Central lymph node dissection and permanent hypoparathyroidism after total thyroidectomy for papillary thyroid...

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Cancer Research

Background:

• Papillary thyroid cancer (PTC) treatment involves total/near-total thyroidectomy (TT) with or without central lymph node dissection (CLND).
• Balancing recurrence risk and surgical morbidity is a key challenge in PTC management.
• A nationwide study evaluated the risk of permanent hypoparathyroidism linked to CLND.

Purpose of the Study:

• To assess the association between central lymph node dissection (CLND) and permanent hypoparathyroidism in papillary thyroid cancer (PTC) patients.
• To identify risk factors for permanent hypoparathyroidism following thyroidectomy for PTC.
• To inform surgical decision-making regarding CLND in PTC treatment.

Main Methods:

• A population-based study utilized data from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (2004-2014).
• Patients with pT1-3 PTC undergoing TT with or without CLND were included.
• Permanent hypoparathyroidism was defined by long-term vitamin D or calcium treatment; logistic regression analyses were performed.

Main Results:

• Permanent hypoparathyroidism occurred more frequently in the TT + CLND group (6.6%) compared to the TT-only group (2.3%).
• CLND was identified as an independent risk factor for permanent hypoparathyroidism (OR 3.74).
• In patients who underwent TT + CLND, node negativity was associated with an increased risk of permanent hypoparathyroidism (OR 3.08).

Conclusions:

• Central lymph node dissection (CLND) is an independent risk factor for permanent hypoparathyroidism after thyroidectomy for papillary thyroid cancer.
• Node negativity in CLND correlates with a higher incidence of permanent hypoparathyroidism.
• These findings underscore the importance of carefully considering the risks and benefits of CLND in PTC management.