RISKS OF COMPLICATION FOLLOWING THYROIDECTOMY

OBJECTIVE: Because hypoparathyroidism is a serious complication of thy roidectomy, we attempted to elucidate factors determining the risk of this postoperative outcome. SETTING:Four tertiary care hospitals in Al buquerque, New Mexico. PATIENTS: A retrospective study of 142 patients who underwent total or subtotal thyroidectomy between 1988 and 1995. MEASUREMENTS ANO MAIN RESULTS: Permanent hypoparathyroidism was define d as hypocalcemic symptoms plus a requirement for oral vitamin D or ca lcium 6 months after thyroidectomy. Factors analyzed to determine thei r contribution to the risk of persistent postoperative hypoparathyroid ism were the indication for thyroidectomy, performance of a preoperati ve thyroid needle biopsy, type of surgery, postoperative pathology, pr esence and stage of thyroid carcinoma, resident surgeon involvement, a nd specialty of the surgeon performing the procedure. Surgical special ty and stage of thyroid carcinoma were independent risk factors for pe rsistent postoperative hypoparathyroidism by multivariate analysis. Ni ne (29%) of 31 patients who had thyroidectomy by otolaryngologists met criteria for permanent hypoparathyroidism, and 6 (5%) of 111 patients who had thyroidectomy by general surgeons met the same criteria (p < .001), Adjustment for the effect of stage did not eliminate the effect of specialty (p = .006), and adjustment for the effect of specialty d id not eliminate the effect of stage [p = .02) on the occurrence of po stoperative hypoparathyroidism. CONCLUSIONS: We conclude from our data that patients undergoing thyroidectomy by an otolaryngologist may be at a higher risk of permanent postoperative hypoparathyroidism than pa tients who undergo thyroidectomy by a general surgeon. This may reflec t differences in case selection or surgical approach or both.