Evaluation of Hypocalcemia Following Total Laryngectomy With and Without Thyroidectomy

Hänel W Eberly; Bao Y Sciscent; F Jeffrey Lorenz; Nguyen Truong; Tonya S King; David Goldenberg; Neerav Goyal

doi:10.1002/ohn.804

Evaluation of Hypocalcemia Following Total Laryngectomy With and Without Thyroidectomy

Otolaryngol Head Neck Surg. 2024 May 13. doi: 10.1002/ohn.804. Online ahead of print.

Authors

Hänel W Eberly¹, Bao Y Sciscent¹, F Jeffrey Lorenz¹, Nguyen Truong¹, Tonya S King², David Goldenberg¹, Neerav Goyal¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, Pennsylvania, USA.
² Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA.

PMID: 38738927
DOI: 10.1002/ohn.804

Abstract

Objective: Hypoparathyroidism and associated hypocalcemia are well-established complications following laryngectomy. This study further characterizes the rates of hypocalcemia in patients undergoing total laryngectomy (TL) with and without thyroidectomy and hemithyroidectomy.

Study design: Retrospective cohort study.

Setting: TriNetX.

Methods: We queried TriNetX, a deidentified patient database, to identify patients who underwent TL with and without thyroidectomy and hemithyroidectomy. Rates of hypocalcemia, low parathyroid hormone (PTH), calcium, and calcitriol supplementation were compared between groups with multivariable repeated measures logistic regression.

Results: We identified 870 patients in the TL without thyroidectomy cohort, 158 patients in the hemithyroidectomy cohort, and 123 in the total thyroidectomy cohort. Rates of hypocalcemia differed between patients receiving total thyroidectomy versus TL alone for 0 to 1 month (odds ratio [OR]: 2.88 [1.95-4.26]) 1 to 6 months (OR: 5.08 [2.29-11.3]), and 6 to 12 months (OR: 2.63 [1.003-6.88]) postoperatively, with adjustment for age at laryngectomy, race, ethnicity, and gender. Results were similar among those who received calcium supplementation. The rate of low PTH levels differed in these groups for 0 to 1 month (OR: 5.13 [3.10-8.51]), 1 to 6 months (OR: 3.47 [1.46-8.22]), and 6 to 12 months (OR: 3.63 [1.40-9.38]) following surgery. Rates of postoperative calcium supplementation were increased for patients receiving total thyroidectomy versus TL for 1 to 6 months (OR: 2.44 [1.62-3.68]), and 6 to 12 months following surgery (OR: 1.79 [1.18-2.72]).

Conclusion: Patients undergoing TL with total thyroidectomy have a higher risk of postoperative hypocalcemia compared to patients receiving TL alone. Risk of parathyroid injury in these patients may warrant further emphasis on PTH measurement after surgery and a multidisciplinary approach to management.

Keywords: hypocalcemia; thyroidectomy; total laryngectomy.