COMPLETION THYROIDECTOMY: A SAFE PROCEDURE FOR PARATHYROID GLANDS FUNCTION WHEN COMPARED WITH ONE-STAGE TOTAL THYROIDECTOMY; A PROSPECTIVE STUDY

AUTHORS:
N. Chereau (Paris, France) , G. Godiris-Petit (Paris, France) , S. Noullet (Paris, France) , A. Hasani (Paris, France) , S. Gaujoux (Paris, France) , F. Menegaux (Paris, France)
Background:
Recent guidelines for thyroid diseases that need surgery favor limited surgical procedures instead of routine total thyroidectomy in one-stage (TT1). A completion thyroidectomy (TT2) may become necessary if final pathology reveals pejorative thyroid cancer criteria, or in case of recurrence of a multinodular goiter with compressive symptoms. The aim of this study was to compare the rates of symptomatic hypocalcemia and permanent hypoparathyroidism following TT1 or TT2.
Methods:
From June 2020 to November 2022, all consecutive patients undergoing TT1 or TT2 in our institution were included in a prospective study. Patients were managed using an algorithm based on 20 min intraoperative PTH (IOPTH20, normal range: 15-65 ng/L) levels guiding potential calcium and calcitriol supplementation starting on POD1.
Results:
This algorithm was used in 1,420 patients (1,217 TT1 and 203 TT2), including 527 (43%) TT1 and 135 (67%) TT2 patients with IOPTH20>20 ng/L (p<0.0001). Symptomatic hypocalcemia was observed in 30 TT1 patients (2.5%) and 2 TT2 patients (1.0%), all of them except 1, with an IOPTH20<20 ng/L. Among these patients, 16 (1.3%) TT1 and none TT2 patients developed a permanent hypoparathyroidism. IOPTH20 was undetectable (<6 ng/L) in 134 (11%) TT1 and 7 (3%) TT2 patients, with a rate of permanent hypoparathyroidism (>6 months after surgery) of 9% (12 patients) and 0 patients, respectively.
Conclusions:
TT2 had lower rates of symptomatic hypocalcemia compared to TT1. Vitamin D-calcium supplementation based on IOPTH20 levels is very efficient to lower symptoms related to hypocalcemia with no increasing risk of permanent hypoparathyroidism.