Publicaciones científicas
Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis
Díez JJ (1,2), Anda E (3), Sastre J (4), Pérez Corral B (5), Álvarez-Escolá C 6, Manjón L (7), Paja M (8), Sambo M (9), Santiago Fernández P (10), Blanco Carrera C (11), Carlos Galofré J (12), Navarro E (13), Zafón C (14), Sanz E 14, Oleaga A (8), Bandrés O (15), Donnay S (16), Megía A (17), Picallo M (9), Sánchez Ragnarsson C (7), Baena-Nieto G (18), García JCF (19), Lecumberri B (6), de la Vega MS (20), Romero-Lluch AR (13), Iglesias P (21,22).
(1) Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
(2) Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
(3) Department of Endocrinology, Complejo Hospitalario de Navarra, Pamplona, Spain.
(4) Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain.
(5) Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain.
(6) Department of Endocrinology, Hospital Universitario La Paz, Madrid, Spain.
(7) Department of Endocrinology, Hospital Universitario Central de Asturias, Oviedo, Spain.
(8) Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain.
(9) Department of Endocrinology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
(10) Department of Endocrinology, Complejo Hospitalario de Jaén, Jaén, Spain.
(11) Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
(12) Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain.
(13) Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
(14) Department of Endocrinology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
(15) Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain.
(16) Department of Endocrinology, Fundación Hospital de Alcorcón, Alcorcón, Madrid, Spain.
(17) Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain.
(18) Department of Endocrinology, Hospital de Jerez, Jerez de la Frontera, Cádiz, Spain.
(19) Department of Endocrinology, Hospital Virgen de la Victoria, Málaga, Spain.
(20) Department of Endocrinology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain.
(21) Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
(22) Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
PURPOSE:
The prevalence of postoperative hypoparathyroidism has been studied in registries and in surgical series with highly variable and imprecise results. However, the frequency of this hormonal deficiency in the clinical practice of endocrinologists is not known with accuracy. We aimed to assess the prevalence and risk factors of hypoparathyroidism in patients undergoing total thyroidectomy in Spain.
METHODS:
We designed a retrospective, multicentre and nation-wide protocol including all patients with total thyroidectomy who were seen in the endocrinology clinic of the participant centers from January to March 2018. Prevalence of hypoparathyroidism was evaluated at discharge of surgery, 3-6 months after surgery, 12 months after surgery and at last visit. Twenty hospitals participated in the study.
RESULTS:
Of 1792 patients undergoing total thyroidectomy, 866 (48.3%) developed postoperative hypoparathyroidism at discharge of surgery. Most of them recover parathyroid function over time. Prevalence of hypoparathyroidism at 3-6 months, 12 months and at last visit was 22.9%, 16.7% and 14.5%, respectively. The risk of developing definitive hypoparathyroidism was related to the presence of parathyroid tissue at histology, lymph node dissection, and two-stage thyroidectomy. Patients with thyroid cancer, with higher postoperative calcium levels and treated by expert surgical teams exhibited lower risk of developing permanent hypoparathyroidism.
CONCLUSIONS:
Although most patients with postsurgical hypoparathyroidism recover parathyroid function, the prevalence of permanent disease in clinical practice is non negligible (14.5%). Postoperative calcium, extent and timing of surgery, the presence of cancer, expert surgical team, and parathyroid tissue at histology are predictors of permanent hypoparathyroidism.
CITA DEL ARTÍCULO Endocrine. 2019 Jul 17. doi: 10.1007/s12020-019-02014-8
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