Table 1. Summary of the included studies of risk factors for hypocalcemia after total thyroidectomy in patients with thyroid cancer.
| Risk factors | Cases | Design | Conclusions | References |
|---|---|---|---|---|
| Age | 200 | Prospective cohort study | The risk for postoperative hypocalcemia was increased 20-fold for patients older than 50 years. | Tolone et al. (2013) |
| 68 | Retrospective study | Children with thyroid cancer are at high risk for postoperative hypocalcemia after total thyroidectomy. | Zobel et al. (2020) | |
| Sex | 2,108 | Retrospective study | Female gender is a strong risk factor that influence early hypocalcemia development. | Del Rio et al. (2019) |
| 734 | Retrospective study | Young female patients undergoing neck dissection are at higher risk of developing temporary hypoparathyroidism. | Privitera et al. (2023) | |
| Magnesium | 312 | Prospective cohort study | Serum magnesium below 1.9 mg/dL had 2.7 times higher odds of developing transient hypocalcemia post-TT. | Karunakaran et al. (2020) |
| Vitamin D | 181 | Retrospective cohort study | A correlation between transient postoperative hypocalcemia and 25-hydroxyvitaminD levels. | Saibene et al. (2022) |
| 100 | Retrospective cohort study | Preoperative serum Vit. D levels did not affect postoperative serum calcium levels. | Layegh et al. (2024) | |
| Pathological type of thyroid cancer | 453 | Retrospective randomized controlled study | TT + iCCND is associated with a significantly increased risk of transient hypoparathyroidism and TT + bCCND is associated with a significantly increased risk of transient and permanent hypoparathyroidism. | Rosati et al. (2022) |
| Parathyroid injury | 657 | Meta-analysis | There is a linear relationship between parathyroid glands preserved in situ and the prevalence of all hypoparathyroidism syndromes. | Sitges-Serra (2021) |
| 244 | Retrospective study | Parathyroid autotransplantation does not influence the rate of postoperative hypocalcemia and/or hypoparathyroidism. | Tartaglia et al. (2016) | |
| Parathyroid protection | 1,870 | Meta-analysis | The application of CNs in total or near-total thyroidectomy combined with CLND for thyroid cancer can better dissect the central lymph nodes and protect parathyroid glands and their function. | Zhang et al. (2023) |
| 1,711 | Meta-analysis | The reduced risk of postoperative hypoparathyroidism and hypocalcemia reflected NIRAF preservation value. | Safia et al. (2024) | |
| 90 | Prospective observational study | ICG angiography of the parathyroid gland is a safe, reliable predictor for postoperative transient hypocalcemia. | Abdelrahim, Amer & Mikhael Nageeb (2022) | |
| PTH | 521 | Retrospective study | POD1 PTH levels ≥ 15 pg/ml along with calcium ≥ 2.0 mmol/l are associated with low risk of symptomatic hypocalcemia. | Riordan et al. (2022) |
| 1,636 | Retrospective cohort study | Approximately one-quarter of all patients with low PTH levels immediately after surgery developed permanent hypoparathyroidism. | Annebäck et al. (2024) | |
| 87 | Retrospective cohort study | Postoperative 4 h PTH to preoperative PTH ratio with a cutoff point around 0.385 is an excellent indicator for identifying patients at risk for postoperative hypocalcemia. | Daskalaki et al. (2022) |
Notes.
- bCCND
- bilateral central compartment neck dissection
- CLND
- complete lymph node dissection
- CNs
- carbon nanoparticles
- iCCND
- ipsilateral central compartment neck dissection
- ICG
- indocyanine green
- NIRAF
- near-infrared autofluorescence
- POD1
- postoperative day 1
- PTH
- parathyroid hormone
- TT
- total thyroidectomy