Risk factors for hypoparathyroidism following radical resection of thyroid papillary carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DU Wei , FAN Jie , ZHANG Xiaojun , FENG Lu

Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, P. R. China;

Corresponding?author：

DU Wei, Email: duweitj@126.com, ddww@zzu.edu.cn

Keywords：

papillary thyroid carcinoma; parathyroid dysfunction; hypocalcemia; hypoparathyroxinemia

DOI：

10.7507/1007-9424.202010095

Video：

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Objective To investigate the risk factors for hypoparathyroidism following radical surgery for patients with thyroid papillary carcinoma (PTC).Methods A retrospective analysis was made on 192 patients with PTC who underwent radical thyroidectomy in the Department of Head Neck and Thyroid Surgery of Henan Cancer Hospital from January 2019 to January 2020. There were 52 males and 140 females with a median age of 48 years. The risk factors of hypocalcemia and hypoparathyroidism syndrome were screened by χ² test and binary logistic regression analysis.Results In 192 patients the proportion of patients with normal or hypoparathyroidism after operation were 62.5% (120/192) and 37.5% (72/192), respectively. Univariate analysis showed that complications, Hashimoto’s thyroiditis (HT), total thyroidectomy, N1a staging, Ⅵ lymph node dissection and parathyroid not planted were risk factors for postoperative hypoparathyroidism in patients with PTC. Binary logistic regression analysis showed that: ① HT, N1a staging and Ⅵ lymph node dissection were independent risk factors for postoperative hypocalcemia [without HT: OR=0.313, 95%CI (0.129, 0.760), P=0.010; N1a staging: OR=3.457, 95%CI (1.637, 7.301), P=0.001; without Ⅵ lymph node dissection: OR=0.115, 95%CI (0.041, 0.323), P<0.001]. ② HT, N1a staging, Ⅵ lymph node dissection and parathyroid not planted were independent risk factors for postoperative low parathyroid hormone [without HT: OR=0.285, 95%CI (0.117, 0.698), P=0.006; N1a staging: OR=3.747, 95%CI (1.762, 7.968), P=0.001; without Ⅵ lymph node dissection: OR=0.112, 95%CI (0.039, 0.317), P<0.010; planted parathyroid: OR=0.464, 95%CI (0.221, 0.978), P=0.043].Conclusion HT, N1a staging, Ⅵ lymph node dissection and parathyroid not planted are vital risk factors for hypoparathyroidism in patients with PTC after radical thyroidectomy.

Citation： DU Wei, FAN Jie, ZHANG Xiaojun, FENG Lu. Risk factors for hypoparathyroidism following radical resection of thyroid papillary carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(7): 878-883. doi: 10.7507/1007-9424.202010095 Copy

