Thyroidectomy with and without laryngectomy: Differences in post-operative hypocalcemia and management

Area of Science:

• Otolaryngology
• Endocrine Surgery
• Oncology

Background:

• Total laryngectomy (TL) combined with thyroidectomy presents risks to parathyroid function.
• Rates of post-operative hypocalcemia (POH) vary based on thyroidectomy extent, with limited prior reporting.
• This study aims to quantify hypocalcemia and hypoparathyroidism rates in TL with and without thyroidectomy.

Purpose of the Study:

• To identify and compare rates of hypocalcemia and hypoparathyroidism in patients undergoing total laryngectomy (TL) with or without thyroidectomy.
• To compare these outcomes against matched cohorts undergoing thyroidectomy alone.
• To assess the need for calcium supplementation post-surgery.

Main Methods:

• Retrospective chart review of 101 TL and 319 thyroidectomy patients from 2016-2019.
• Analysis of post-operative and post-discharge calcium and parathyroid hormone levels.
• Evaluation of intraoperative parathyroid management and calcium supplementation requirements.

Main Results:

• TL with total thyroidectomy (TT) showed significantly higher odds of hypocalcemia (OR 10.7) and hypoparathyroidism (OR 16.5) versus TT alone.
• TL with hemithyroidectomy (HT) increased odds of hypoparathyroidism (OR 1.6) versus HT alone.
• Addition of any thyroidectomy to TL increased odds of hypocalcemia (OR 4.4) and hypoparathyroidism (OR 4.5). Long-term calcium supplementation was significantly more likely in combined procedures.

Conclusions:

• Combined TL and thyroidectomy markedly increases the risk of parathyroid dysfunction and POH.
• Enhanced visualization during TL does not negate the risk of parathyroid injury; careful dissection and preservation are vital.
• Stringent post-operative calcium monitoring, similar to thyroidectomy protocols, is essential after TL.