Hipoparatiroïdisme postoperatori: importància del temps i gènere
- Autores: Inés Villarroya Marquina
- Directores de la Tesis: Leyre Lorente Poch (dir. tes.), Juan Jose Sancho Insenser (codir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2021
- Idioma: español
- Tribunal Calificador de la Tesis: Salvador Navarro Soto (presid.), Nuria Argudo (secret.), Joaquín Gómez Ramírez (voc.)
- Programa de doctorado: Programa de Doctorado en Cirugía y Ciencias Morfológicas por la Universidad Autónoma de Barcelona
- Materias:
- Enlaces
- Tesis en acceso abierto en: TDX
- Resumen
Parathyroid insufficiency due to intraoperative injury of parathyroid glands is the main complication after total thyroidectomy. It is characterized by a decrease of parathormone (PTH) leading to hypocalcemia and vitamin D – phosphate disequilibrium that causes several clinical manifestations in a variety of target organs, decreasing considerably the patient’s quality of life.
Among the several factors involved in postoperative parathyroid failure, female gender has been repeatedly reported as a risk factor for hypocalcemia after total thyroidectomy. There is, however, a scarcity of studies assessing the influence of women’s age and menstrual status on parathyroid function recovery.
Parathyroid insufficiency can last from only some hours or becoming a permanent hypoparathyroidism. Little is known about the recovery of the parathyroid function in the long-term basis.
In this thesis we aimed to assess the influence of gender on post-thyroidectomy hypoparathyroidism and analyze factors involved in parathyroid failure in female patients. Secondly, we aimed to investigate the time to recover the parathyroid function in patients diagnosed with protracted hypoparathyroidism (one month after total thyroidectomy) and the variables affecting such recovery.
For the first aim, a cohort of patients who underwent total thyroidectomy for benign disease was followed for 18 years and the prevalence of each parathyroid failure syndrome was collected; an epidemiologic comparison was made between genders, as well as for a subdivision of female groups according to their menstrual status (<45 years-old or older).
Results from this study found that the prevalence of postoperative hypocalcemia was ten points higher in women than in the men, and permanent hypoparathyroidism was 5.55-fold more common in women than in men. Women aged <45 years presented higher rates of all three syndromes despite similar number of parathyroid glands remaining in situ (not autografted nor inadvertently resected) (PGRIS). Young age and low PGRIS were the only independent variables predicting postoperative hypocalcemia in female patients.
For the second aim, a cohort of 854 patients who underwent total thyroidectomy for either benign or malignant pathology was assess after a following up for 15 years. The prevalence of protracted hypoparathyroidism was 16.6%, and only 4.2% patients never recovered their optimal parathyroid function. Interestingly, from the patients who recovered their parathyroid function, one-third did so beyond 6 months after surgery. Patients who recovered after one year of follow-up (11.3%) had the four parathyroid glands preserved in situ and serum calcium concentration at one month >9 mg/dL. PGRIS and a serum calcium concentration >9 mg/dL (>2.25 mmol/L) at one postoperative month were crucial for the recovery of the parathyroid function.
This work is relevant to the scientific community because it shows that recovery of parathyroid function after total thyroidectomy can be expected up until one year or beyond, especially if the four glands are preserved. Thus, the period of follow-up of these patients may be longer than the one recommended by the current clinical management guidelines. Additionally, this work analyzes the female menstrual stage, and it is the first one suggesting a hormonal factor influencing post-thyroidectomy parathyroid function.