1.	李婷婷, 李素梅, 許琳琳. 甲狀腺癌流行病學分析及超聲診斷價值. 醫學信息, 2020, 33(5): 85-87.
2.	崔玉山, 劉洪亮. 甲狀腺癌流行病學特征和碘營養關系研究進展. 環境衛生學雜志, 2020, 10(2): 212-217.
3.	莊英革. 探究甲狀腺全切除術在甲狀腺癌臨床治療中的有效性及安全性. 中國現代藥物應用, 2020, 14(21): 99-101.
4.	Anuwong A, Ketwong K, Jitpratoom P, et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg, 2018, 153(1): 21-27.
5.	汪矛斐, 袁申毅, 袁建明, 等. 甲狀腺切除術后甲狀旁腺功能減退的危險因素分析. 外科理論與實踐, 2020, 25(2): 124-128.
6.	Halwani C, Turki S, Akkari K. Predictive factors for post-total thyroidectomy hypocalcaemia. Tunis Med, 2020, 98(10): 720-725.
7.	Sebastian M, Rudnicki J, Jakubaszko W, et al. Clinical and biochemical factors affecting postoperative hypocalcemia after near-total thyroidectomy. Adv Clin Exp Med, 2013, 22(5): 675-682.
8.	Kweon SS, Shin MH, Chung IJ, et al. Thyroid cancer is the most common cancer in women, based on the data from population-based cancer registries, South Korea. Jpn J Clin Oncol, 2013, 43(10): 1039-1046.
9.	Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab, 2020, 105(6): 1722-1736.
10.	Hakami Y, Khan A. Hypoparathyroidism. Front Horm Res, 2019, 51: 109-126.
11.	Yu Y, Zhang J, Lu G, et al. Clinical relationship between IgG4-positive Hashimoto’s thyroiditis and papillary thyroid carcinoma. J Clin Endocrinol Metab, 2016, 101(4): 1516-1524.
12.	熊建霞, 楊易戎, 張海濤. 橋本氏甲狀腺炎與甲狀腺乳頭狀癌的免疫學關系. 臨床與病理雜志, 2020, 40(10): 2757-2763.
13.	Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
14.	沈曉卉, 呂春暉, 陳海珍, 等. 甲狀腺癌中央區淋巴結清掃和術后甲狀旁腺功能減退. 外科理論與實踐, 2016, 21(4): 312-317.
15.	Su AP, Wang B, Gong Y, et al. Risk factors of hypoparathyroidism following total thyroidectomy with central lymph node dissection. Medicine (Baltimore), 2017, 96(39): e8162.
16.	P?duraru DN, Ion D, Carsote M, et al. Post-thyroidectomy hypocalcemia—risk factors and management. Chirurgia (Bucur), 2019, 114(5): 564-570.
17.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 2015, 35(7): 731-736.
18.	Shi C, Tian B, Li S, et al. Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: A retrospective Chinese population study. Medicine (Baltimore), 2016, 95(46): e5148.
19.	夏文飛, 李興睿. 甲狀腺術中甲狀旁腺的識別與保護臨床新進展. 臨床外科雜志, 2020, 28(3): 282-284.
20.	Ilahi A, Muco E, Ilahi TB. Anatomy, head and neck, parathyroid//StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2021 Jan. https://www.statpearls.com/articlelibrary/viewarticle/26658/.
21.	Ponce de León-Ballesteros G, Velázquez-Fernández D, Hernández-Calderón FJ, et al. Hypoparathyroidism after total thyroidectomy: importance of the intraoperative management of the parathyroid glands. World J Surg, 2019, 43(7): 1728-1735.
22.	宋西成, 鄭海濤. 甲狀旁腺自熒光顯影技術應用研究. 山東大學耳鼻喉眼學報, 2020, 34(3): 19-25.
23.	朱精強, 蘇安平, 王明俊. 《甲狀腺圍手術期甲狀旁腺功能保護指南(2018 版)》解讀. 中國普外基礎與臨床雜志, 2019, 26(10): 1145-1148.
24.	王慧, 周樂, 孫輝. 細針穿刺洗脫液檢測在甲狀腺和甲狀旁腺外科應用進展. 中華內分泌外科雜志, 2018, 12(2): 163-165.
25.	Lerchenberger M, Al Arabi N, Gallwas JKS, et al. Intraoperative near-infrared autofluorescence and indocyanine green imaging to identify parathyroid glands: a comparison. Int J Endocrinol, 2019, 2019: 4687951.
26.	田文, 陳志達, 郗洪慶, 等. 近紅外自體熒光顯像技術在甲狀腺癌根治性手術中輔助甲狀旁腺識別應用 1 例報告并文獻復習. 中國實用外科雜志, 2020, 40(5): 591-593.

