Thyroid Surgery Increases Kidney Disease Risk

TOPLINE:

After a total thyroidectomy, patients have a higher risk for chronic kidney disease (CKD), especially those having hypoparathyroidism.

METHODOLOGY:

• Despite daily medication, hypoparathyroidism, a common complication after total thyroidectomy, is associated with an increased risk for kidney disease.
• To estimate the risk for CKD following total thyroidectomy, researchers identified all patients from Danish health registries who underwent the surgery between January 1998 and December 2017 for indications including goiter, cancer, and thyrotoxicosis.
• They evaluated 2421 patients (median age, 51.2 years; 79.2% women) who underwent total thyroidectomy and matched them by age and sex in a 1:10 ratio with 24,210 individuals from the general population (median follow-up for all, 5.5 years).
• CKD was considered present if the criteria for stage III or higher were met, defined by an estimated glomerular filtration rate < 60 mL/min/1.73 m², confirmed by at least two measurements taken 90 days or more apart.
• Hypoparathyroidism was defined as a new postoperative treatment with active vitamin D continuing past the index date 12 months after surgery.

TAKEAWAY:

• The risk for CKD 10 years after total thyroidectomy was 13.5% (95% CI, 9.3-17.7) among patients with hypoparathyroidism and 11.6% (95% CI, 9.7-13.7) among those without hypoparathyroidism; it was 5.8% (95% CI, 5.3-6.2) in individuals in the comparison cohort.
• The risk for CKD after thyroidectomy was two to three times higher in patients with and without hypoparathyroidism (adjusted hazard ratio [HR], 3.23 and 2.27; 95% CI, 2.37-4.41 and 1.87-2.75, respectively) than in individuals in the comparison cohort.
• Additionally, the risk for CKD was higher in patients without previous comorbidities, whether they had hypoparathyroidism or not (adjusted HR, 4.76 and 2.46; 95% CI, 3.14-7.22 and 1.88-3.21, respectively), than in those with known comorbidities.
• The cumulative incidence of developing CKD after 5 and 10 years was highest for patients with thyrotoxicosis, followed by those with goiter, but not for patients with cancer.

IN PRACTICE:

“In patients with hypoPT [hypoparathyroidism] and a need for long-term treatment with active vitamin D after TT [total thyroidectomy], there is an increased risk of developing CKD. Notably, we also identified an elevated CKD risk even in cases where parathyroid function was normal after TT,” the authors wrote.

SOURCE:

The study was led by Rasmus Reinke, MD, PhD, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark, and was published online in The Journal of Clinical Endocrinology & Metabolism.

LIMITATIONS:

The observational design of this study prevented handling of all potential unmeasured confounders. Data from multiple databases might have led to miscoding or missing information. Differences in clinical practice and strategies for reducing calcium and active vitamin D intake after total thyroidectomy could have affected the prevalence of hypoparathyroidism.

DISCLOSURES:

This study received funding from the fund for the advancement of health research in Central Denmark Region. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.