Issue: February 2023
Fact checked byRichard Smith

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December 22, 2022
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Total thyroidectomy safe for most older adults with Graves’ disease

Issue: February 2023
Fact checked byRichard Smith
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Few older adults who undergo total thyroidectomy for treatment of Graves’ disease developed hypoparathyroidism requiring calcitriol therapy, according to data published in Thyroid.

Carolyn Dacey Seib

“Operative management with total thyroidectomy will not be the best option for all older adults with Graves’ disease, some of whom may have increased surgical risk due to other medical problems,” Carolyn Dacey Seib, MD, MAS, assistant professor in the department of surgery at Stanford University, told Healio. “However, surgery will be a good option for some older patients, including those with large or symptomatic goiters, thyroid eye disease, concurrent primary hyperparathyroidism or those who want expedient and definitive management of their hyperthyroidism. These patients should feel reassured that the incidence of hypoparathyroidism, in addition to neck hematoma or recurrent laryngeal nerve injury, in this study was low and feel comfortable asking for a referral to discuss thyroidectomy with a surgeon.”

Few Medicare beneficiaries who undergo a total thyroidectomy developed permanent hypoparathyroidism
Data were derived from Seib CD, et al. Thyroid. 2022;doi:10.1089/thy.2022.0140.

Seib and colleagues conducted a population-based cohort study of 4,650 Medicare beneficiaries diagnosed with Graves’ disease who underwent a total thyroidectomy from 2007 to 2017 (mean age, 72.8 years; 85.6% women; 78.8% white). Age, sex, race and ethnicity, comorbidities and ZIP code of residence were collected. A claims-based frailty index was used to categorize patients as robust, prefrail, mildly frail or moderately to severely frail. Permanent hypoparathyroidism was identified through one or more Part D pharmacy claims for calcitriol 6 to 12 months after a total thyroidectomy. The percentage of participants with a concurrent diagnosis for hypoparathyroidism 1 year after thyroidectomy was determined. Researchers also collected incidences of neck hematoma and recurrent laryngeal nerve injury within 14 days of a thyroidectomy.

Of the cohort, 2.2% developed permanent hypoparathyroidism and were treated with calcitriol after thyroidectomy. Of those with a calcitriol prescription, 29.8% had a diagnosis code for hypoparathyroidism.

Adults with permanent hypoparathyroidism were older than those who did not develop the condition (mean age, 74.2 years vs. 72.8 years; P = .04). In multivariable analysis, adults aged 76 years or older had a higher likelihood for permanent hypoparathyroidism after a total thyroidectomy for the treatment of Graves’ disease compared with adults aged 66 to 75 years (adjusted OR = 1.68; 95% CI, 1.13-2.51). No other patient characteristics were associated with permanent hypoparathyroidism.

Few adults had other perioperative complications from total thyroidectomy, with 2.1% diagnosed with neck hematoma and 0.9% needing a hematoma evacuation within 14 days of a thyroidectomy. Of the cohort, 3.9% having a temporary or permanent recurrent laryngeal nerve injury, with 1.6% having a recurrent laryngeal nerve injury 6 to 12 months after their thyroidectomy.

Seib noted that researchers didn’t analyze surgeon operative experience as part of the study. She recommended older adults interested in operative management for Graves’ disease reach out to an experienced thyroid surgeon to reduce their risk of complications.

“We are doing further research to document the long-term benefits and risks of thyroidectomy for Graves’ disease in older adults, such as the incidence of cardiovascular disease and adverse events in this population,” Seib said. “This will help our older patients make more informed treatment decisions.”

For more information:

Carolyn Dacey Seib, MD, MAS, can be reached at cseib@stanford.edu.