Parathyroid Hormone Reduction Predicts Transient Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective...

Area of Science:

• Endocrinology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Total thyroidectomy with central lymph node dissection (CLND) is a standard procedure for papillary thyroid carcinoma.
• Postoperative hypocalcemia is a common complication, necessitating identification of predictive risk factors.

Purpose of the Study:

• To investigate the risk factors for postoperative hypocalcemia following total thyroidectomy with CLND.
• To identify predictors of transient hypocalcemia in patients undergoing this procedure.

Main Methods:

• A single-center prospective study included 176 patients with papillary thyroid carcinoma undergoing total thyroidectomy and CLND.
• Preoperative and postoperative parathyroid hormone (PTH) and calcium levels were monitored.
• Logistic regression and receiver operating characteristic (ROC) curve analyses were used to identify risk factors and assess predictive accuracy.

Main Results:

• Transient hypocalcemia occurred in 28.98% of patients, with 1.14% developing permanent hypoparathyroidism.
• A decrease in postoperative PTH levels was a significant risk factor for transient hypocalcemia in the overall cohort, bilateral CLND group, and female patients.
• Tumor diameter was identified as a risk factor for transient hypocalcemia specifically in female patients.
• ROC curve analysis indicated that a 71.00% PTH level reduction accurately predicted transient hypocalcemia in female patients and the bilateral CLND group.

Conclusions:

• Asymptomatic female patients undergoing bilateral CLND with a 71.00% PTH level reduction are at high risk for transient hypocalcemia.
• Monitoring PTH levels postoperatively is crucial for predicting and managing hypocalcemia after total thyroidectomy with CLND.