Abstract
Purpose: The aim of this study was to compare the rate of hypocalcaemia after thyroid resection in patients with versus patients without Graves’ Ophthalmopathy (GO).
Patients and Methods: 153 patients following thyroid surgery for Grave's disease were studied. Patients were divided into three groups according to the severity of GO at the time of surgery using the NOSPECS classification. Subgroup I comprised of 70 patients without GO, subgroup II comprised of 63 patients with moderate GO and 20 patients with severe GO were assigned to Subgroup III. Association between severe ophthalmopathy and postoperative hypocalcaemia after thyroidectomy was investigated.
Results: 12/70 patients complained transient and 3/70 permanent hypocalcemia within subgroup I. 14/63 patients developed transient and 4/63 patients permanent hypocalcaemia within subgroup II. There were 7/20 patients with transient and 5/20 cases with permanent hypocalcaemia in the patient group with severe GO (subgroup III). The incidence of permanent postthyroidectomy hypocalcaemia was significantly higher in the subgroup III with severe GO when compared to the subgroup I without GO (p=0.004).
Conclusion: Although postthyroidectomy hypocalcemia seems to be a multifactorial phenomenon, this study implicates unknown role of severe GO at time of surgery in the development of hypocalcaemia after thyroid surgery for Graves’ disease. Therefore, patients with GO should be considered for surgery at high volume centres specialised in thyroid and parathyroid surgery.
Key words
Graves' disease - hypoparathyroidism - endocrine ophthalmopathy - cross sectional study - NOSPECS
References
-
1
Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H.
The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients.
Surgery.
2003;
133
((2))
180-185
-
2
Lal G, Ituarte P, Kebebew E, Siperstein A, Duh QY, Clark OH.
Should total thyroidectomy become the preferred procedure for surgical management of Graves' disease?.
Thyroid.
2005;
15
((6))
569-574
-
3
Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR.
Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve.
Surgery.
2005;
137
((3))
342-347
-
4
Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, Racadot A, Proye C.
Hypocalcemia following thyroid surgery: incidence and prediction of outcome.
World J Surg.
1998;
22
((7))
718-724
-
5
Demeester-Mirkine N, Hooghe L, Geetruyden J Van, Maer- telaer V de.
Hypocalcemia after thyroidectomy.
Arch Surg.
1992;
127
854-858
-
6
MacHenry CR, Speroff T, Wentworth D, Murphy T.
Risk factors for post-thyroidectomy hypocalcemia.
Surgery.
1994;
116
641-648
-
7
Herranz-Gonzalez J, Garlian J, Martinez-Vidal J, Gavilan C.
Complications following thyroid surgery.
Arch Otolaryngol Head Neck Surg.
1991;
117
516-518
-
8
Shindo ML, Sinha UK, Rice DH.
Safety of thyroidectomy in resi-dency: a review of 186 consecutive cases.
Laryngoscope.
1995;
105
1173-1175
-
9
Wingert DJ, Friesein SR, Illio Poulos JI. et al .
Post-thyroidectomy hypocalcemia: incidence and risks factors.
Am J Surg.
1986;
152
606-610
-
10
Bahn RS, Heufelder AE.
Mechanisms of disease: pathogenesis of Graves' ophthalmopathy.
N Engl J Med.
1993;
329
1468-1475
-
11
Yamada M, Li AW, Wall JR.
Thyroid-associated ophthalmopathy: clinical features, pathogenesis and management.
Crit Rev Clin Lab Sci.
2000;
37
523-549
-
12
Mizokami T, Salvi M, Wall JR.
Eye muscle antibodies in Graves’ ophthalmopathy: pathogenic or secondary epiphenomenon?.
J Endocrinol Invest.
2004;
27
221-229
-
13
El Kaissi Frauman A, Wall JR.
Thyroid-associated ophthalmopathy – a practical guide to classification, natural history and management.
Int Med J.
2004;
34
482-491
-
14
Hassan I, Koller M, Kluge C, Hoffmann S, Zielke A, Rothmund M.
Supervised surgical trainees perform thyroid surgery for Graves' disease safely.
Langenbecks Arch Surg.
2006;
391
((6))
597-602
-
15
Werner SC.
Modification of the classification of the eye changes of Graves’ disease: recommendations of the ad hoc committee of the American Thyroid Association.
J Clin Endocrinol Metab.
