Elisabeth Maurer1, Katja Maschuw2, Alexander Reuss3, Hans Udo Zieren4, Andreas Zielke5, Peter Goretzki6, Dietmar Simon7, Cornelia Dotzenrath8, Thomas Steinmüller9, Joachim Jähne10, Matthias Kemen11, Stephan Coerper12, Ingo Leister13, Christoph Nies14, Mark Hartel15, Andreas Türler16, Katharina Holzer17, Ayman Agha18, Michael Knoop19, Thomas Musholt20, Benaz Aminossadati3, Detlef K Bartsch1. 1. Department of Visceral, Thoracic, and Vascular Surgery, Philipps University, Marburg, Germany. 2. Department of General, Visceral, and Thoracic Surgery, Hospital Lippe, Lippe, Germany. 3. Coordinating Center for Clinical Trials-KKS, Philipps University Marburg, Germany. 4. Department of General and Visceral Surgery, St. Agatha Hospital Köln, Cologne, Germany. 5. Department of Endocrine Surgery, Katharinen Hospital, Stuttgart, Germany. 6. Department of Endocrine Surgery, Lukas Hospital, Neuss, Germany. 7. Department of general and Visceral Surgery, Bethesda Hospital, Duisburg, Germany. 8. Department of Endocrine Surgery, Helios University, Wuppertal, Germany. 9. Department of General and Visceral Surgery, DRK Hospital Berlin Westend, Berlin, Germany. 10. Department of General and Visceral Surgery, Hospital Diakovere Henriettenstift, Hannover, Germany. 11. Department of Visceral Surgery, Evangelisches Krankenhaus, Herne, Germany. 12. Department of General and Visceral Surgery, Hospital Martha-Maria, Nürnberg, Germany. 13. Department of Minimal-Invasive, Endocrine and Visceral Surgery, Hospital Berlin, Waldfriede, Germany. 14. Department of General and Visceral Surgery, Niels-Stensen-Kliniken Marien Hospital, Osnabrück, Germany. 15. Department of Surgery, Hospital Dortmund GmbH, Dortmund, Germany. 16. Department of General and Visceral Surgery, Johanniter Hospital, Bonn, Germany. 17. Department of General and Visceral Surgery, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany. 18. Department of General, Visceral and Endocrine Surgery, Hospital München Bogenhausen, München, Germany. 19. Department of General and Visceral Surgery, Hospital Frankfurt Oder, Frankfurt, Germany. 20. Section of Endocrine Surgery, Department of General, Visceral and Transplant Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
Abstract
BACKGROUND: Previous data suggest that the incidence of hypoparathyroidism after surgery for Graves disease (GD) is lower after subtotal thyroidectomy compared to total thyroidectomy (TT). The present study evaluated the incidence of postoperative hypoparathyroidism after near-total (NTT) versus TT in GD. METHODS/ DESIGN: In a multicenter prospective randomized controlled clinical trial, patients with GD were randomized intraoperatively to NTT or TT. Primary endpoint was the incidence of transient postoperative hypoparathyroidism. Secondary endpoints were permanent hypoparathyroidism, transient recurrent laryngeal nerve palsy (RLNP), reoperations for bleeding, inadvertently removed parathyroid glands, and recurrent hyperthyroidism after 12 months. RESULTS: Eighteen centers randomized 205 patients to either TT (n = 102) or NTT (n = 103) within 16 months. According to intention-to-treat postoperative transient hypoparathyroidism occurred in 19% (20/103) patients after NTT and in 21% (21 of 102) patients after TT (P = 0.84), which persisted >6 months in 2% and 5% of the NTT and TT groups (P = 0.34). The rates of parathyroid autotransplantation (NTT 24% vs TT 28%, P = 0.50) and transient RLNP (NTT 3% vs TT 4%, P = 0.35) was similar in both groups. The rate of reoperations for bleeding tended to be higher in the NTT group (3% vs 0%, P = 0.07) and the rate of inadvertently removed parathyroid glands was significantly higher after NTT (13% vs 3%, P = 0.01). An existing endocrine orbitopathy improved in 35% and 24% after NTT and TT (P = 0.61). Recurrent disease occurred in only 1 patient after TT (P = 0.34). CONCLUSION: NTT for GD is not superior to TT regarding transient postoperative hypoparathyroidism.
BACKGROUND: Previous data suggest that the incidence of hypoparathyroidism after surgery for Graves disease (GD) is lower after subtotal thyroidectomy compared to total thyroidectomy (TT). The present study evaluated the incidence of postoperative hypoparathyroidism after near-total (NTT) versus TT in GD. METHODS/ DESIGN: In a multicenter prospective randomized controlled clinical trial, patients with GD were randomized intraoperatively to NTT or TT. Primary endpoint was the incidence of transient postoperative hypoparathyroidism. Secondary endpoints were permanent hypoparathyroidism, transient recurrent laryngeal nerve palsy (RLNP), reoperations for bleeding, inadvertently removed parathyroid glands, and recurrent hyperthyroidism after 12 months. RESULTS: Eighteen centers randomized 205 patients to either TT (n = 102) or NTT (n = 103) within 16 months. According to intention-to-treat postoperative transient hypoparathyroidism occurred in 19% (20/103) patients after NTT and in 21% (21 of 102) patients after TT (P = 0.84), which persisted >6 months in 2% and 5% of the NTT and TT groups (P = 0.34). The rates of parathyroid autotransplantation (NTT 24% vs TT 28%, P = 0.50) and transient RLNP (NTT 3% vs TT 4%, P = 0.35) was similar in both groups. The rate of reoperations for bleeding tended to be higher in the NTT group (3% vs 0%, P = 0.07) and the rate of inadvertently removed parathyroid glands was significantly higher after NTT (13% vs 3%, P = 0.01). An existing endocrine orbitopathy improved in 35% and 24% after NTT and TT (P = 0.61). Recurrent disease occurred in only 1 patient after TT (P = 0.34). CONCLUSION: NTT for GD is not superior to TT regarding transient postoperative hypoparathyroidism.
Authors: Elisabeth Maurer; Christian Vorländer; Andreas Zielke; Cornelia Dotzenrath; Moritz von Frankenberg; Hinrich Köhler; Kerstin Lorenz; Theresia Weber; Joachim Jähne; Antonia Hammer; Knut A Böttcher; Katharina Schwarz; Carsten Klinger; Heinz J Buhr; Detlef K Bartsch Journal: J Clin Med Date: 2020-12-11 Impact factor: 4.241