Evaluation of hypoparathyroidism following laryngectomy

Abstract

Background Hypoparathyroidism is a recognised complication following laryngectomy; it is associated with significant short-and long-term morbidity. This study aimed to further characterise this condition, identify risk factors and describe preventative and management strategies in a large cohort. Materials and methods This was a retrospective study at a tertiary referral centre for head and neck cancers. All consecutive patients who had total laryngectomy over an eight-year period were included. Results A total of 140 patients were included. Rates of transient and long-term hypoparathyroidism were 14.3% and 10.1%, respectively. The following factors were significantly associated with transient post-surgical hypocalcaemia or hypoparathyroidism: total thyroidectomy (relative risk, RR, 4.33; 95% confidence interval, CI, 1.86–10.10), oesophagectomy (RR 6.05; 95% CI 2.92–12.53) and female sex (RR 3.23; 95% CI 1.45–7.19). In addition, total thyroidectomy (RR 5.89; 95% CI 1.94–17.86), central neck dissection (RR 3.97; 95% CI 1.42–11.10), oesophagectomy (RR 9.38; 95% CI 4.13–21.3), pharyngectomy (RR 7.14; 95% CI 2.08–24.39) and female sex (RR 5.52; 95% CI 1.95–15.63) were risk factors for long-term hypoparathyroidism. There was variability in the use of preventative measures, monitoring and management of hypocalcaemia and hypoparathyroidism following total laryngectomy. Conclusions Transient hypocalcaemia and long-term hypoparathyroidism occur in a significant proportion of patients after laryngectomy. A standard protocol is required to improve care.