Long-Term Non-skeletal Complications in Patients with Thyroid Cancer and Hypoparathyroidism Post-total Thyroidectomy.

Abstract

Background: Thyroid cancer (TC) is a prevalent endocrine malignancy with rising incidence attributed to advancements in diagnostic technology. Despite its generally favorable prognosis, post-surgical complications, including hypoparathyroidism, can cause long-term health challenges. This study evaluated the risk of non-skeletal complications in TC patients with hypoparathyroidism.

Materials and methods: A retrospective cohort study was conducted using the National Health Insurance Service-National Sample Cohort (2002-2019), including TC patients diagnosed between 2006 and 2019. Participants were categorized into TC with hypoparathyroidism (TC with hypoP), TC without hypoparathyroidism (TC without hypoP), and matched controls. Propensity score matching and Cox proportional-hazards models evaluated the incidence and risk of non-skeletal complications, including diabetes mellitus, dyslipidemia, cardiovascular and renal outcomes, and cataracts.

Results: This study included 430 and 850 patients in the TC with hypoP and TC without hypoP groups, respectively, and their matched controls. The TC with hypoP group showed significantly higher risks of diabetes mellitus (HR 1.31, 95% CI: 1.01-1.68), dyslipidemia (HR 1.29, 95% CI: 1.06-1.57), urinary stones (HR 1.61, 95% CI: 1.00-2.57), and cataracts (HR 1.50, 95% CI: 1.15-1.95), compared to controls (all P<0.05). Hypertension risk was higher in the TC with hypoP group versus the TC without hypoP group (HR 1.39, 95% CI: 1.00-1.93, P=0.048). Women had higher urinary stone risk, while cataract risk increased in patients aged over 50.

Conclusion: TC patients with hypoparathyroidism are at an increased risk for specific non-skeletal complications, particularly older adults and women. These findings underscore the need for targeted monitoring and management strategies in this population. Further prospective studies are warranted to validate these associations and elucidate the underlying mechanisms.