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Development and validation of a new model for predicting hypocalcaemia after total thyroidectomy: the NuGra model

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Abstract

Background

Hypocalcaemia is the most frequent complication after total thyroidectomy. Finding a method for its early detection has become a priority. A single-center prospective cohort study was conducted to identify risk factors for postoperative hypocalcaemia, develop an early detection model, and test its validity in a different group of patients.

Methods

The sample was composed of patients who underwent a total thyroidectomy between May 2012 and September 2015. Demographic, clinical, laboratory, and surgical data were collected. The incidence of hypocalcaemia and permanent hypoparathyroidism was calculated. Bivariate and multivariate analysis identified several independent predictors of hypocalcaemia, which were used to design a predictive model. The validity of the model was subsequently tested in a different cohort. Area under the ROC curve (AUROC) was calculated to determine its predictive power.

Results

The study and validation groups included 352 and 118 patients, respectively. Seventy-three patients developed laboratory-confirmed hypocalcaemia (20.7%), and symptomatic in 43 (12.2%). Multivariate analysis confirmed as independent predictors of hypocalcaemia the higher number of parathyroid glands identified [OR 1.41(0.98, 2.02); p = 0.063] and pre-to-postoperative gradient of parathormone decline [OR 1.06(1.04, 1.08); p < 0.001]. Based on these variables, the NuGra (Number of parathyroid glands identified-Gradient of decline) model was developed for predicting laboratory-confirmed hypocalcaemia. Its predictive power was high (AUROC 0.902, CI 0.857–0.947) for the study and the validation group (AUROC 0.956, CI 0.919–0.993).

Conclusions

A higher number of parathyroid glands identified and a higher gradient of parathormone decline are risk factors for post-thyroidectomy hypocalcaemia. The NuGra model is useful for early prediction of individual risk for hypocalcaemia.

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Abbreviations

iPTH:

Intact parathormone

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Acknowledgments

The authors are grateful to S. Gil Loza for starting the collection of data for this study, and J.V García Lario for the implementation of quick iPTH determination in our center. Also, the authors acknowledge the Department of Surgery of the University of Granada for the support in the preparation of this paper.

Author information

Authors and Affiliations

  1. Unit of Endocrine Surgery, Department of General Surgery, Virgen de las Nieves University Hospital, 18012, Av. De las Fuerzas Armadas, Granada, Spain

    Jennifer Triguero Cabrera, Elena Fernández Segovia, Selene González Martínez, Nuria Victoria Muñoz Pérez, Juan Ignacio Arcelus Martínez & Jesús María Villar del Moral

  2. Department of Surgery, University of Granada, Granada, Spain

    Juan Ignacio Arcelus Martínez

  3. Unit of Management and Research Support (FIBAO), Virgen de las Nieves University Hospital, Granada, Spain

    Manuela Expósito Ruiz

Authors
  1. Jennifer Triguero Cabrera
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  2. Elena Fernández Segovia
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  3. Selene González Martínez
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  4. Nuria Victoria Muñoz Pérez
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  5. Juan Ignacio Arcelus Martínez
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  7. Jesús María Villar del Moral
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jennifer Triguero Cabrera, Elena Fernández Segovia, Selene González Martínez, Nuria Victoria Muñoz Pérez, Manuela Expósito Ruiz, Juan Ignacio Arcelus, and Jesús María Villar del Moral. The first draft of the manuscript was written by Jennifer Triguero Cabrera, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jennifer Triguero Cabrera.

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The authors declare that they have no conflict of interest.

Ethics approval and consent

Informed consent for operation and for inclusion in the study were obtained from all patients, in accordance with the Declaration of Helsinki. The study was approved by the Regional Ethics Committee (University of Granada).

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Triguero Cabrera, J., Fernández Segovia, E., González Martínez, S. et al. Development and validation of a new model for predicting hypocalcaemia after total thyroidectomy: the NuGra model. Langenbecks Arch Surg 406, 1199–1209 (2021). https://doi.org/10.1007/s00423-020-02002-x

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