Risk factors for postoperative haemorrhage after total thyroidectomy: clinical results based on 2,678 patients.
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ABSTRACT:
SUBMITTER: Zhang X
PROVIDER: S-EPMC5539252 | biostudies-other | 2017 Aug
REPOSITORIES: biostudies-other
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Project description:ImportanceBecause inadvertent damage of parathyroid glands can lead to postoperative hypocalcemia, their identification and preservation, which can be challenging, are pivotal during total thyroidectomy.ObjectiveTo determine if intraoperative imaging systems using near-infrared autofluorescence (NIRAF) light to identify parathyroid glands could improve parathyroid preservation and reduce postoperative hypocalcemia.Design, setting, and participantsThis randomized clinical trial was conducted from September 2016 to October 2018, with a 6-month follow-up at 3 referral hospitals in France. Adult patients who met eligibility criteria and underwent total thyroidectomy were randomized. The exclusion criteria were preexisting parathyroid diseases.InterventionsUse of intraoperative NIRAF imaging system during total thyroidectomy.Main outcomes and measuresThe primary outcome was the rate of postoperative hypocalcemia (a corrected calcium <8.0 mg/dL [to convert to mmol/L, multiply by 0.25] at postoperative day 1 or 2). The main secondary outcomes were the rates of parathyroid gland autotransplantation and inadvertent parathyroid gland resection.ResultsA total of 245 of 529 eligible patients underwent randomization. Overall, 241 patients were analyzed for the primary outcome (mean [SD] age, 53.6 [13.6] years; 191 women [79.3%]): 121 who underwent NIRAF-assisted thyroidectomy and 120 who underwent conventional thyroidectomy (control group). The temporary postoperative hypocalcemia rate was 9.1% (11 of 121 patients) in the NIRAF group and 21.7% (26 of 120 patients) in the control group (between-group difference, 12.6% [95% CI, 5.0%-20.1%]; P = .007). There was no significant difference in permanent hypocalcemia rates (0% in the NIRAF group and 1.6% [2 of 120 patients] in the control group). Multivariate analyses accounting for center and surgeon heterogeneity and adjusting for confounders, found that use of NIRAF reduced the risk of hypocalcemia with an odds ratio of 0.35 (95% CI, 0.15-0.83; P = .02). Analysis of secondary outcomes showed that fewer patients experienced parathyroid autotransplantation in the NIRAF group than in the control group: respectively, 4 patients (3.3% [95% CI, 0.1%-6.6%) vs 16 patients (13.3% [95% CI, 7.3%-19.4%]; P = .009). The number of inadvertently resected parathyroid glands was significantly lower in the NIRAF group than in the control group: 3 patients (2.5% [95% CI, 0.0%-5.2%]) vs 14 patients (11.7% [95% CI, 5.9%-17.4%], respectively; P = .006).Conclusions and relevanceThe use of NIRAF for the identification of the parathyroid glands may help improve the early postoperative hypocalcemia rate significantly and increase parathyroid preservation after total thyroidectomy.Trial registrationClinicalTrials.gov Identifier: NCT02892253.
| S-EPMC6865247 | biostudies-literature
Project description:ObjectiveWe evaluated if preoperative TG levels affected postoperative levels and if other factors may influence the optimal time to check postoperative TG.MethodsThis is a prospective, observational pilot study. We approved and enrolled 50 subjects ≥ 19 years scheduled for total thyroidectomy and measured serum TG, thyroglobulin antibody (TG ab), and TSH preoperatively and post thyroidectomy at 7-14 days, 4 and 6 weeks, and 3 months in subjects with benign pathology, with additional 6- and 12-month measurements in subjects with thyroid cancer.ResultsPreoperative TG was significantly higher in the benign (median 167.5 ng/mL vs 30.8 ng/mL) than in the malignant (p = 0.0006) group. In the benign group, 76.5% (13/17) of subjects had an undetectable TG < 0.2 ng/mL by 12 weeks postoperatively. In the malignant group, 70.6% (12/17) of those who did not receive RAI therapy and 25% (1/4) of those who did receive RAI had undetectable TG < 0.2 ng/mL by 12 weeks. Subset analysis showed 94.1% (16/17) of the benign, 70.6% of the malignant without RAI, and 50% (2/4) of the malignant with RAI achieved TG < 1.0 ng/mL by 6 weeks postoperatively. Four subjects in the malignant group reached undetectable TG levels as early as 7-14 days postoperatively.ConclusionPreoperative TG levels did not predict the risk of malignancy nor time to TG nadir postoperatively. We did not find a difference in TG elimination half-life between the benign and malignant groups. The median time to reach undetectable TG levels in both benign and malignant groups who did not receive RAI therapy was 12 weeks. However, those with preexisting hypothyroidism and hyperthyroidism had lower levels of TG overall in the malignant group which can be taken into consideration besides other known factors that can affect TG levels post thyroidectomy. This trial is registered with Clinicaltrials.gov NCT02347683.
