Hypoparathyroidism and mortality after total thyroidectomy: A nationwide matched cohort study

TY - JOUR

T1 - Hypoparathyroidism and mortality after total thyroidectomy

T2 - A nationwide matched cohort study

AU - Reinke, Rasmus

AU - Udholm, Sebastian

AU - Christiansen, Christian Fynbo

AU - Almquist, Martin

AU - Londero, Stefano

AU - Rejnmark, Lars

AU - Rasmussen, Thomas Bøjer

AU - Rolighed, Lars

N1 - © 2024 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.

PY - 2024/4

Y1 - 2024/4

N2 - OBJECTIVE: Total thyroidectomy (TT) carries a risk of hypoparathyroidism (hypoPT). Recently, hypoPT has been associated with higher overall mortality rates. We aimed to evaluate the frequency of hypoPT and mortality in patients undergoing TT in Denmark covering 20 years.DESIGN: Retrospective Cohort study.PATIENTS AND MEASUREMENTS: Using population-based registries, we identified all Danish individuals who had undergone TT between January 1998 and December 2017. We included a comparison cohort by randomly selecting 10 citizens for each patient, matched on sex and birth year. HypoPT was defined as treatment with active vitamin D after 12 months postoperatively. We used cumulative incidence to calculate risks and Cox regression to compare the rate of mortality between patients and the comparison cohort. We evaluated patients in different comorbidity groups using the Charlson Comorbidity Index and by different indications for surgery.RESULTS: 7912 patients underwent TT in the period. The prevalence of hypoPT in the study period was 16.6%, 12 months postoperatively. After adjusting for potential confounders the risk of death due to any causes (hazard ratio; 95% confidence intervals) following TT was significantly increased (1.34; 1.15-1.56) for patients who developed hypoPT. However, subgroup analysis revealed mortality was only increased in malignancy cases (2.48; 1.99-3.10) whereas mortality was not increased when surgery was due to benign indications such as goitre (0.88; 0.68-1.15) or thyrotoxicosis (0.86; 0.57-1.28).CONCLUSIONS: The use of active vitamin D for hypoPT was prevalent one year after TT. Patients with hypoPT did not have an increased risk of mortality following TT unless the indication was due to malignancy.

AB - OBJECTIVE: Total thyroidectomy (TT) carries a risk of hypoparathyroidism (hypoPT). Recently, hypoPT has been associated with higher overall mortality rates. We aimed to evaluate the frequency of hypoPT and mortality in patients undergoing TT in Denmark covering 20 years.DESIGN: Retrospective Cohort study.PATIENTS AND MEASUREMENTS: Using population-based registries, we identified all Danish individuals who had undergone TT between January 1998 and December 2017. We included a comparison cohort by randomly selecting 10 citizens for each patient, matched on sex and birth year. HypoPT was defined as treatment with active vitamin D after 12 months postoperatively. We used cumulative incidence to calculate risks and Cox regression to compare the rate of mortality between patients and the comparison cohort. We evaluated patients in different comorbidity groups using the Charlson Comorbidity Index and by different indications for surgery.RESULTS: 7912 patients underwent TT in the period. The prevalence of hypoPT in the study period was 16.6%, 12 months postoperatively. After adjusting for potential confounders the risk of death due to any causes (hazard ratio; 95% confidence intervals) following TT was significantly increased (1.34; 1.15-1.56) for patients who developed hypoPT. However, subgroup analysis revealed mortality was only increased in malignancy cases (2.48; 1.99-3.10) whereas mortality was not increased when surgery was due to benign indications such as goitre (0.88; 0.68-1.15) or thyrotoxicosis (0.86; 0.57-1.28).CONCLUSIONS: The use of active vitamin D for hypoPT was prevalent one year after TT. Patients with hypoPT did not have an increased risk of mortality following TT unless the indication was due to malignancy.

KW - Humans

KW - Cohort Studies

KW - Retrospective Studies

KW - Thyroidectomy/adverse effects

KW - Hypoparathyroidism/etiology

KW - Neoplasms/complications

KW - Vitamin D

KW - Postoperative Complications/etiology

KW - thyrotoxicosis

KW - hypoparathyroidism

KW - thyroid cancer

KW - total thyroidectomy

KW - mortality

UR - http://www.scopus.com/inward/record.url?scp=85186230021&partnerID=8YFLogxK

U2 - 10.1111/cen.15037

DO - 10.1111/cen.15037

M3 - Journal article

C2 - 38375986

SN - 0300-0664

VL - 100

SP - 408

EP - 415

JO - Clinical Endocrinology

JF - Clinical Endocrinology

IS - 4

ER -