Patients who also undergo a parathyroidectomy at the same time as total thyroidectomy are at high risk of immediate and long-term hypoparathyroidism, says a recent study published online April 10, 2023 in Journal of Surgical Research.¹

This study involved 13,647 (95.4%) patients who underwent total thyroidectomy (TTX) and 654 (4.6%) who had total thyroidectomy (TTX) with concurrent parathyroidectomy (PTX) for primary hyperparathyroidism from January 2014 through April 2020. Data for the selected participants was obtained from the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) database. Patients younger than 18 years, those scheduled for thyroid lobectomy or with secondary and tertiary hyperparathyroidism, incidental parathyroidectomy, re-operative thyroidectomy or parathyroidectomy or those who were missing were missing a number of excised parathyroid glands in the combined surgery group were not included in the trial. Patients who underwent both surgeries simultaneously were older (63 vs 51%, respectively) and tended to be female (85.3% vs 81.4%, respectively). Of these, nearly 6% had ≥3 parathyroid glands removed, 8.6% had 3 glands removed, 22.3% had 2 glands removed, while the majority (63%) had one gland removed.

Patients who underwent total thyroidectomy + concurrent parathyroidectomy had a higher risk of hypoparathyroidism at 30 days (9.6% vs 7.4%, respectively) and 6 months (7.9% vs 3.1%, respectively).

A strong association for hypoparathyroidism was noted with concurrent parathyroidectomy on multivariable regression analysis. At 30 days, these patients were twice more likely to develop hypoparathyroidism at 30 days with odds ratio of 2.09. The risk increased 4 times in 6 months with OR of 4.63. These patients also had a higher probability of ER visits after the surgery with OR of 1.66. However, the combined procedure was not associated with neck hematoma or recurrent laryngeal nerve injury.

These findings highlight the need for educating patients who undergo total thyroidectomy with simultaneous parathyroidectomy about the risk of hypoparathyroidism, both immediate and long-term as part of the informed consent process. “Intraoperatively, surgeons should proceed with awareness of these risks and should use available adjuncts, including intraoperative parathyroid hormone, which may help guide the extent of the PTX”, the researchers concluded. The study also advocates close follow-up of these patients for signs of hypoparathyroidism along with calcium monitoring and supplementation.

Reference

1. Cisco R, et al. Increased risk of complications associated with concurrent parathyroidectomy in patients undergoing total thyroidectomy. J Surg Res. 2023 Apr 10;288:275-281. doi: 10.1016/j.jss.2023.02.036.