Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Surgery, Gävle Hospital, Gävle, Sweden.
Br J Surg. 2024 Jan 3;111(1). doi: 10.1093/bjs/znad366.
A previous nationwide study from Sweden showed that the rate of permanent hypoparathyroidism is high and under-rated in the Swedish Quality Register. This retrospective population-based study aimed to validate the rate and diagnosis of permanent hypoparathyroidism found in the previous study. A secondary aim was to assess the relationship between the rate of low parathyroid hormone (PTH) levels within 24 h after surgery and the rate of permanent hypoparathyroidism.
All patients who underwent total thyroidectomy from 2005 to 2015 in a region of Sweden were included. Data were retrieved from local health records, the National Patient Registry, the Swedish Prescribed Drug Registry, and the Swedish Quality Register. A strict definition of permanent hypoparathyroidism was used, including biochemical data and attempts to stop the treatment.
A total of 1636 patients were included. Altogether, 143 patients (8.7 per cent) developed permanent hypoparathyroidism. Of these, 102 (6.2 per cent) had definitive permanent hypoparathyroidism, whereas 41 (2.5 per cent) had possible permanent hypoparathyroidism, because attempts to stop the treatment were lacking (28) or patients were lost to follow-up (13). The agreement between the Swedish Quality Register and the chart review was 29.3 per cent. A proportion of 23.2 per cent with a PTH level below the reference value corresponded to a 6.7 per cent rate of permanent hypoparathyroidism.
The risk of permanent hypoparathyroidism after total thyroidectomy is high. Some patients are overtreated because attempts to stop the treatment are lacking. Quality registers might underestimate the risk of permanent hypoparathyroidism. Approximately one-quarter of all patients with low PTH levels immediately after surgery developed permanent hypoparathyroidism.
瑞典此前的一项全国性研究表明，瑞典质量登记册中永久性甲状旁腺功能减退症的发生率高且被低估。本回顾性基于人群的研究旨在验证之前研究中发现的永久性甲状旁腺功能减退症的发生率和诊断。次要目的是评估手术后 24 小时内甲状旁腺激素（PTH）水平低的发生率与永久性甲状旁腺功能减退症的发生率之间的关系。
纳入 2005 年至 2015 年期间在瑞典一个地区接受全甲状腺切除术的所有患者。数据从当地健康记录、国家患者登记处、瑞典处方药物登记处和瑞典质量登记处获取。使用严格的永久性甲状旁腺功能减退症定义，包括生化数据和停止治疗的尝试。
共纳入 1636 例患者。共有 143 例（8.7%）发生永久性甲状旁腺功能减退症。其中，102 例（6.2%）为明确的永久性甲状旁腺功能减退症，41 例（2.5%）为可能的永久性甲状旁腺功能减退症，因为缺乏停止治疗的尝试（28 例）或患者失访（13 例）。瑞典质量登记处和图表审查之间的一致性为 29.3%。PTH 水平低于参考值的比例为 23.2%，对应的永久性甲状旁腺功能减退症发生率为 6.7%。
全甲状腺切除术后永久性甲状旁腺功能减退症的风险很高。由于缺乏停止治疗的尝试，一些患者接受了过度治疗。质量登记处可能低估了永久性甲状旁腺功能减退症的风险。大约四分之一的所有患者在手术后立即出现低 PTH 水平，发展为永久性甲状旁腺功能减退症。
