Hypoparathyroidism after total thyroidectomy: reactive to symptoms supplementation.

Autor: Constant M; Department of Digestive Surgical Oncology - Liver Transplantation Unit, CHU Besancon, France3 Boulevard Alexandre Fleming, 25000, Besançon Cedex, France. mconstant@chu-besancon.fr., Schillo F; Department of Endocrinology, CHU Besancon, France., Billet S; Department of Endocrinology, CHU Besancon, France., Heyd B; Department of Digestive Surgical Oncology - Liver Transplantation Unit, CHU Besancon, France3 Boulevard Alexandre Fleming, 25000, Besançon Cedex, France., Doussot A; Department of Digestive Surgical Oncology - Liver Transplantation Unit, CHU Besancon, France3 Boulevard Alexandre Fleming, 25000, Besançon Cedex, France., Bouviez N; Department of Digestive Surgical Oncology - Liver Transplantation Unit, CHU Besancon, France3 Boulevard Alexandre Fleming, 25000, Besançon Cedex, France.
Jazyk: angličtina
Zdroj: BMC surgery [BMC Surg] 2024 Sep 14; Vol. 24 (1), pp. 264. Date of Electronic Publication: 2024 Sep 14.
DOI: 10.1186/s12893-024-02534-9
Abstrakt: Introduction: After total thyroidectomy (TT), postoperative hypoparathyroidism (PH) is the most frequent complication. Yet, management strategies for PH remain disputed. The aim of this study was to evaluate outcomes of a reactive supplementation in case of symptomatic PH. Additionally, risk factors for symptomatic PH and readmission due to PH were analyzed.
Materials and Methods: All consecutive patients who underwent TT or completion from 2017 to 2022 were considered for inclusion. During this period, a reactive to symptom vitamin-calcium supplementation was used. The primary outcome was the occurrence of severe PH after discharge resulting in readmission.
Results: Overall, 307 patients were included, of which 98 patients (31.9%) developed symptomatic PH including 43 patients before discharge. Independent risk factors for developing symptomatic PH were age (p = 0.010) and postoperative day 1 (POD1) PTH level (p < 0.001). Overall, 264 patients (86%) did not present PH before discharge and were discharged home. Among them, 55 patients (20.8%) experienced symptomatic PH, requiring readmission in 18 patients. The overall readmission rate owing to symptomatic PH requiring intravenous supplementation despite oral vitamin-calcium supplementation was 6.8% (n = 18). Independent risk factors for symptomatic PH-related readmission were age (p = 0.007) and POD1 PTH level (p < 0.001). Adequate cut-off values for predicting readmission were POD1 albumin-adjusted calcium = 2.1 mmol/l (Sensibility = 0.95, Specificity = 0.30) and POD1 PTH = 11.5 pg/ml (Sensibility = 0.90, Specificity = 0.71).
Conclusion: Supplementing only symptomatic patients was safe and efficient. This attitude does not alter on morbidity, mortality or readmission rate which is in line with current literature.
(© 2024. The Author(s).)
Databáze: MEDLINE
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