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Article: Graves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomy

TitleGraves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomy
Authors
KeywordsMedicine & Public Health
Surgery
Abdominal Surgery
Cardiac Surgery
General Surgery
Thoracic Surgery
Vascular Surgery
Issue Date2011
PublisherSpringer New York
Citation
World Journal of Surgery, 2011, v. 35, n. 10, p. 2212-2218 How to Cite?
AbstractBACKGROUND: Studies have evaluated the effect of thyroidectomy on the course of Graves' ophthalmopathy (GO) but it is unclear how GO as an indication might affect surgical outcomes. We aimed to evaluate the impact of this indication on surgical outcomes in Graves' disease (GD). METHODS: From 1995 to 2008, 329 patients with GD underwent thyroidectomy. Patients were stratified into two groups, namely, those with GO as indication (GO) and those with non-GO indication (non-GO). Outcomes were compared between the groups and outcomes with significance were further analyzed by multivariate analyses to determine independent factors. RESULTS: The GO group was significantly older (P < 0.001), had more males (P < 0.001), and fewer relapses (P < 0.001) than the non-GO group. It also had a higher proportion of total/near-total thyroidectomy (P < 0.001), despite a shorter operating time (P = 0.024) and less blood loss (P = 0.010). When only total/near-total thyroidectomy was considered, the GO group had significantly more permanent hypoparathyroidism than the non-GO group (9.2 vs. 1.6%, P = 0.038), but the rate of permanent hypoparathyroidism was similar in the two groups when only those with parathyroid autotransplantation were considered. Other complications were similar between the two groups. By multivariate analysis, GO as indication was an independent risk factor for temporary (OR 1.97, P = 0.033) and permanent hypoparathyroidism (OR 4.76, P = 0.007). CONCLUSION: GO as a surgical indication (i.e., unstable or active GO requiring ophthalmic treatment or follow-up) was associated with increased risk of temporary and permanent hypoparathyroidism after bilateral thyroidectomy. Routine parathyroid autotransplantation may reduce the risk of permanent hypoparathyroidism in this select patient group.
Persistent Identifierhttp://hdl.handle.net/10722/144869
ISSN
2015 Impact Factor: 2.523
2015 SCImago Journal Rankings: 1.375
PubMed Central ID
ISI Accession Number ID
References

Nielsen CH, Brix TH, Leslie RG, Hegedus L (2009) A role for autoantibodies in enhancement of pro-inflammatory cytokine responses to a self-antigen, thyroid peroxidase. Clin Immunol 133(2):218–227 doi: 10.1016/j.clim.2009.07.014

Prabhakar BS, Bahn RS, Smith TJ (2003) Current perspective on the pathogenesis of Graves’ disease and ophthalmopathy. Endocr Rev 24(6):802–835 doi: 10.1210/er.2002-0020

Stalberg P, Svensson A, Hessman O, Akerstrom G, Hellman P (2008) Surgical treatment of Graves’ disease: evidence-based approach. World J Surg 32(7):1269–1277. doi: doi: 10.1007/s00268-008-9497-9

Tominaga T, Yokoyama N, Nagataki S, Cho BY, Koh CS, Chen JL et al (1997) International differences in approaches to 131I therapy for Graves’ disease: case selection and restrictions recommended to patients in Japan, Korea, and China. Thyroid 7(2):217–220 doi: 10.1089/thy.1997.7.217

Wartofsky L, Glinoer D, Solomon B, Nagataki S, Lagasse R, Nagayama Y et al (1991) Differences and similarities in the diagnosis and treatment of Graves’ disease in Europe, Japan, and the United States. Thyroid 1(2):129–135 doi: 10.1089/thy.1991.1.129

Ku CF, Lo CY, Chan WF, Kung AW, Lam KS (2005) Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease. ANZ J Surg 75(7):528–531 doi: 10.1111/j.1445-2197.2005.03441.x

Menconi F, Marino M, Pinchera A, Rocchi R, Mazzi B, Nardi M et al (2007) Effects of total thyroid ablation versus near-total thyroidectomy alone on mild to moderate Graves’ orbitopathy treated with intravenous glucocorticoids. J Clin Endocrinol Metab 92(5):1653–1658 doi: 10.1210/jc.2006-1800