| S-EPMC6402205 | biostudies-literature
Project description:Thyroid cancer incidence is increasing, and with it, an increase in total thyroidectomy. There are limited studies comparing outcomes in total thyroidectomy performed in the inpatient versus outpatient setting.The objective of this study was to perform a comparative analysis of risk factors and outcomes of postoperative morbidity and mortality in total thyroidectomy performed as an inpatient versus outpatient surgery.Retrospective cohort study of data from the 2005 to 2014 multi-institutional, risk-adjusted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. A multivariate regression model with corresponding odds ratios and 95% confidence intervals was used to determine 30-day morbidity and mortality after total thyroidectomies, and also risk factors of postoperative outcomes.From 2005 to 2014, 40,025 total thyroidectomies were performed (48.5% inpatient, 51.5% outpatient). The 30-day complication rate for all total thyroidectomies was 7.74%. Multivariate logistic regression analysis was performed to control for potential confounding variables. Preoperative factors that affected complications rates for inpatient thyroidectomies included: age ?70, non-Caucasian race, dependent functional status, history of congestive heart failure, smoking history, bleeding disorder, wound infection, and preoperative sepsis (P?<?0.05). In addition, preoperative factors affecting complications in thyroidectomy performed as an outpatient surgery included malignant thyroid pathology (P??0.05).We identified a subset of preoperative conditions that affect risk of complications after total thyroidectomy. Recommendations for patient selection for outpatient total thyroidectomies should be modified to account for pre-existing conditions that increase the risk of postoperative morbidity.
| S-EPMC5293415 | biostudies-literature
Project description:IntroductionWhile the relationship between hypertension and incident intracerebral haemorrhage is well established, other risk factors are less clear. This study examined risk factors for primary intracerebral haemorrhage, separately for lobar and non-lobar intracerebral haemorrhage.Patients and methodsIncidence of intracerebral haemorrhage was studied among 28,416 individuals from the population-based Malmö Diet and Cancer cohort. Intracerebral haemorrhage cases were ascertained using the Swedish Hospital Discharge Register and the Stroke Register of Malmö, validated by review of hospital records and images, and classified by location by a neuroradiologist. Multivariable Cox regression was used.ResultsThree hundred and thirty-three intracerebral haemorrhages occurred, mean follow-up time was 18.4 years. Systolic blood pressure (hazard ratio per 10 mmHg 1.19 [95% confidence interval 1.13-1.26], diastolic blood pressure (hazard ratio 1.42 [1.27-1.59]), oral anticoagulants (hazard ratio 4.26 [2.17-8.38]), smoking (hazard ratio 1.45 [1.14-1.87]), living alone (hazard ratio 1.32 [1.04-1.69]) and low apolipoprotein B (hazard ratio per 10 mg/dL: 0.94 [0.90-0.99]) were significantly associated with incident intracerebral haemorrhage after multivariable adjustment. Systolic blood pressure, smoking and oral anticoagulants were associated with lobar intracerebral haemorrhage. Systolic blood pressure, diastolic blood pressure, living alone and diabetes were associated with non-lobar intracerebral haemorrhage. Diabetes and diastolic blood pressure showed significantly different relationships with lobar and non-lobar intracerebral haemorrhage. Alcohol, apolipoprotein A1, body mass index, waist circumference, physical activity and education were not independently associated with intracerebral haemorrhage.Discussion and conclusions: Blood pressure, smoking, low apolipoprotein B, oral anticoagulants and living alone were associated with intracerebral haemorrhage. Diabetes was associated with non-lobar intracerebral haemorrhage only. Further research is required on differences between lobar and non-lobar intracerebral haemorrhage.
