Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
Endocrine. 2019 Nov;66(2):405-415. doi: 10.1007/s12020-019-02014-8. Epub 2019 Jul 17.
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.
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.
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.
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.
术后甲状旁腺功能减退症的患病率已在注册中心和外科系列中进行了研究，但结果差异较大且不精确。然而，内分泌科医生临床实践中这种激素缺乏的频率并不能准确知晓。我们旨在评估西班牙行甲状腺全切除术患者甲状旁腺功能减退症的患病率及其危险因素。
我们设计了一项回顾性、多中心、全国性的方案，纳入了 2018 年 1 月至 3 月期间在参与中心内分泌科门诊就诊的所有行甲状腺全切除术的患者。术后出院时、术后 3-6 个月、12 个月及末次就诊时评估甲状旁腺功能减退症的患病率。共有 20 家医院参与了该研究。
在 1792 例行甲状腺全切除术的患者中，866 例（48.3%）在术后出院时发生术后甲状旁腺功能减退症。大多数患者随着时间的推移恢复甲状旁腺功能。术后 3-6 个月、12 个月及末次就诊时甲状旁腺功能减退症的患病率分别为 22.9%、16.7%和 14.5%。发生永久性甲状旁腺功能减退症的风险与组织学上存在甲状旁腺组织、淋巴结清扫术和甲状腺两阶段切除术相关。患有甲状腺癌、术后血钙水平较高且由专家手术团队治疗的患者发生永久性甲状旁腺功能减退症的风险较低。
尽管大多数术后甲状旁腺功能减退症患者的甲状旁腺功能恢复，但在临床实践中永久性疾病的患病率并不低（14.5%）。术后血钙、手术范围和时间、癌症的存在、专家手术团队和组织学上存在甲状旁腺组织是永久性甲状旁腺功能减退症的预测因素。