Leech NJ, Dayan CM (1998) Controversies in the management of Graves’ disease. Clin Endocrinol (Oxf) 49(3):273–280 doi: 10.1046/j.1365-2265.1998.00558.x

Tallstedt L, Lundell G, Torring O, Wallin G, Ljunggren JG, Blomgren H et al (1992) Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism The Thyroid Study Group. N Engl J Med 326(26):1733–1738 doi: 10.1056/NEJM199206253262603

Abe Y, Sato H, Noguchi M, Mimura T, Sugino K, Ozaki O et al (1998) Effect of subtotal thyroidectomy on natural history of ophthalmopathy in Graves’ disease. World J Surg 22(7):714–717. doi: doi: 10.1007/s002689900458

Levitt MD, Edis AJ, Agnello R, McCormick CC (1988) The effect of subtotal thyroidectomy on Graves’ ophthalmopathy. World J Surg 12(5):593–597. doi: doi: 10.1007/BF01655858

Hassan L, Danila R, Maurer E, Osei-Agymang T, Zielke A (2008) Severe Graves’ ophthalmopathy may be a factor for the development of postthyroidectomy hypocalcemia. Exp Clin Endocrinol Diabetes 116:614–618 doi: 10.1055/s-2008-1065333

Lang BH, Lo CY (2005) Total thyroidectomy for multinodular goiter in the elderly. Am J Surg 190(3):418–423 doi: 10.1016/j.amjsurg.2005.03.029

Bahn RS, Heufelder AE (1993) Pathogenesis of Graves’ ophthalmopathy. N Engl J Med 329(20):1468–1475 doi: 10.1056/NEJM199311113292007

Yip J, Lang BH, Lo CY (2011) Changing trend in surgical indication and management for Graves’ disease. Am J Surg. doi:10.1016/j.amjsurg.2011.01.029

Miccoli P, Vitti P, Rago T, Iacconi P, Bartalena L, Bogazzi F et al (1996) Surgical treatment of Graves’ disease: subtotal or total thyroidectomy? Surgery 120(6):1020–1024; discussion 1024–1025 doi: 10.1016/S0039-6060(96)80049-3

Palit TK, Miller CC 3rd, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90(2):161–165 doi: 10.1006/jsre.2000.5875

Witte J, Goretzki PE, Dotzenrath C, Simon D, Felis P, Neubauer M et al (2000) Surgery for Graves’ disease: total versus subtotal thyroidectomy—results of a prospective randomized trial. World J Surg 24(11):1303–1311. doi: doi: 10.1007/s002680010216

Abboud B, Sargi Z, Akkam M, Sleilaty F (2002) Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 195(4):456–461 doi: 10.1016/S1072-7515(02)01310-8

Lo CY, Lam KY (2001) Routine parathyroid autotransplantation during thyroidectomy. Surgery 129(3):318–323 doi: 10.1067/msy.2001.111125

Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133(2):180–185 doi: 10.1067/msy.2003.61

Abboud B, Sleilaty G, Zeineddine S, Braidy C, Aouad R, Tohme C et al (2008) Is therapy with calcium and vitamin D and parathyroid autotransplantation useful in total thyroidectomy for preventing hypocalcemia? Head Neck 30(9):1148–1154; discussion 1154–1155 doi: 10.1002/hed.20836

Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I et al (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24(11):1335–1341. doi: doi: 10.1007/s002680010221

Yamashita H, Noguchi S, Tahara K, Watanabe S, Uchino S, Kawamoto H et al (1997) Postoperative tetany in patients with Graves’ disease: a risk factor analysis. Clin Endocrinol (Oxf) 47(1):71–77 doi: 10.1046/j.1365-2265.1997.2201033.x

Gerding MN, van der Meer JW, Broenink M, Bakker O, Wiersinga WM, Prummel MF (2000) Association of thyrotrophin receptor antibodies with the clinical features of Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 52(3):267–271 doi: 10.1046/j.1365-2265.2000.00959.x

Eckstein AK, Plicht M, Lax H, Neuhauser M, Mann K, Lederbogen S et al (2006) Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab 91(9):3464–3470 doi: 10.1210/jc.2005-2813