| S-EPMC7538759 | biostudies-literature
Project description:IntroductionBased on thyroid cancer data from patients treated in Liaocheng People’s Hospital in 2017, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective.Patients and MethodsClinical and pathological data from 552 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, 40 patients underwent endoscopic surgery, with resection including lobectomy + central lymph node dissection of the affected lobe, while 512 cases underwent total thyroidectomy + central lymph node dissection.ResultsThe metastasis rate for all patients was 59.42%. Further, among patients with bilateral or multiple tumors or capsule invasion, the proportions who developed metastatic disease were 63.54% and 71.19% and 67.46%, respectively. Meanwhile, the incidence of contralateral accidental malignancy was 7.25% after postoperative paraffin pathology.DiscussionRates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. It is recommended that, among patients with risk factors, initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.
| S-EPMC7246312 | biostudies-literature
Project description:ObjectiveA meta-analysis to investigate the risk factors for postoperative hypocalcaemia after thyroidectomy in adult patients.MethodsA systematic search of publications in the electronic databases (PubMed®, The Cochrane Library, Web of Science, OVID and Embase®) from inception to June 2020 was conducted. Screening of titles, abstracts and full texts and data extraction were independently performed by two authors. The OR was selected as the pooled estimate.ResultsThe analysis included 23 studies. Twelve significant risk factors for postoperative hypocalcaemia were identified: hypoparathyroidism, OR 5.58; total thyroidectomy, OR 3.59; hypomagnesaemia, OR 2.85; preoperative vitamin D deficiency, OR 2.32; female sex, OR 1.49; thyroid malignancy, OR 1.85; thyroiditis, OR 1.48; substernal multinodular goitres, OR 1.70; parathyroidectomy, OR 1.58; central compartment neck dissection, OR 1.17; modified radical neck dissection, OR 1.57; and central neck dissection, OR 1.54.ConclusionsThis meta-analysis provides moderate-to-high quality evidence that the 12 risk factors were predictive of postoperative hypocalcaemia, which should be monitored closely before thyroidectomy.
| S-EPMC8010841 | biostudies-literature
Project description:Chronic hypoparathyroidism (HypoPT) is a common complication after total thyroidectomy and it impacts affected patients' quality of life (QoL). This study aimed to assess the QoL in patients with chronic HypoPT independently from their concurrent hypothyroidism and other comorbidities. For this purpose a follow-up study was performed, including 14 patients who developed chronic HypoPT after total thyroidectomy and 28 age- and sex-matched patients who had intact parathyroid function after total thyroidectomy. We used the RAND Short Form 36 Health Survey (SF-36) to compare the QoL between patients with or without chronic HypoPT. Chronic HypoPT patients had lower QoL scores in all domains of the RAND-SF-36 questionnaire and significant impairment in six of eight domains after adjustment for relevant confounders. They were more often operated because of a toxic diagnosis (p = .01), often being Graves disease. Additionally adjusting for surgical indications resulted in three of eight domains being significant affected. Chronic HypoPT is associated with significantly impairment of QoL, independently of the concurrent disease of hypothyroidism, comorbidities, and prospective values of TSH and serum (se)-ionized-Ca++. There is a need for more focus and better treatment of patients experiencing chronic HypoPT after surgery. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
| S-EPMC8046100 | biostudies-literature
Project description:BackgroundAs hypocalcemia is the most common complication of total thyroidectomy, identifying its risk factors should guide prevention and management. The purpose of this study was to determine the risk factors for postthyroidectomy hypocalcemia.MethodsWe searched PubMed, Web of Science and EMBASE through January 31, 2019, and assessed study quality using the Newcastle-Ottawa Scale.ResultsFifty studies with 22,940 patients met the inclusion criteria, of which 24.92% (5716/22,940) had transient hypocalcemia and 1.96% (232/11,808) had permanent hypocalcemia. Significant (P < 0.05) predictors of transient hypocalcemia were: younger age, female, parathyroid autotransplantation (PA), inadvertent parathyroid excision (IPE), Graves' disease (GD), thyroid cancer, central lymph node dissection, preoperative severe Vitamin D deficiency, preoperative Vitamin D deficiency and a lower postoperative 24 h parathyroid hormone (PTH) level. Preoperative magnesium, preoperative PTH and Hashimoto's thyroiditis were not significant predictors of transient hypocalcemia. IPE, GD, and thyroid cancer were associated with an increased rate of permanent hypocalcemia, but gender and PA did not predict permanent hypocalcemia.ConclusionImportant risk factors for transient and permanent hypocalcemia were identified. However, given the limited sample size and heterogeneity of this meta-analysis, further studies are required to confirm our preliminary findings.
