Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Endocrine. 2022 Oct;78(1):151-158. doi: 10.1007/s12020-022-03153-1. Epub 2022 Aug 1.
Persistent hypoparathyroidism (hypoPT) is a major complication of total thyroidectomy. Nonetheless, previous reports may have underestimated the prevalence of hypoPT due to patient selection bias. We aimed to estimate the actual prevalence of persistent hypoPT after total thyroidectomy and to find predictive factors for postoperative hypoPT.
This study retrospectively reviewed data from a health insurance claims-based database provided by the Japan Medical Data Center Co., Ltd. From 2009 to 2019, 2388 patients who underwent total thyroidectomy were identified using the medical procedure codes. Persistent hypoPT was defined as the prescription of active vitamin D supplements for >1 year postoperatively and the assignment of hypoPT codes. The prevalence of persistent hypoPT was estimated at two different levels: minimum and maximum estimations with or without postoperative osteoporosis and/or renal failure codes. Correlates for persistent hypoPT were investigated among several demographic and clinical variables.
Of the 2388 patients, 1752 (73.4%) were women with a mean age of 45 years. The types of diseases were: benign thyroid disease (n = 235), malignant thyroid tumors (n = 1570), Graves ' disease (n = 558), and malignancy combined with Graves' disease (n = 25). The minimum and the maximum estimation of the prevalence of persistent hypoPT were 15.0 and 20.3%, respectively. Multivariate logistic regression analysis showed that the malignant tumor (odds ratio, 1.8) independently correlated with persistent hypoPT.
The prevalence of persistent hypoPT after total thyroidectomy estimated by the claims-based database was higher than previously recognized. Comprehensive attempts to preserve parathyroid function, especially in malignant diseases, are essential.
持续性甲状旁腺功能减退症（简称 hypoPT）是甲状腺全切除术的主要并发症。尽管如此，由于患者选择偏倚，先前的报告可能低估了 hypoPT 的患病率。我们旨在估计甲状腺全切除术后持续性 hypoPT 的实际患病率，并寻找术后 hypoPT 的预测因素。
本研究回顾性分析了日本医疗数据中心有限公司提供的基于健康保险索赔的数据库中的数据。2009 年至 2019 年期间，使用医疗程序代码确定了 2388 例接受甲状腺全切除术的患者。术后持续性 hypoPT 定义为开具活性维生素 D 补充剂超过 1 年，并分配 hypoPT 代码。通过有无术后骨质疏松症和/或肾衰竭代码，对持续性 hypoPT 的患病率进行了最低和最高估计。在几个人口统计学和临床变量中研究了持续性 hypoPT 的相关因素。
在 2388 例患者中，1752 例（73.4%）为女性，平均年龄为 45 岁。疾病类型为：良性甲状腺疾病（n=235）、恶性甲状腺肿瘤（n=1570）、格雷夫斯病（n=558）和恶性肿瘤合并格雷夫斯病（n=25）。持续性 hypoPT 的最低和最高估计患病率分别为 15.0%和 20.3%。多变量逻辑回归分析显示，恶性肿瘤（比值比，1.8）与持续性 hypoPT 独立相关。
基于索赔数据库估计的甲状腺全切除术后持续性 hypoPT 的患病率高于先前认识。全面尝试保留甲状旁腺功能，特别是在恶性疾病中，是至关重要的。