1977;
44
203-204
-
16
Stan MN, Garrity JA, Bradley EA, Woog JJ, Bahn MM, Brennan MD, Bryant SC, Achenbach SJ, Bahn RS.
Randomized, double-blind, placebo-controlled trial of long-acting release octreotide for treatment of Graves’ ophthalmopathy.
J Clin Endocrinol Metab.
2006;
91
((12))
4817-4824
-
17
Delbridge L.
Total thyroidectomy: the evolution of surgical technique.
ANZ Journal of Surgery.
2003;
73
((9))
761-768
-
18
Reber PM, Heath H.
Hypocalcemic emergencies.
Med Clin North Am.
1995;
79
93
-
19
Bellamy RJ, Kendall-Taylor P.
Unrecognized hypocalcaemia diagnosed 36 years after thyroidectomy.
J R Soc Med.
1995;
88
690
-
20
Ku CF, Lo CY, Chan WF, Kung AW, Lam KS.
Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves' disease.
ANZ J Surg.
2005 Jul;
75
((7))
528-531
-
21
Dolapci M, Doganay M, Reis E, Kama NA.
Truncal ligation of the inferior thyroid arteries does not affect the incidence of hypocalcaemia after thyroidectomy.
Eur J Surg.
2000;
166
((4))
286-288
-
22
Prim MP, Diego JI de, Hardisson D, Madero R, Gavilan J.
Factors related to nerve injury and hypocalcemia in thyroid gland surgery.
Otolaryngol Head Neck Surg.
2001;
124
((1))
111-1114
-
23
Pantazi H, Papapetrou PD.
Changes in parameters of bone and mineral metabolism during therapy for hyperthyroidism.
J Clin Endocrinol Metab.
2000;
85
((3))
1099-1106
-
24
Weetman P.
The spectrum of autoimmunity in thyroid disease.
Thyroid international.
2005;
1
3-13
-
25
Goswami R, Brown EM, Kochupillai N, Gupta N, Rani R, Kifor O, Chattopadhyay N.
Prevalence of calcium sending receptor autoantibodies in patients with sporadic idiopathic hypoparathyroidism.
Eur J Endocrinol.
2004;
150
9-18
-
26
Li Y, Song YH, Rais N, Connor E, Schatz D, Muir A, Maclaren N.
Autoantibodies to the extracellular domain of the calcium sensing receptor in patients with acquired hypoparathyroidism.
J Clin Invest.
1996;
97
910-914
-
27
Peterson P, Krohn KJ.
Mapping of B cell epitopes on steroid 17 alpha-hydroxylase, an autoantigen in autoimmune polyglandular syndrome type I.
Clin Exp Immunol.
1994;
98
104-109
-
28
Cakir M, Karayalcin U.
Graves' disease coexisting with probable autoimmune hypoparathyroidism.
Exp Clin Endocrinol Diabetes.
2003 Sep;
111
((6))
374-376
-
29
Gopinath B, Ma G, Wall JR.
Eye signs and serum eye muscle and collagen XIII antibodies in patients with transient and progressive thyroiditis.
Thyroid.
2007 22;
17
((11))
1123-1129
-
30
Gopinath B, Adams CL, Musselman R, Tani J, Wall JR.
Antibodies against calsequestrin and type XIII collagen are good markers for chronic upper eyelid retraction.
Ocul Immunol Inflamm.
2007 Mar-Apr;
15
((2))
81-88
-
31
Bednarczuk T, Gopinath B, Ploski R, Wall JR.
Susceptibility genes in Graves’ ophthalmopathy: searching for a needle in a haystack?.
Clin Endocrinol (Oxf).
2007;
67
((1))
3-19
-
32 Chen QY, Kukreja A, Maclaren NK. The autoimmune polyglandular syndromes. DeGroot LJ, Jameson JL, Eds.; Endocrinology. 4th ed. Philadelphia: WB Saunders Company 2001: 587-599
-
33
Perheentupa J.
APS-I/APECED: the clinical disease and therapy.
Endocrinol Metab Clin North Am.
2002;
31
295-320
Correspondence
I. Hassan
Department of Visceral-, Thoracic-, and Vascular Surgery
Philipps University of Marburg
Baldingerstraße
35033 Marburg
Germany
Phone: +49/6421/286 664 43
Fax: +49/6421/286 89 95
Email: hassan@med.uni-marburg.de
