Risk factors of hypoparathyroidism after total thyroidectomy and bilateral central lymph node dissection in patients with papillary thyroid carcinoma / 中华内分泌外科杂志

ABSTRACT

Objective To investigate the risk factors of hypoparathyroidism after total thyroidectomy and bilateral central lymph node dissection in patients with papillary thyroid carcinoma.Methods Data of patients with PTC who accepted total thyroidectomy and bilateral central lymph node dissection in the Department of Thyroid Surgery from Jan.2013 to Jun.2016 were collected and analyzed retrospectively.The patients were divided into normal group,transient hypoparathyroidism group and permanent hypoparathyroidism group according to the level of serum parathyroid hormone within 6 months after surgery.Clinical data were collected for comparison between the three groups.The risk factors of hypoparathyroidism were indentified with univariate analysis and multivariate analysis.Results A total of 468 patients,241 in the normal group and 227 in the hypoparathyroidism group (220 in the transient hypoparathyroidism group and 7 in the permanent hypoparathyroidism group),were included in the study.Univariate analysis showed that without application of carbon nanoparticles (P=0.04) and autotransplantation of more than one parathyroid gland (P＜0.001) were risk factors of hypoparathyroidism,and without application of carbon nanoparticles (P=0.047),incidental parathyroidectomy of one parathyroid gland (P=0.04),gross extrathyroidal extension (P=0.006) and c N1a were risk factors of permanent hypoparathyroidism.Multivariate analysis showed that without application of carbon nanoparticles (OR,0.437;95％ CI,0.243-0.789;P=0.006) and autotransplantation of more than one parathyroid gland (OR,3.025;95％ CI,1999-4579;,P=0.000) were independent risk fact ors of hypoparathyroidism,and without application of carbon nanoparticles (OR,0.197;95％ CI,0.039-0.982;P=0.048) and gross extrathyroidal extension (OR,12.381;95％ CI,1.432-107.036;P=0.022) were independent risk factors of permanent hypoparathyroidism.Conclusion When total thyroidectomy and bilateral central lymph nodes dissection were performed,carbon nanoparticles were routinely applied.Although autotransplantation of more than one parathyroid gland can increase the incidence of transient hypoparathyroidism,it can reduce the incidence of permanent hypoparathyroidism.If extrathyroidal extension is suspected,hypoparathyroidism should be emphasized to patient,and accurate operation should be done to reduce the incidence of hypoparathyroidism.