Lang BH, Lo CY (2010) Vitamin D3 deficiency is associated with late-onset hypocalcemia after minimally invasive parathyroidectomy in a vitamin D borderline area. World J Surg 34(6):1350–1355. doi: doi: 10.1007/s00268-009-0377-8

 

DC FieldValueLanguage
dc.contributor.authorWong, KPen_US
dc.contributor.authorLang, BHHen_US
dc.date.accessioned2012-02-21T05:44:37Z-
dc.date.available2012-02-21T05:44:37Z-
dc.date.issued2011en_US
dc.identifier.citationWorld Journal of Surgery, 2011, v. 35, n. 10, p. 2212-2218en_US
dc.identifier.issn0364-2313en_US
dc.identifier.urihttp://hdl.handle.net/10722/144869-
dc.description.abstractBACKGROUND: Studies have evaluated the effect of thyroidectomy on the course of Graves' ophthalmopathy (GO) but it is unclear how GO as an indication might affect surgical outcomes. We aimed to evaluate the impact of this indication on surgical outcomes in Graves' disease (GD). METHODS: From 1995 to 2008, 329 patients with GD underwent thyroidectomy. Patients were stratified into two groups, namely, those with GO as indication (GO) and those with non-GO indication (non-GO). Outcomes were compared between the groups and outcomes with significance were further analyzed by multivariate analyses to determine independent factors. RESULTS: The GO group was significantly older (P < 0.001), had more males (P < 0.001), and fewer relapses (P < 0.001) than the non-GO group. It also had a higher proportion of total/near-total thyroidectomy (P < 0.001), despite a shorter operating time (P = 0.024) and less blood loss (P = 0.010). When only total/near-total thyroidectomy was considered, the GO group had significantly more permanent hypoparathyroidism than the non-GO group (9.2 vs. 1.6%, P = 0.038), but the rate of permanent hypoparathyroidism was similar in the two groups when only those with parathyroid autotransplantation were considered. Other complications were similar between the two groups. By multivariate analysis, GO as indication was an independent risk factor for temporary (OR 1.97, P = 0.033) and permanent hypoparathyroidism (OR 4.76, P = 0.007). CONCLUSION: GO as a surgical indication (i.e., unstable or active GO requiring ophthalmic treatment or follow-up) was associated with increased risk of temporary and permanent hypoparathyroidism after bilateral thyroidectomy. Routine parathyroid autotransplantation may reduce the risk of permanent hypoparathyroidism in this select patient group.en_US
dc.languageengen_US
dc.publisherSpringer New Yorken_US
dc.relation.ispartofWorld Journal of Surgeryen_US
dc.rightsThe Author(s)en_US
dc.rightsCreative Commons: Attribution 3.0 Hong Kong Licenseen_US
dc.subjectMedicine & Public Healthen_US
dc.subjectSurgeryen_US
dc.subjectAbdominal Surgeryen_US
dc.subjectCardiac Surgeryen_US
dc.subjectGeneral Surgeryen_US
dc.subjectThoracic Surgeryen_US
dc.subjectVascular Surgeryen_US
dc.titleGraves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomyen_US
dc.typeArticleen_US
dc.identifier.openurlhttp://library.hku.hk:4551/resserv?sid=springerlink&genre=article&atitle=Graves’ Ophthalmopathy as an Indication Increased the Risk of Hypoparathyroidism After Bilateral Thyroidectomy&title=World Journal of Surgery&issn=03642313&date=2011-10-01&volume=35&issue=10& spage=2212&authors=Kai-Pun Wong, Brian Hung-Hin Langen_US
dc.description.naturepublished_or_final_versionen_US
dc.identifier.doi10.1007/s00268-011-1236-yen_US
dc.identifier.pmid21858556-
dc.identifier.pmcidPMC3170470-
dc.identifier.scopuseid_2-s2.0-80855123768en_US
dc.identifier.hkuros194102-
dc.relation.referencesNielsen CH, Brix TH, Leslie RG, Hegedus L (2009) A role for autoantibodies in enhancement of pro-inflammatory cytokine responses to a self-antigen, thyroid peroxidase. Clin Immunol 133(2):218–227en_US
