Increased risk of hypoparathyroidism found among patients undergoing total thyroidectomy and concurrent parathyroidectomy

A new study found that there is an increased risk of immediate and long-term risk of hypoparathyroidism in patients undergoing concurrent parathyroidectomy during total thyroidectomy. The study results were published in The Journal of Surgical Research.  

Total thyroidectomy (TTX) is a common surgery with issues like recurrent laryngeal nerve injury, neck hematoma, and hypoparathyroidism. A small percentage of thyroidectomy patients also get a scheduled concurrent parathyroidectomy (PTX) for the management of primary hyperparathyroidism. But there is limited research on the risk profile of TTX with concurrent PTX (TTX + PTX). Hence researchers conducted a study to investigate the association of concurrent parathyroidectomy (PTX) with risks of total thyroidectomy (TTX) through analysis of Collaborative Endocrine Surgery Quality Improvement Program data. 

Data was collected from the Collaborative Endocrine Surgery Quality Improvement Program database for patients who underwent TTX or TTX + PTX from January 2014 through April 2020. Multivariable logistic regression was performed to predict hypoparathyroidism, vocal cord dysfunction, neck hematoma, and postoperative emergency department visit. Covariates included patient demographics, patient body mass index, indication for surgery, central neck dissection, anticoagulation use, and surgeon volume. 

Key findings: 

• Nearly 13,647 patients underwent TTX and 654 patients underwent TTX + PTX.
• Higher unadjusted rates of hypoparathyroidism were noticed in TTX + PTX patients at 30 d (9.6% versus 7.4%) and 6 mo (7.9% versus 3.1%).
• There was an increased risk of hypoparathyroidism at 30 d and 6 mo and an increased risk of postoperative emergency department visits in the TTX + PTX group on multivariable regression.

There were no reports of recurrent laryngeal nerve injury or neck hematoma in the TTX+PTX group. 

Thus, simultaneous PTX in patients undergoing TTX is associated with an increased risk of immediate and long-term hypoparathyroidism. Hence this should be discussed in informed consent decisions and operative decision-making. 

Further reading: Cisco R, Arnow K, Barreto N, Lin D, Kebebew E, Seib C. Increased Risk of Complications Associated With Concurrent Parathyroidectomy in Patients Undergoing Total Thyroidectomy [published online ahead of print, 2023 Apr 10]. J Surg Res. 2023;288:275-281. doi: 10.1016/j.jss.2023.02.036