Risk factors for hypocalcemia and correlation between thyroid volume and incidental parathyroidectomy after total thyroidectomy: single center experience

Year 2023, Volume: 6 Issue: 2, 421 - 427, 27.03.2023

Hakan Şıvgın , Mustafa Sami Bostan

https://doi.org/10.32322/jhsm.1234225

Abstract

Aim: We aimed to investigate correlation between the effects of age, sex, disease, pathologic diagnosis, parathyroid autotransplantation, presence of parathyroid in the pathology specimen and clinicopathological variables and thyroid volume, postoperative hypocalcemia after bilateral total thyroidectomy.
Material and Method: A retrospective study planned in tertiary university hospital on patients undergone bilateral total thyroidectomy and neck dissection when necessary surgery for thyroid pathologies. Minimum calcium values in the postoperative period were recorded as transient or permanent hypocalcemia. The cases were statistically analyzed for the relationship between the volume of the thyroid gland removed and hypocalcemia. The effects of sex, pathological diagnosis, preoperative hyperthyroidism, anatomical retrosternal extension, number of parathyroid glands seen and preserved intraoperatively, parathyroid gland autoimplantation, parathyroid gland removal in the pathological specimen, nerve monitoring, bilateral total thyroidectomy and central and lateral neck dissection were analyzed for postoperative hypocalcemia.
Results: Totally 763 patients were included in the study. The mean age of the patients was 50.6 years (SD:12.8) and the sex of 575 (75.4%) patients was female. Hypocalcemia was more common in women than in men (31% vs 17%; p<0.001). Patients who underwent incidental parathyroidectomy (IPT) (yes, 43% vs no, 25%; p<0.001) and parathyroid autotransplantation (yes, 82% vs no, 27%; p=0.001) had statistically significantly higher rates of hypocalcemia. In the univariate analysis, it was determined from the available data that an increase in thyroid volume had a statistically significant effect on hypocalcemia, albeit at a low level [OR:1.002 (95%CI:1-1.004]. In the multivariate logistic regression model, the independent variables associated with postoperative hypocalcemia were female sex [OR: 2.33 (95%CI: 1.49-3.62)], thyroid volume [OR: 1.003 (95%CI:1-1.005)], IPT [OR:2.29 (95%CI:1.48-3.54)] and parathyroid autotransplantation [OR:1.999 (95%CI:2.1-47.5)]. While the effect of increased thyroid volume on hypocalcemia was very low, being female and incidental parathyroidectomy increased hypocalcemia 2.3 fold and parathyroid autotransplantation increased hypocalcemia 10-fold.
Conclusion: Incidental parathyroidectomy is a remarkable association, which determines the complication of postoperative hypocalcemia, and the presence of parathyroid tissue in the pathology specimen in cases with small thyroid volume.

Keywords

Hypocalcemia, thyroidectomy, thyroid volume, incidental parathyroidectomy

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