Liu Kailin, Wang Nana, Zhao Peng, Zhao Baoyan, Wang Zhihao, Sun Yongjie, Geng Chong
Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Second Department of Breast Diseases, Second Department of Thyroid Diseases,Shandong Second Provincial General Hospital No. 4, Jinan, Shandong, China.
Front Endocrinol (Lausanne). 2025 Sep 3;16:1594781. doi: 10.3389/fendo.2025.1594781. eCollection 2025.
Hypoparathyroidism is a frequent complication following thyroidectomy. However, the risk factors for postoperative hypoparathyroidism remain poorly characterized. This study aims to investigate routine clinical characteristics to identify predictors of postoperative hypoparathyroidism.
A retrospective analysis was conducted on 3,638 patients who underwent total or hemithyroidectomy with isthmusectomy through open surgery with routine central lymph node dissection. Based on postoperative serum parathyroid hormone(PTH) levels, patients were subdivided according to the normal reference PTH levels or the Q3 quartile of PTH decline rate. Spearman correlation analysis and stepwise multiple linear regression were used to identify factors affecting preoperative serum PTH levels. Univariate and multivariate logistic regression analyses were performed to explore risk factors for postoperative hypoparathyroidism.
Among patients developed postoperative hypoparathyroidism. Multivariate logistic regression revealed that Hashimoto's thyroiditis (HT) (=1.786, =0.007) and preoperative blood glucose (=1.319, =0.005) was an independent risk factor, while body mass index (BMI)≥24 (=0.714, =0.032),elevated preoperative PTH levels (=0.988, =0.013)and male (=0.554, =0.002) were protective factors. Among patients in the Q3 quartile,postoperative PTH decline rate was positively associated with HT (=2.266, 0.001), preoperative PTH levels (=1.032, 0.001), and blood glucose (=1.234, =0.027), while it was negatively associated with BMI≥24 (=0.611, =0.013), hemoglobin (=0.984, =0.003), and high-density lipoprotein cholesterol (HDL-C) (=0.426, =0.007).Additionally, male (=0.558, =0.003) and preoperative serum Ca levels (=0.110, =0.011) were negatively correlated with the postoperative PTH decline rate in patients undergoing hemithyroidectomy with isthmusectomy. Furthermore, age had no significant effect on the incidence of postoperative hypoparathyroidism.
This study demonstrates that preoperative high glucose levels and HT are risk factors for hypoparathyroidism after total thyroidectomy, while BMI≥24 serves as a protective factor against postoperative hypoparathyroidism. Additionally, female is a risk factor for hypoparathyroidism after both total thyroidectomy and hemithyroidectomy with isthmusectomy, while higher hemoglobin levels and HDL-C are negatively correlated with the decline in PTH levels after total thyroidectomy.
甲状旁腺功能减退是甲状腺切除术后常见的并发症。然而，术后甲状旁腺功能减退的危险因素仍未得到充分描述。本研究旨在调查常规临床特征以识别术后甲状旁腺功能减退的预测因素。
对3638例行全甲状腺切除或半甲状腺切除加峡部切除并常规行中央淋巴结清扫的开放手术患者进行回顾性分析。根据术后血清甲状旁腺激素（PTH）水平，按照正常参考PTH水平或PTH下降率的Q3四分位数对患者进行细分。采用Spearman相关性分析和逐步多元线性回归来识别影响术前血清PTH水平的因素。进行单因素和多因素逻辑回归分析以探讨术后甲状旁腺功能减退的危险因素。
在发生术后甲状旁腺功能减退的患者中。多因素逻辑回归显示，桥本甲状腺炎（HT）（比值比=1.786，P=0.007）和术前血糖（比值比=1.319，P=0.005）是独立危险因素，而体重指数（BMI）≥24（比值比=0.714，P=0.032）、术前PTH水平升高（比值比=0.988，P=0.013）和男性（比值比=0.554，P=0.002）是保护因素。在Q3四分位数的患者中，术后PTH下降率与HT（比值比=2.266，P=0.001）、术前PTH水平（比值比=1.032，P=0.001）和血糖（比值比=1.234，P=0.027）呈正相关，而与BMI≥24（比值比=0.611，P=0.013）、血红蛋白（比值比=0.984，P=0.003）和高密度脂蛋白胆固醇（HDL-C）（比值比=0.426，P=0.007）呈负相关。此外，男性（比值比=0.558，P=0.003）和术前血清钙水平（比值比=0.110，P=0.011）与行半甲状腺切除加峡部切除患者的术后PTH下降率呈负相关。此外，年龄对术后甲状旁腺功能减退的发生率无显著影响。
本研究表明，术前高血糖水平和HT是全甲状腺切除术后甲状旁腺功能减退的危险因素，而BMI≥24是预防术后甲状旁腺功能减退的保护因素。此外，女性是全甲状腺切除和半甲状腺切除加峡部切除术后甲状旁腺功能减退的危险因素，而较高的血红蛋白水平和HDL-C与全甲状腺切除术后PTH水平的下降呈负相关。