1. 李婷婷, 李素梅, 許琳琳. 甲狀腺癌流行病學分析及超聲診斷價值. 醫學信息, 2020, 33(5): 85-87.
2. 崔玉山, 劉洪亮. 甲狀腺癌流行病學特征和碘營養關系研究進展. 環境衛生學雜志, 2020, 10(2): 212-217.
3. 莊英革. 探究甲狀腺全切除術在甲狀腺癌臨床治療中的有效性及安全性. 中國現代藥物應用, 2020, 14(21): 99-101.
4. Anuwong A, Ketwong K, Jitpratoom P, et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg, 2018, 153(1): 21-27.
5. 汪矛斐, 袁申毅, 袁建明, 等. 甲狀腺切除術后甲狀旁腺功能減退的危險因素分析. 外科理論與實踐, 2020, 25(2): 124-128.
6. Halwani C, Turki S, Akkari K. Predictive factors for post-total thyroidectomy hypocalcaemia. Tunis Med, 2020, 98(10): 720-725.
7. Sebastian M, Rudnicki J, Jakubaszko W, et al. Clinical and biochemical factors affecting postoperative hypocalcemia after near-total thyroidectomy. Adv Clin Exp Med, 2013, 22(5): 675-682.
8. Kweon SS, Shin MH, Chung IJ, et al. Thyroid cancer is the most common cancer in women, based on the data from population-based cancer registries, South Korea. Jpn J Clin Oncol, 2013, 43(10): 1039-1046.
9. Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab, 2020, 105(6): 1722-1736.
10. Hakami Y, Khan A. Hypoparathyroidism. Front Horm Res, 2019, 51: 109-126.
11. Yu Y, Zhang J, Lu G, et al. Clinical relationship between IgG4-positive Hashimoto’s thyroiditis and papillary thyroid carcinoma. J Clin Endocrinol Metab, 2016, 101(4): 1516-1524.
12. 熊建霞, 楊易戎, 張海濤. 橋本氏甲狀腺炎與甲狀腺乳頭狀癌的免疫學關系. 臨床與病理雜志, 2020, 40(10): 2757-2763.
13. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
14. 沈曉卉, 呂春暉, 陳海珍, 等. 甲狀腺癌中央區淋巴結清掃和術后甲狀旁腺功能減退. 外科理論與實踐, 2016, 21(4): 312-317.
15. Su AP, Wang B, Gong Y, et al. Risk factors of hypoparathyroidism following total thyroidectomy with central lymph node dissection. Medicine (Baltimore), 2017, 96(39): e8162.
16. P?duraru DN, Ion D, Carsote M, et al. Post-thyroidectomy hypocalcemia—risk factors and management. Chirurgia (Bucur), 2019, 114(5): 564-570.
17. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 2015, 35(7): 731-736.
18. Shi C, Tian B, Li S, et al. Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: A retrospective Chinese population study. Medicine (Baltimore), 2016, 95(46): e5148.
19. 夏文飛, 李興睿. 甲狀腺術中甲狀旁腺的識別與保護臨床新進展. 臨床外科雜志, 2020, 28(3): 282-284.
20. Ilahi A, Muco E, Ilahi TB. Anatomy, head and neck, parathyroid//StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2021 Jan. https://www.statpearls.com/articlelibrary/viewarticle/26658/.
21. Ponce de León-Ballesteros G, Velázquez-Fernández D, Hernández-Calderón FJ, et al. Hypoparathyroidism after total thyroidectomy: importance of the intraoperative management of the parathyroid glands. World J Surg, 2019, 43(7): 1728-1735.
22. 宋西成, 鄭海濤. 甲狀旁腺自熒光顯影技術應用研究. 山東大學耳鼻喉眼學報, 2020, 34(3): 19-25.
23. 朱精強, 蘇安平, 王明俊. 《甲狀腺圍手術期甲狀旁腺功能保護指南(2018 版)》解讀. 中國普外基礎與臨床雜志, 2019, 26(10): 1145-1148.
24. 王慧, 周樂, 孫輝. 細針穿刺洗脫液檢測在甲狀腺和甲狀旁腺外科應用進展. 中華內分泌外科雜志, 2018, 12(2): 163-165.
25. Lerchenberger M, Al Arabi N, Gallwas JKS, et al. Intraoperative near-infrared autofluorescence and indocyanine green imaging to identify parathyroid glands: a comparison. Int J Endocrinol, 2019, 2019: 4687951.
26. 田文, 陳志達, 郗洪慶, 等. 近紅外自體熒光顯像技術在甲狀腺癌根治性手術中輔助甲狀旁腺識別應用 1 例報告并文獻復習. 中國實用外科雜志, 2020, 40(5): 591-593.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk factors for hypoparathyroidism following radical resection of thyroid papillary carcinoma

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