Postoperative hypoparathyroidism in total thyroidectomy incidence and predictive factors

Abstract

Objective: Total thyroidectomy is increasingly accepted as a choice of treatment not only for malignant but also for benign thyroid disorders. Nowadays, postoperative hypocalcaemia is the major concern in total thyroidectomy. The aim of this study is to quantify risk factors contributing to postoperative hypocalcaemia rates. Material and methods: Medical records of 88 patients who underwent total thyroidectomy from 2000 to 2004 were reviewed. In addition to demographic information, postoperative hypocalcaemia and related risk factors were identified. Results: The most common indication for total thyroidectomy was multinodular goiter (53.4%). One patient with anaplastic thyroid carcinoma died because of respiratory failure (1.1%). Temporary and permanent hypoparathyroidism rates were 26.1% and 3.4 %, respectively. Parathyroid reimplantation was performed to 7 patients (7.9%). Indication of surgery was statistically associated with an increased incidence of hypocalcemia (P=0.019 for thyroid carcinoma and P=0.005 for completion thyroidectomy), whereas, sex, age, neck dissection and parathyroid reimplantation were not. Conclusions: Postoperative hypocalcaemia is the major concern for thyroid surgeons. Completion and total thyroidectomy for thyroid malignancy increased postoperative hypoparathyroidism. With meticulous attention to operative technique and anatomical detail, surgeons can achieve low morbidity rates.

Amaç: Total tiroidektomi, günümüzde, malign oldu¤u kadar, benign tiroid hastal›klar›nda da kullan›lan cerrahi yöntemdir. Postoperatif hipokalsemi, total tiroidektomilerden sonra karfl›m›za ç›kabilecek major bir komplikasyondur. Bu çal›flmada, postoperatif hipokalsemiler için olas› risk faktörlerini ortaya koymay› amaçlad›k. Gereç ve Yöntem: 2000–2004 y›llar› aras›nda, de¤iflik sebeplerden dolay› total tiroidektomiye maruz kalm›fl olan 88 hasta retrospektif olarak de¤erlendirildi. Postoperatif hipokalsemi oranlar› ve bunla ilgili risk faktörleri de¤erlendirildi. Bulgular: Total tiroidektomi için en fazla endikasyonu multinodüler guatr oluflturdu (%53.4). Mortalite 1 hastada gözlendi (%1.1). Geçici ve kal›c› hipokalsemi oranlar› s›ras›yla %26.1 ve %3.4 idi. Yedi hastaya paratiroid reimplantasyonu yap›ld›. Cerrahi endikasyon ve postoperatif hipokalsemi oranlar› aras›nda anlaml› bir iliflki gözlendi (tiroid kanserleri için p=0.019 ve tamamlay›c› tiroidektomiler için p=0.005). Bununla birlikte, hastan›n yafl›, cinsiyeti, boyun diseksiyonu ve paratiroid reimplantasyonu ile istatistiksel bir iliflki yoktu. Sonuç: Tamamlay›c› tiroidektomiler ve tiroid kanserleri için gerçeklefltirilen total tiroidektomiler, postoperatif hipoklasemi aç›s›ndan risk faktörleridir. Anatomik bilgilerin ›fl›¤› alt›nda dikkatli bir cerrahi teknik ile postoperatif hipokalsemi oranlar› oldukça azalt›labilecektir.