Reinke Rasmus, Londero Stefano Christian, Almquist Martin, Rejnmark Lars, Rolighed Lars
Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
Department of Surgery, Lund University Hospital, Lund, Sweden.
Endocr Connect. 2023 Aug 24;12(9). doi: 10.1530/EC-23-0198. Print 2023 Sep 1.
Total thyroidectomy is associated with a high risk of postoperative hypoparathyroidism, mainly due to the unintended surgical damage to the parathyroid glands or their blood supply. It is possible that surgeons who also perform parathyroid surgery see lower rates of postoperative hypoparathyroidism. In a single institution, we investigated the effects of restricting total thyroidectomy operations for Graves' disease to two surgeons who performed both thyroid and parathyroid surgeries. We aimed to evaluate the rates of postoperative hypoparathyroidism in a 10-year period with primary attention toward patients with Graves' disease.
Retrospective cohort study from a single institution.
We defined the rate of permanent hypoparathyroidism after total thyroidectomy as the need for active vitamin D 6 months postoperatively. Between 2012 and 2016, seven surgeons performed all thyroidectomies. From January 2017, only surgeons also performing parathyroid surgery carried out thyroidectomies for Graves' disease.
We performed total thyroidectomy in 543 patients. The rate of permanent hypoparathyroidism decreased from 28% in 2012-2014 to 6% in 2020-2021. For patients with Graves' disease, the rate of permanent hypoparathyroidism decreased from 36% (13 out of 36) in 2015-2016 to 2% (1 out of 56) in 2020-2021. In cancer patients, the rate of permanent hypoparathyroidism decreased from 30% (14 out of 46) in 2012-2014 to 10% (10 out of 51) in 2020-2021.
Restricting thyroidectomy to surgeons who also performed parathyroid operations reduced postoperative hypoparathyroidism markedly. Accordingly, we recommend centralisation of the most difficult thyroid operations to centres and surgeons with extensive experience in parathyroid surgery.
Thyroid surgery is performed by many different surgeons with marked differences in outcome. Indeed, the risk of postoperative permanent hypoparathyroidism may be very high in low-volume centres. This serious condition affects the quality of life and increases long-term morbidity and the patients develop a life-long dependency of medical treatments. We encountered a high risk of hypoparathyroidism after the operation for Graves' disease and restricted the number of surgeons to two for these operations. Further, these surgeons were experienced in both thyroid and parathyroid surgeries. We show a dramatic reduction in postoperative hypoparathyroidism after this change. Accordingly, we recommend centralisation of total thyroidectomy to surgeons with experience in both thyroid and parathyroid procedures.
全甲状腺切除术与术后甲状旁腺功能减退的高风险相关，主要原因是甲状旁腺及其血供受到意外手术损伤。同时进行甲状旁腺手术的外科医生术后甲状旁腺功能减退的发生率可能较低。在单一机构中，我们调查了将Graves病的全甲状腺切除术限制由两位同时进行甲状腺和甲状旁腺手术的外科医生实施的效果。我们旨在评估10年间术后甲状旁腺功能减退的发生率，主要关注Graves病患者。
来自单一机构的回顾性队列研究。
我们将全甲状腺切除术后永久性甲状旁腺功能减退的发生率定义为术后6个月需要活性维生素D。2012年至2016年期间，7位外科医生进行了所有甲状腺切除术。从2017年1月起，仅由同时进行甲状旁腺手术的外科医生对Graves病患者实施甲状腺切除术。
我们对543例患者进行了全甲状腺切除术。永久性甲状旁腺功能减退的发生率从2012 - 2014年的28%降至2020 - 2021年的6%。对于Graves病患者，永久性甲状旁腺功能减退的发生率从2015 - 2016年的36%（36例中的13例）降至2020 - 2021年的2%（56例中的1例）。在癌症患者中，永久性甲状旁腺功能减退的发生率从2012 - 2014年的30%（46例中的14例）降至2020 - 2021年的10%（51例中的10例）。
将甲状腺切除术限制由同时进行甲状旁腺手术的外科医生实施可显著降低术后甲状旁腺功能减退的发生率。因此，我们建议将最困难的甲状腺手术集中于在甲状旁腺手术方面有丰富经验的中心和外科医生。
甲状腺手术由许多不同的外科医生进行，结果存在显著差异。事实上，在手术量少的中心，术后永久性甲状旁腺功能减退的风险可能非常高。这种严重情况会影响生活质量并增加长期发病率，患者会产生终身医疗依赖。我们在Graves病手术后遇到甲状旁腺功能减退的高风险，并将这些手术的外科医生数量限制为两位。此外，这些外科医生在甲状腺和甲状旁腺手术方面都有经验。我们发现这一改变后术后甲状旁腺功能减退显著减少。因此，我们建议将全甲状腺切除术集中于在甲状腺和甲状旁腺手术方面都有经验的外科医生。
