Original ArticleSurgeons and Patients Disagree on the Potential Consequences of Hypoparathyroidism
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.
REFERENCES (14)
- et al.
Informed consent: how much and what do patients understand?
Am J Surg.
(2009) - et al.
Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient
World J Surg.
(2000) Clinical practice
Hypoparathyroidism. N Engl J Med.
(2008)- et al.
Hypocalcemia following thyroid surgery: incidence and prediction of outcome
World J Surg.
(1998) - et al.
The effect of PTH(1-84) on quality of life in hypoparathyroidism
J Clin Endocrinol Metab.
(2013) - et al.
Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D
Eur J Endocrinol.
(2002) - et al.
Making consent patient centered
BMJ.
(2003)
Cited by (47)
The relative importance of treatment outcomes to surgeons’ recommendations for low-risk thyroid cancer
2023, Surgery (United States)Postoperative hypoparathyroidism: Prevention is mandatory
2022, Surgery (United States)Hypoparathyroidism: Consequences, economic impact, and perspectives. A case series and systematic review
2021, Annales d'EndocrinologieQuality of life in hypoparathyroidism
2019, BoneSigns and Symptoms of Hypoparathyroidism
2018, Endocrinology and Metabolism Clinics of North America