Thyroid cancer with hypoparathyroidism tied to higher risk for several comorbidities
Key takeaways:
- Being diagnosed with thyroid cancer and hypoparathyroidism may raise risk for several comorbidities.
- Targeted monitoring of complications is needed for those with thyroid cancer and hypoparathyroidism.
Among adults with thyroid cancer, those with hypoparathyroidism after a thyroidectomy may have increased risk for several complications such as diabetes, hypertension and dyslipidemia, researchers reported.
In a retrospective analysis of data from South Korea’s National Health Insurance Service–National Sample Cohort, researchers compared the diagnosis of complications between adults with thyroid cancer and hypoparathyroidism and those with thyroid cancer who did not have hypoparathyroidism after a thyroidectomy. Outcomes for each group were also compared with a control group without thyroid cancer or hypoparathyroidism. Researchers found having thyroid cancer and hypoparathyroidism raised risk for several complications compared with controls as well as increased risk for hypertension vs. adults with thyroid cancer without hypoparathyroidism.
The findings were published in The Journal of Clinical Endocrinology & Metabolism.
“These findings highlight the need for targeted monitoring and management strategies for nonskeletal complications in patients with thyroid cancer and hypoparathyroidism,” Hwa Young Ahn, MD, PhD, associate professor in the department of internal medicine at Chung-Ang University College of Medicine in South Korea, and Eun Kyung Lee, MD, PhD, clinical specialist of the Center for Thyroid Cancer and associate scientist of the Research Institute at the National Cancer Center in South Korea, and colleagues wrote.
Researchers obtained data from patients diagnosed with thyroid cancer from 2006 to 2019. Of those with thyroid cancer, 430 with hypoparathyroidism (median age, 55 years; 89.1% women) and 850 without hypoparathyroidism (median age, 55 years; 80% women) were included in the study. Each thyroid cancer group was matched 1:5 with control participants without thyroid cancer or hypoparathyroidism. Risks for nonskeletal complications were collected for up to 10 years of follow-up.
Compared with healthy controls, patients with thyroid cancer and hypoparathyroidism had increased risk for diabetes (HR = 1.31; 95% CI, 1.01-1.68), dyslipidemia (HR = 1.29; 95% CI, 1.06-1.57), urinary stones (HR = 1.61; 95% CI, 1-2.57) and cataracts (HR = 1.5; 95% CI, 1.15-1.95). Individuals with thyroid cancer and without hypoparathyroidism also had higher risk for diabetes (HR = 1.27; 95% CI, 1.04-1.56) and dyslipidemia (HR = 1.22; 95% CI, 1.06-1.42) than controls.
“This suggests that factors beyond hypoparathyroidism itself may contribute to the elevated risk of nonskeletal complications in patients with thyroid cancer,” the researchers wrote.
Adults with thyroid cancer and hypoparathyroidism had higher risk for hypertension than those with thyroid cancer without hypoparathyroidism (HR = 1.39; 95% CI, 1-1.93). The two groups had no other significant differences in risk for other complications.
Among adults aged 50 years and older, those with thyroid cancer and hyperparathyroidism had a higher risk for cataracts than controls (HR = 1.46; 95% CI, 1.1-1.92) and adults with thyroid cancer without hypoparathyroidism (HR = 1.39; 95% CI, 1.01-1.93).
The cataract findings are “believed to result from the deposition of calcium phosphate salts on the lens,” the researchers wrote. “Long-term hypoparathyroidism and advanced age are risk factors for cataract progression.”
In sex-specific analysis, women with thyroid cancer and hypoparathyroidism had a higher risk for urinary stones than women in the control group (HR = 1.96; 95% CI, 1.21-3.19) and women with thyroid cancer and no hypoparathyroidism (HR = 2.05; 95% CI, 1.1-3.81). Women with thyroid cancer and hypoparathyroidism also had increased risk for chronic kidney disease (HR = 1.96; 95% CI, 1.21-3.19) and cataracts (HR = 2.66; 95% CI, 1.05-6.75) than those in the control group.
The researchers noted longitudinal cohort studies with longer follow-up are needed to validate the findings.
Perspective
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This study on postoperative hypoparathyroidism in patients with thyroid cancer included a large cohort, two comparison groups and propensity matching to reduce confounding bias.
The findings were interesting because compared with control, thyroid cancer with hypoparathyroidism was associated with greater risk of diabetes, dyslipidemia, urinary stones, and cataracts, but when the researchers compared the same cohort to thyroid cancer without hypoparathyroidism, only hypertension was higher in the hypoparathyroid cohort. This is unexpected because clinically one would assume that at a minimum, urinary stones would be more common in patients with hypoparathyroidism, as they are at risk for high urine calcium levels.
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