Recovery of parathyroid function in patients with thyroid cancer treated by total thyroidectomy: An analysis of 685 patients with hypoparathyroidism at discharge of surgery
Juan J Díez 1 , Emma Anda 2 , Julia Sastre 3 , Begoña Pérez-Corral 4 , Cristina Álvarez-Escolá 5 , Laura Manjón 6 , Miguel Paja 7 , Marcel Sambo 8 , Piedad Santiago-Fernández 9 , Concepción Blanco-Carrera 10 , Juan C Galofré 11 , Elena Navarro 12 , Carles Zafón 13 , Eva Sanz 13 , Amelia Oleaga 7 , Orosia Bandrés 14 , Sergio Donnay 15 , Ana Megía 16 , María Picallo 8 , Cecilia Sánchez-Ragnarsson 6 , Gloria Baena-Nieto 17 , José Carlos Fernández-García 18 , Beatriz Lecumberri 5 , Manel Sahún de la Vega 19 , Ana R Romero-Lluch 12 , Pedro Iglesias 20
Objective: We aimed to study the predictive factors for recovery of parathyroid function in hypoparathyroid patients after total thyroidectomy for thyroid cancer.
Methods: We designed a retrospective, multicentre and nation-wide analysis of patients with total thyroidectomy who were seen in twenty endocrinology departments from January to March 2018.
We selected patients with histologically proven thyroid cancer and retrieved information related to surgical procedure and thyroid cancer features. Survival analysis and Cox regression analysis were used to study the relationship between these variables and the recovery of parathyroid function.
Results: From 685 patients with hypoparathyroidism at discharge of surgery, 495 (72.3%) recovered parathyroid function over time. Kaplan-Meier analysis showed that this recovery was significantly related to the presence of specialized surgical team (P<0.001), identification of parathyroid glands at surgery (P<0.001), papillary histopathology (P=0.040), and higher levels of postoperative calcium (Ca) (P<0.001) and parathyroid hormone (PTH) (P<0.001).
Subjects with gross extrathyroidal extension (P=0.040), lymph node metastases (P=0.004), and surgical re-intervention after initial surgery (P=0.024) exhibited a significant risk of persistence of hypoparathyroidism. Multivariate Cox regression analysis showed that the significant and independent factors for recovery of parathyroid function were postoperative concentrations of Ca (P=0.038) and PTH (P=0.049). The presence of lymph node metastases was a negative predictor of recuperation of parathyroid function (P=0.042) in this analysis.
Conclusion: In patients with thyroid cancer, recovery of parathyroid function after total thyroidectomy was directly related to postoperative Ca and PTH concentrations, and inversely related to lymph node metastases.
CITATION Endocrinol Diabetes Nutr (Engl Ed). Jun-Jul 2021;68(6):398-407. doi: 10.1016/j.endien.2021.10.009.