Risk factors for postoperative hypoparathyroidism after total thyroidectomy / 中华普通外科杂志

ABSTRACT

Objective:To study the risk factors of postoperative permanent hypoparathyroidism after total thyroidectomy.Methods:In this retrospective study ,the receiver operating characteristic (ROC) curve of postoperative 24 h parathyroid hormone(PTH) values was used to predict the risk of permanent hypoparathyroidism.The clinical and pathological features that related to postoperative permanent hypoparathyroidism were studied by χ2 test and multivariate Logistic regression analysis. Results:Eight hundred and eighty-nine patients were enrolled, the incidence of postoperative transient and permanent hypoparathyroidism was 33.3% and 4.0%, respectively. When 24 h PTH levels less than or equal to 5.84 pg/ml were used as cut off value, the sensitivity of the prediction of permanent hypoparathyroidism was 100%, the specificity was 72%, and the positive predictive value was 22.5%. The presence of parathyroid gland in the pathologic specimen, parathyroid autotransplantation and PTH≤5.84 pg/ml at 24 h after operation were statistically significant risk factor for permanent hypoparathyroidism in multivariate analysis( χ2=10.900, P=0.001; χ2=4.415, P=0.044; χ2=13.576, P=0.000). Group analysis found that the lower 24 h PTH the higher incidence of permanent hypoparathyroidism. Conclusions:For patients undergoing total thyroidectomy, when parathyroid gland is involved and/or the PTH value is low at 24 h after surgery, the occurrence of permanent hypoparathyroidism is high.