Identifying Predictors Of Permanent Hypoparathyroidism After Thyroid Cancer Surgery - A Comprehensive Real-Life Retrospective Analysis

Introduction: Postoperative hypoparathyroidism (POH) is a common complication of total thyroidectomy, leading to low serum calcium levels due to insufficient parathyroid hormone secretion and has a significant impact on patients quality of life, often requiring lifelong medication and follow-up. The possibility of a post operation permanent POH (p-POH) after thyroid surgery, especially in department dedicated to endocrine surgery is expected to be around 2.2%, yet in real-life, the numbers are significantly higher. Identifying predictors of p-POH remains a critical unmet need in clinical practice. Objective: This study aims to identify potential predictive factors for developing p-POH in patients undergoing thyroid cancer surgery, and improving preoperative planning, surgical techniques, and patient outcomes. Methods: We conducted a retrospective analysis of 522 patients selected from the X of the X of X database, that underwent thyroid surgery for differentiated thyroid cancer with a follow-up of 12 months. The primary outcome was the incidence of p-POH, defined as the requirement for calcium and/or vitamin D supplementation beyond 12 months postsurgery. Statistical analyses were performed to assess associations between clinical and surgical variables, such as histology, lymph node metastases, central/lateral compartment neck dissection, and response to therapy, with the occurrence of p-POH. Results: Among the 522 patients analyzed, 60 (11.5%) developed p-POH. Strong predictors of p-POH included the extent of neck dissection, the presence of lymph node metastases, total thyroidectomy compared to lobectomy, American Thyroid Association (ATA) risk stratification, and the number of lymph nodes removed. Conversely, tumor size, radioiodine therapy, and one-year treatment response were not significant predictors. Conclusion: This study identifies the primary predictive factors for p-POH following thyroid cancer surgery. Our findings highlight the importance of a multidisciplinary approach involving both endocrinologists and surgeons, as well as the need for tailored surgical techniques and preoperative planning to reduce the risk of p-POH and prevent adding chronic conditions to treated patients.