Increased mortality risk for adults who undergo total thyroidectomy for cancer
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Key takeaways:
- Adults who undergo a total thyroidectomy due to cancer have an increased all-cause mortality risk.
- No increased mortality risk was seen for adults who have a thyroidectomy to treat goiter or thyrotoxicosis.
Adults who develop hypoparathyroidism after a total thyroidectomy have an increased risk for all-cause mortality compared with the general population, but only if the indication for their surgery was cancer, according to study data.
“The continuous postoperative treatment of hypoparathyroidism with active vitamin D following total thyroidectomy has been a frequent complication in the last 20 years,” Rasmus Reinke, a PhD student in the department of otorhinolaryngology, head and neck surgery at Aarhus University Hospital in Denmark, and colleagues wrote in a study published in Clinical Endocrinology. “For patients who underwent total thyroidectomy due to goiter or thyrotoxicosis, postoperative mortality was not affected compared to a comparison cohort, regardless of the presence or absence of hypoparathyroidism. However, when the indication for surgery was malignancy, the risk of mortality was higher than in a matched comparison cohort.”
Researchers conducted a population-based cohort study with data from 7,883 adults who underwent total thyroidectomy from 1998 to 2017 in Denmark and had data available in the Danish National Patient Registry (median age, 52.1 years; 78.6% women). Adults were classified into three groups by thyroid surgery indication: goiter, thyrotoxicosis and malignancy. People who filled a prescription for vitamin D at 12 months after surgery according to the Danish National Prescription Registry were defined as having hypoparathyroidism. Adults still alive 1 year after total thyroidectomy were matched, 1:10, by sex and birth year with people from the general population in the Danish Civil Registration System.
Of adults who underwent a total thyroidectomy, 44% had goiter as the primary indication, 28.9% had cancer and 25.9% had thyrotoxicosis. Hypoparathyroidism was prevalent among 16.6% of adults in the total thyroidectomy group 1 year after surgery.
Adults who developed hypoparathyroidism after thyroidectomy had a higher risk for all-cause mortality compared with healthy adults (adjusted HR = 1.34; 95% CI, 1.15-1.56). However, the risk for all-cause mortality was similar among adults who had a thyroidectomy due to a goiter or thyrotoxicosis compared with controls. Participants who had a thyroidectomy due to cancer had a higher risk for mortality compared with healthy adults at 1 year. The increased mortality risk was observed both for adults with cancer who developed hypoparathyroidism (aHR = 2.48; 95% CI, 1.99-3.1) and those without hypoparathyroidism (aHR = 1.59; 95% CI, 1.42-1.78) compared with controls.
“Patients with hypoparathyroidism did not have increased mortality compared with a reference cohort when total thyroidectomy was performed on benign indications,” the researchers wrote. “However, mortality risk was found to be increased in thyroid cancer patients. This finding may reflect a well‐known risk of long‐term mortality after thyroid cancer operations.”
Perspective
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Hypoparathyroidism is the most common complication of total thyroidectomy and occurs in 0.5% to 20% of patients. Implicated factors include extent of surgery, female sex, lymph node dissection, auto transplantation of the parathyroid, and extremes of age. There are conflicting data for overall mortality in patients with hypoparathyroidism, with recent studies showing higher mortality in this cohort. The mechanism behind this is not well elucidated.
In this retrospective, population-based cohort study with data from 7,883 adults who underwent total thyroidectomy, 16% of the patients developed hypoparathyroidism. Patients were classified according to indication for thyroid surgery, such as goiter, thyrotoxicosis or malignancy, and the median follow-up time was 7.1 years. The researchers included a comparison cohort of 78,830 individuals by randomly selecting 10 citizens for each patient, matched on sex and birth year from the general population in the Danish Civil Registration System. The risk for death due to any cause was increased in patients with hypoparathyroidism. However, mortality was not increased when surgery was performed for benign thyroid disease.
Hypoparathyroidism impairs quality of life and increases the risk of developing comorbidities across multiple organ systems, including renal, neurologic and cardiovascular. This condition also places a great financial burden on the health system, with need for careful monitoring of patients over time. This study, encompassing a substantial sample size, offers reassurance that mortality is not increased in patients undergoing surgery for benign thyroid conditions.
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