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

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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, 许琳琳. 甲状腺癌流行病学分析及超声诊断价值. 医学信息, 2020, 33(5): 85-87.
2.	崔玉山, 刘洪亮. 甲状腺癌流行病学特征和碘营养关系研究进展. 环境卫生学杂志, 2020, 10(2): 212-217.
3.	庄英革. 探究甲状腺全切除术在甲状腺癌临床治疗中的有效性及安全性. 中国现代药物应用, 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. 甲状腺切除术后甲状旁腺功能减退的危险因素分析. 外科理论与实践, 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, 杨易戎, 张海涛. 桥本氏甲状腺炎与甲状腺乳头状癌的免疫学关系. 临床与病理杂志, 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.	沈晓卉, 吕春晖, 陈海珍, 等. 甲状腺癌中央区淋巴结清扫和术后甲状旁腺功能减退. 外科理论与实践, 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.	Păduraru DN, Ion D, Carsote M, et al. Post-thyroidectomy hypocalcemia—risk factors and management. Chirurgia (Bucur), 2019, 114(5): 564-570.
17.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 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.	夏文飞, 李兴睿. 甲状腺术中甲状旁腺的识别与保护临床新进展. 临床外科杂志, 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, 郑海涛. 甲状旁腺自荧光显影技术应用研究. 山东大学耳鼻喉眼学报, 2020, 34(3): 19-25.
23.	朱精强, 苏安平, 王明俊. 《甲状腺围手术期甲状旁腺功能保护指南(2018 版)》解读. 中国普外基础与临床杂志, 2019, 26(10): 1145-1148.
24.	王慧, 周乐, 孙辉. 细针穿刺洗脱液检测在甲状腺和甲状旁腺外科应用进展. 中华内分泌外科杂志, 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, 陈志达, 郗洪庆, 等. 近红外自体荧光显像技术在甲状腺癌根治性手术中辅助甲状旁腺识别应用 1 例报告并文献复习. 中国实用外科杂志, 2020, 40(5): 591-593.

1. 李婷婷, 李素梅, 许琳琳. 甲状腺癌流行病学分析及超声诊断价值. 医学信息, 2020, 33(5): 85-87.
2. 崔玉山, 刘洪亮. 甲状腺癌流行病学特征和碘营养关系研究进展. 环境卫生学杂志, 2020, 10(2): 212-217.
3. 庄英革. 探究甲状腺全切除术在甲状腺癌临床治疗中的有效性及安全性. 中国现代药物应用, 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. 甲状腺切除术后甲状旁腺功能减退的危险因素分析. 外科理论与实践, 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, 杨易戎, 张海涛. 桥本氏甲状腺炎与甲状腺乳头状癌的免疫学关系. 临床与病理杂志, 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. 沈晓卉, 吕春晖, 陈海珍, 等. 甲状腺癌中央区淋巴结清扫和术后甲状旁腺功能减退. 外科理论与实践, 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. Păduraru DN, Ion D, Carsote M, et al. Post-thyroidectomy hypocalcemia—risk factors and management. Chirurgia (Bucur), 2019, 114(5): 564-570.
17. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 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. 夏文飞, 李兴睿. 甲状腺术中甲状旁腺的识别与保护临床新进展. 临床外科杂志, 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, 郑海涛. 甲状旁腺自荧光显影技术应用研究. 山东大学耳鼻喉眼学报, 2020, 34(3): 19-25.
23. 朱精强, 苏安平, 王明俊. 《甲状腺围手术期甲状旁腺功能保护指南(2018 版)》解读. 中国普外基础与临床杂志, 2019, 26(10): 1145-1148.
24. 王慧, 周乐, 孙辉. 细针穿刺洗脱液检测在甲状腺和甲状旁腺外科应用进展. 中华内分泌外科杂志, 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, 陈志达, 郗洪庆, 等. 近红外自体荧光显像技术在甲状腺癌根治性手术中辅助甲状旁腺识别应用 1 例报告并文献复习. 中国实用外科杂志, 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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