Analysis Of The Risk Factors Of Hypoparathyroidism After Total Thyroidectomy And Billateral Central Lymph Node Dissection In Patients With Papillary Thyroid Carcinoma

Purpose:To investigate the clinical risk factors of hypoparathyroidism(HOP)in patients with papillary thyroid carcinoma(PTC)after total thyroidectomy(TT)and bilateral central lymph node dissection(BCLND),providing reference and help to predict the occurrence of parathyroidism after TT+BCLND.Methods:This study collected and retrospectively analyzed the clinical data of 98 patients who underwent total thyroidectomy and bilateral central lymph node dissection In the department of Otorhinolaryngology-Head and Neck Surgery of cancer hospital affiliated to guangzhou medical university from January 2017 to August 2019 and were final pathologically confirmed as papillary thyroid cancer,the patients were divided into normal parathyroid group,transient hypoparathyroidism group and permanent hypoparathyroidism group according to the blood calcium level and parathyroid hormone(PTH)level within 6 months after surgery.The basic clinical data between the three groups were analyzed and compared using SPSS17.0 software with univariate analysis and multivariate analysis,so as to find the clinical independent risk factorts of postoperative hypoparathyroidism and permanent parathyroidism.Results:A total of 98 patients who underwent total thyroidectomy(TT)and bilateral central lymph node dissection were included in this study.33 cases(33.7%)in the normal group and 65 patients(66.4%)suffered postoperative hypoparathyroidism,among whom 61 patients(62.2%)were transient hypoparathyroidism and 4 patints(4.1%)were permanent hypoparathyroidism.Univariate analysis indicated that the incidence of postoperative parathyroidism was lower in patients using carbon nanoparticles than in patients not using carbon nanoparticles(58.3%% VS 78.9%,P=0.035),and the difference was statistically significant.The incidence of postoperative parathyroidism after autotransplantation of parathyroid gland was higher than that without autotransplantation of parathyroid gland(85.3% VS 51%,P=0.001),and the difference was statistically significant.The incidence of postoperative parathyroidism of patients with hashimoto's thyroiditis was higher than that without hashimoto's thyroiditis(88.2% VS 61.7%,P=0.036),and the difference was statistically significant.The incidence of permanent hypoparathyroidism of patients with extrathyroidal invasion was higher than that in patients without extrathyroidal invasion(20% VS 2%,P=0.043),and the difference was statistically significant.Multivariate analysis showed that carbon nanoparticles(?=-1.240,OR=0.288,P=0.038,95%CI: 0.107~1.224)is an independent protective factor for postoperative hypothyroidism,while autotransplantation of parathyroid gland(?=1.829,OR=6.227,P=0.012,95%CI: 1.496 ~ 25.921)and combined hashimoto's thyroiditis(?=1.787,OR=5.974,P=0.042,95%CI:1.069~33.377)is an independent risk factor for postoperative parathyroidism.Conlusion:The use of carbon nanoparticles during the operation can protect the parathyroid gland.Although intraoperative autotransplantation of parathyroid gland increased the incidence of postoperative transient parathyroidism,it did not increase the incidence of postoperative permanent parathyroidism.Thyroid papillary carcinoma with hashimoto's thyroiditis may cause increased difficulty in separating the thyroid gland from the parathyroid gland during the operation,and it is more likely to occur hypoparathyroidism after the operation.During the operation,the discovery of extrathyroidal invasion will increase the difficulty of preserving the original parathyroid gland,and the postoperative permanent hypoparathyroidism function is more likely to occur.