| S-EPMC7943836 | biostudies-literature
Project description:BackgroundThyroidectomy is one of the common endocrinological surgeries for the treatment of thyroid disorders. Hypocalcemia is the potential complication after thyroidectomy, where is persistency can lead to serious systemic effects. The aim of this study is to evaluate the incidence of hypocalcemia in thyroidectomy patients.MethodsIn this cross-sectional study, patients referred to (XXX) for thyroidectomy from 2019 to 2020 were enrolled. Preoperative serum calcium and postoperative 24- and 48-h calcium levels were evaluated in these patients. Demographic data (sex and gender), calcium levels, type of thyroidectomy and duration of surgery was recorded for all the patients. SPSS v22 was used for statistical analysis. P < 0.05 was considered as statistically significant.ResultsOf 143 patients included in the study, the mean age was 49.7 ± 10.9 years and 61.5% were females and 38.5% were males. 49% patients had hypocalcemia in the first 24 hours after surgery and 63.6% following 48 hours of the surgery. The difference in calcium levels at three intervals were statistically significant, p = 0.001. The incidence of hypocalcemia was significantly more in women at 48 postoperative hours, p = 0.025. The age and duration of surgery was not significantly correlated with hypocalcemia, p > 0.05, whereas, patients who underwent total thyroidectomy had greater incidence of hypocalcemia 24 hours after the surgery, p = 0.021.ConclusionsThe incidence of hypocalcemia is greater in total thyroidectomy and female patients. Our study did not report significant correlation between duration of the surgery and age of the patients.
| S-EPMC8178078 | biostudies-literature
Project description:BackgroundEstimation of parathyroid hormone (PTH) after thyroid surgery helps to predict the development of hypocalcemia and allows early intervention and management with oral calcium and/or vitamin D supplementation in the postoperative period.Patients and methodsThis retrospective study included 57 patients who underwent total or completion thyroidectomy within 4 years. Measurement of serum PTH level was done 3 h after surgery for its change and prediction of hypocalcemia.ResultsThe mean age was 42.11 years, females constituted 46 patients (80.7%), the main surgical procedure was total thyroidectomy in 51 patients (89.5%), and the main cause for surgery was multinodular goiter in 33 patients (57.8%). Three hours after surgery 47 patients (82.5%) had serum PTH levels of >10 pg/ml (mean 28.06) and 44 patients (77.2%) had normal serum calcium (mean 8.66). Most of these 47 patients (82.46%) didn't require postoperative supplementation, while from other 10 patients (17.5%) with serum PTH level of <10 pg/ml, 7 patients (12.28%) required both oral calcium and vitamin D, and 3 patients (5.26%) required only oral vitamin D.There was a significant correlation between the 3-h postoperative PTH level and hypocalcemia (P-value 0.000). The type of pathology had no significant association with lowserum PTH level after surgery (P-value 0.166).ConclusionPTH measurements at 3 h after total thyroidectomy is an accurate predictor for the development of hypocalcemia and allows starting early calcium and/or vitamin D supplements for the asymptotic patients with PTH level of less than 10 pg/ml, which is considered a high-risk group. Also it facilitates a safe and early (2nd t day post operative) discharge of those patients with serum PTH levels greater than 10 pg/ml without any supplements.Further studies are needed to compare the result of early serum PTH level with the day one serum PTH level after total thyroidectomy to predict hypocalcemia.
| S-EPMC8058903 | biostudies-literature