Advanced age does not increase morbidity after total thyroidectomy. Result of a prospective study

Area of Science:

• Endocrinology
• Surgical Oncology
• Geriatric Medicine

Background:

• Total thyroidectomy is a common procedure, but concerns exist regarding increased complication rates in elderly patients due to comorbidities.
• Specific risks such as hypoparathyroidism and recurrent laryngeal nerve palsy are critical to evaluate in this demographic.

Purpose of the Study:

• To analyze the specific surgical risks, including hypoparathyroidism and recurrent nerve palsy, associated with total thyroidectomy in elderly patients (≥70 years).
• To compare complication rates between patients aged 70 and above and those younger than 70 undergoing total thyroidectomy.

Main Methods:

• A prospective, multicenter trial involving 1329 patients undergoing total thyroidectomy across 13 hospital sites.
• Primary endpoint: postoperative hypocalcemia (albumin-corrected serum calcium <2 mmol/L at day 2). Secondary endpoints: recurrent nerve palsy, hypocalcemia and nerve palsy at 6 months, operative duration, and pain.
• Patients were stratified into two groups: <70 years and ≥70 years.

Main Results:

• Overall hypocalcemia rates were 20.02% at day 2 and 1.98% at 6 months. Abnormal vocal cord motility was observed in 9.92% at day 2 and 0.95% at 6 months.
• Patients aged ≥70 years showed a non-significantly lower rate of hypocalcemia at day 2 (14.85% vs. 20.44%) and at 6 months (0% vs. 2.15%) compared to younger patients.
• Abnormal vocal cord motility rates were similar between the age groups: 12.00% vs. 9.75% at day 2 and 2.06% vs. 0.86% at 6 months for older vs. younger patients, respectively.

Conclusions:

• Total thyroidectomy is a feasible and safe procedure for patients aged 70 years and older.
• Advanced age (≥70 years) does not appear to significantly increase the morbidity associated with total thyroidectomy.
• The study is registered on ClinicalTrials.gov (NCT01551914).