dc.relation.referencesdoi: 10.1016/j.clim.2009.07.014en_US
dc.relation.referencesPrabhakar BS, Bahn RS, Smith TJ (2003) Current perspective on the pathogenesis of Graves’ disease and ophthalmopathy. Endocr Rev 24(6):802–835en_US
dc.relation.referencesdoi: 10.1210/er.2002-0020en_US
dc.relation.referencesStalberg P, Svensson A, Hessman O, Akerstrom G, Hellman P (2008) Surgical treatment of Graves’ disease: evidence-based approach. World J Surg 32(7):1269–1277. doi:en_US
dc.relation.referencesdoi: 10.1007/s00268-008-9497-9en_US
dc.relation.referencesTominaga T, Yokoyama N, Nagataki S, Cho BY, Koh CS, Chen JL et al (1997) International differences in approaches to 131I therapy for Graves’ disease: case selection and restrictions recommended to patients in Japan, Korea, and China. Thyroid 7(2):217–220en_US
dc.relation.referencesdoi: 10.1089/thy.1997.7.217en_US
dc.relation.referencesWartofsky L, Glinoer D, Solomon B, Nagataki S, Lagasse R, Nagayama Y et al (1991) Differences and similarities in the diagnosis and treatment of Graves’ disease in Europe, Japan, and the United States. Thyroid 1(2):129–135en_US
dc.relation.referencesdoi: 10.1089/thy.1991.1.129en_US
dc.relation.referencesKu CF, Lo CY, Chan WF, Kung AW, Lam KS (2005) Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease. ANZ J Surg 75(7):528–531en_US
dc.relation.referencesdoi: 10.1111/j.1445-2197.2005.03441.xen_US
dc.relation.referencesMenconi F, Marino M, Pinchera A, Rocchi R, Mazzi B, Nardi M et al (2007) Effects of total thyroid ablation versus near-total thyroidectomy alone on mild to moderate Graves’ orbitopathy treated with intravenous glucocorticoids. J Clin Endocrinol Metab 92(5):1653–1658en_US
dc.relation.referencesdoi: 10.1210/jc.2006-1800en_US
dc.relation.referencesLeech NJ, Dayan CM (1998) Controversies in the management of Graves’ disease. Clin Endocrinol (Oxf) 49(3):273–280en_US
dc.relation.referencesdoi: 10.1046/j.1365-2265.1998.00558.xen_US
dc.relation.referencesTallstedt L, Lundell G, Torring O, Wallin G, Ljunggren JG, Blomgren H et al (1992) Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism The Thyroid Study Group. N Engl J Med 326(26):1733–1738en_US
dc.relation.referencesdoi: 10.1056/NEJM199206253262603en_US
dc.relation.referencesAbe Y, Sato H, Noguchi M, Mimura T, Sugino K, Ozaki O et al (1998) Effect of subtotal thyroidectomy on natural history of ophthalmopathy in Graves’ disease. World J Surg 22(7):714–717. doi:en_US
dc.relation.referencesdoi: 10.1007/s002689900458en_US
dc.relation.referencesLevitt MD, Edis AJ, Agnello R, McCormick CC (1988) The effect of subtotal thyroidectomy on Graves’ ophthalmopathy. World J Surg 12(5):593–597. doi:en_US
dc.relation.referencesdoi: 10.1007/BF01655858en_US
dc.relation.referencesHassan L, Danila R, Maurer E, Osei-Agymang T, Zielke A (2008) Severe Graves’ ophthalmopathy may be a factor for the development of postthyroidectomy hypocalcemia. Exp Clin Endocrinol Diabetes 116:614–618en_US
dc.relation.referencesdoi: 10.1055/s-2008-1065333en_US
dc.relation.referencesLang BH, Lo CY (2005) Total thyroidectomy for multinodular goiter in the elderly. Am J Surg 190(3):418–423en_US
dc.relation.referencesdoi: 10.1016/j.amjsurg.2005.03.029en_US
dc.relation.referencesBahn RS, Heufelder AE (1993) Pathogenesis of Graves’ ophthalmopathy. N Engl J Med 329(20):1468–1475en_US
dc.relation.referencesdoi: 10.1056/NEJM199311113292007en_US
dc.relation.referencesYip J, Lang BH, Lo CY (2011) Changing trend in surgical indication and management for Graves’ disease. Am J Surg. doi:10.1016/j.amjsurg.2011.01.029en_US
