Elsevier

Endocrine Practice

Volume 20, Issue 5, May 2014, Pages 427-446
Endocrine Practice

Original Article
Surgeons and Patients Disagree on the Potential Consequences of Hypoparathyroidism

https://doi.org/10.4158/EP13321.ORGet rights and content

ABSTRACT

Objective

To test the hypothesis that surgeons and their patients underestimate the potential negative impact that permanent hypoparathyroidism has on quality of life (QOL).

Methods

We used a modified SF-36 assessment tool to compare the perceptions of patients with permanent hypoparathyroidism to the perceptions of control subjects who were given a standardized preoperative statement about the complications of hypoparathyroidism. We also elicited the perceptions of endocrine surgeons regarding the QOL impacts of hypoparathyroidism using a subset of questions from the modified SF-36.

Results

A total of 340 postsurgical patients with permanent hypoparathyroidism, 200 controls, and 102 surgeons participated in the study. Both surgeons and controls underestimated the negative impact of hypoparathyroidism on QOL when compared to patients living with permanent hypoparathyroidism. Forty-seven percent of hypoparathyroid patients believed that their health was “much worse” than before surgery, compared with 16% of surgeons (P < .001) and 7% of controls (P < .001). Postoperative hypoparathyroid patients also reported far more negative effects on QOL, from interference with social activities, paresthesias, muscle cramping, and medications than were anticipated by surgeons or controls (P < .05 for all comparisons). In each of the 8 dimensions of QOL, including physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional well-being, social functioning, pain, and general health, hypoparathyroid patients reported a significantly lower mean score compared to the control group (P < .001 for all comparisons).

Conclusion

The impact of postoperative hypoparathyroidism on patient QOL is consistently and significantly underestimated by surgeons and subjects receiving surgical consultation. (Endocr Pract. 2014;20:427-446)

Section snippets

INTRODUCTION

Hypoparathyroidism is the most common complication following total thyroidectomy (1). Although transient hypoparathyroidism resolves within 6 months after surgery, permanent hypoparathyroidism is defined as the physiologic state of insufficient parathyroid hormone (PTH) to maintain normocalcemia 6 months after surgery, requiring vitamin D and calcium supplementation. The incidence of permanent hypoparathyroidism after total thyroidectomy ranges between 0 and 10% in clinical reports and falls to

Experimental Design

This prospective study included 3 population cohorts totaling 642 participants, including 102 experienced endocrine surgeons, 200 controls, and 340 postoperative patients with permanent hypoparathyroidism. We used a modified SF-36 questionnaire to evaluate the perceptions regarding the QOL impacts of hypoparathyroidism of all 3 cohorts. Prior to taking the survey, the controls were given a standardized preoperative statement describing the risks and consequences of permanent hypoparathyroidism (

Baseline Participant Characteristics

A total of 340 postsurgical patients with permanent hypoparathyroidism, 200 controls, and 102 surgeons participated in the study. Demographic characteristics were obtained from the modified SF-36 survey for both the control and postoperative patient groups. The median ages of the control group and the postoperative hypoparathyroid group were comparable, at 46 (range, 18 to 88) and 50 (range, 19 to 77) years, respectively. Both the control and postoperative hypoparathyroid groups had a higher

DISCUSSION

Successful informed consent prior to any procedure relies on effective communication between physician and patient. Given this statement, it is often taken for granted that physicians informing patients about the potential risks of a procedure have an accurate understanding of the involved complications and their effects on patients. Although a substantial body of literature regarding the process of informed consent exists, few prior studies have compared preoperative perceptions of a surgical

CONCLUSION

In summary, our findings show that the current methodology used in educating patients about and obtaining their consent for thyroid surgery does not adequately convey the potential impact of hypoparathyroidism to these patients. Surgeons as well as controls significantly and consistently underestimate the negative impact on QOL that thyroid surgery has postoperatively on patients with hypoparathyroidism. Surgeons should be increasingly aware of this tendency to underestimate potential

DISCLOSURE

The authors have no multiplicity of interest to disclose.

ACKNOWLEDGMENT

We thank Nathaneal Hevelone and Jiping Wang for their assistance with statistical analyses. We also thank Matthew Leclair for his help with data collection and Michelle Mello for her guidance with this project. Finally, we wish to thank James Sanders for his help with subject recruitment. The authors had full access to all of the data in this study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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