. 16: 2867. https://doi.org/10.3390/cancers16162867