dc.relation.referencesdoi: 10.1016/j.amjsurg.2011.01.029en_US
dc.relation.referencesMiccoli P, Vitti P, Rago T, Iacconi P, Bartalena L, Bogazzi F et al (1996) Surgical treatment of Graves’ disease: subtotal or total thyroidectomy? Surgery 120(6):1020–1024; discussion 1024–1025en_US
dc.relation.referencesdoi: 10.1016/S0039-6060(96)80049-3en_US
dc.relation.referencesPalit TK, Miller CC 3rd, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90(2):161–165en_US
dc.relation.referencesdoi: 10.1006/jsre.2000.5875en_US
dc.relation.referencesWitte J, Goretzki PE, Dotzenrath C, Simon D, Felis P, Neubauer M et al (2000) Surgery for Graves’ disease: total versus subtotal thyroidectomy—results of a prospective randomized trial. World J Surg 24(11):1303–1311. doi:en_US
dc.relation.referencesdoi: 10.1007/s002680010216en_US
dc.relation.referencesAbboud B, Sargi Z, Akkam M, Sleilaty F (2002) Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 195(4):456–461en_US
dc.relation.referencesdoi: 10.1016/S1072-7515(02)01310-8en_US
dc.relation.referencesLo CY, Lam KY (2001) Routine parathyroid autotransplantation during thyroidectomy. Surgery 129(3):318–323en_US
dc.relation.referencesdoi: 10.1067/msy.2001.111125en_US
dc.relation.referencesThomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133(2):180–185en_US
dc.relation.referencesdoi: 10.1067/msy.2003.61en_US
dc.relation.referencesAbboud B, Sleilaty G, Zeineddine S, Braidy C, Aouad R, Tohme C et al (2008) Is therapy with calcium and vitamin D and parathyroid autotransplantation useful in total thyroidectomy for preventing hypocalcemia? Head Neck 30(9):1148–1154; discussion 1154–1155en_US
dc.relation.referencesdoi: 10.1002/hed.20836en_US
dc.relation.referencesThomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I et al (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24(11):1335–1341. doi:en_US
dc.relation.referencesdoi: 10.1007/s002680010221en_US
dc.relation.referencesYamashita H, Noguchi S, Tahara K, Watanabe S, Uchino S, Kawamoto H et al (1997) Postoperative tetany in patients with Graves’ disease: a risk factor analysis. Clin Endocrinol (Oxf) 47(1):71–77en_US
dc.relation.referencesdoi: 10.1046/j.1365-2265.1997.2201033.xen_US
dc.relation.referencesGerding MN, van der Meer JW, Broenink M, Bakker O, Wiersinga WM, Prummel MF (2000) Association of thyrotrophin receptor antibodies with the clinical features of Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 52(3):267–271en_US
dc.relation.referencesdoi: 10.1046/j.1365-2265.2000.00959.xen_US
dc.relation.referencesEckstein AK, Plicht M, Lax H, Neuhauser M, Mann K, Lederbogen S et al (2006) Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab 91(9):3464–3470en_US
dc.relation.referencesdoi: 10.1210/jc.2005-2813en_US
dc.relation.referencesLang BH, Lo CY (2010) Vitamin D3 deficiency is associated with late-onset hypocalcemia after minimally invasive parathyroidectomy in a vitamin D borderline area. World J Surg 34(6):1350–1355. doi:en_US
dc.relation.referencesdoi: 10.1007/s00268-009-0377-8en_US
dc.relation.referencesEckstein AK, Lax H, Losch C, Glowacka D, Plicht M, Mann K et al (2007) Patients with severe Graves’ ophthalmopathy have a higher risk of relapsing hyperthyroidism and are unlikely to remain in remission. Clin Endocrinol (Oxf) 67(4):607–612en_US
dc.identifier.volume35en_US
dc.identifier.issue10en_US
dc.identifier.spage2212en_US
dc.identifier.epage2218en_US
dc.identifier.eissn1432-2323en_US
dc.identifier.isiWOS:000294807800005-
dc.description.otherSpringer Open Choice, 21 Feb 2012en_US
dc.identifier.citeulike9716783-

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