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

ABSTRACT

Objective To evaluate the risk factors for postoperative hypoparathyroidism.Methods Tolally 200 patients with thyroid diseases undergoing total thyroidectomy at Department of General Surgery,Ruijin Hospital from Sep 2012 to Oct 2015 were followed up.The related risk factors were analyzed.x2 test and Fisher's exact test were used to analyze the correlation between hypoparathyroidism after total thyroidectomy and the other clinical factors.Multiple logistic regression analysis was performed to identify these risk factors.We analyzed the receiver operating characteristic (ROC) curve and calculated the area under the curve (AUC).The highest accuracy cutoff levels of intact parathyroid hormone (iPTH) level at 1 day after thyroidectomy (iPTH 1 d) and ％ iPTH decline were determined from the ROC curves.Results Of the 200 patients,66.5％ developed hypoparathyroidism on the first day,6.5％developed hypoparathyroidism in 6 months after surgery.That was 3.5％ in 1 year.The femaleness(OR =2.966,95％ CI1.480-5.945,P =0.002),age (OR =0.972,95％ CI0.946-0.999,P =0.039),and bilateral center lymph node dissection (OR =5.508,95％ CI1.693-17.923,P =0.005) were independently correlated with postoperative hypoparathyroidism.The parathyroid hormone concentration on postoperative day 1 (OR =0.738,95％ CI0.556-0.979,P =0.035) and 131I remnant ablation therapy (OR =12.887,95％ CI3.434-48.367,P =0.000) were independent risk factors for postoperative hypoparathyroidism in 6 month.Both iPTH ＜ 3.05 pg/ml and ＞ 92.5％ iPTH decline on post-op dl could accurately predict significant hypoparathyroidism postoperative 6 month with accuracy of 82.1％ and 78.2％.Conclusions Bilateral center lymph node dissection and 131I remnant ablation therapy are risk factors for postoperative hypoparathyroidism,the iPTH1 d and ％ iPTH decline can predict hypoparathyroidism in postoperative 6 month.