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Peer-reviewedCC BYFrontiers in endocrinology

Prediction of early postoperative hypocalcemia and hypoparathyroidism after thyroidectomy for papillary thyroid carcinoma: dual-outcome prediction models

  • Cuiping Zhou1
  • Qian Chen1
  • Shuyan Liu1
  • Nuoxuan Niu1
  • Xinyu Ban1
  • Shiyang Wang1
  • Jinfeng Yan1
  • Ying Bi1
  • Jing Liu1
  • Jie Liu1
  • Yanxia Bai1
  1. 1Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi’an Jiaotong University , , ,
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Abstract

Background: Postoperative hypocalcemia and hypoparathyroidism are two common complications after total or subtotal/near-total for papillary thyroid carcinoma (PTC). This study aimed to identify significant predictors of early postoperative hypocalcemia and hypoparathyroidism and develop prediction nomograms for risk stratification in PTC patients.

Methods: A total of 1036 PTC patients who underwent total or subtotal/near-total thyroidectomy were retrospectively enrolled. Multivariable logistic regression with prespecified variables was performed to identify independent predictors for two outcomes: (1) early postoperative hypocalcemia, and (2) hypoparathyroidism. Nomograms were constructed for each outcome. Model performance was assessed by area under the receiver operating characteristic curve (AUC), calibration plots and decision curve analysis (DCA). Bootstrap internal validation (500 resamples) was used to correct for optimism.

Results: Among 1,036 patients, 325 (31.4%) developed early postoperative hypocalcemia, and 228 (22.0%) met criteria for hypoparathyroidism. For hypocalcemia, independent predictors were preoperative calcium (per 0.1 mmol/L: OR 0.298, 95% CI 0.234-0.374, P < 0.001), thyroidectomy extent (subtotal vs. total: OR 0.75, 95% CI 0.025-0.709, P = 0.033), lateral neck dissection (LND) (OR 3.197, 95% CI 1.742-5.852, P < 0.001), and ultrasound risk score (central lymph node involvement: OR 4.013, 95% CI 2.559-6.323, P < 0.001; lateral lymph node involvement: OR 3.387, 95% CI 1.700-6.825, P < 0.001; primary nodule only: OR 1.899, 95% CI 1.119-3.198, P = 0.016). For hypoparathyroidism, independent predictors were preoperative calcium (per 0.1 mmol/L: OR 0.417, 95% CI 0.330-0.519, P < 0.001) and ultrasound risk score (central lymph node involvement: OR 3.388, 95% CI 2.137-5.360, P < 0.001; lateral lymph node involvement: OR 3.468, 95% CI 1.712-7.218, P<0.001; primary nodule only: OR 1.677, 95% CI 0.942-2.926, P = 0.073). The hypocalcemia model showed good discrimination (AUC 0.836, 95% CI 0.810-0.861), as did the hypoparathyroidism model (AUC 0.768, 95% CI 0.752-0.816).

Conclusions: Simple models integrating preoperative calcium, surgical extent, and ultrasound findings effectively predict early postoperative hypocalcemia and hypoparathyroidism in PTC patients undergoing total or subtotal/near-total, which may assist in preoperative risk stratification and guide prophylactic management.

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Cite

BibTeXRIS
BibTeX
@article{zhou2026prediction,
  title = {{Prediction of early postoperative hypocalcemia and hypoparathyroidism after thyroidectomy for papillary thyroid carcinoma: dual-outcome prediction models}},
  author = {Cuiping Zhou and Qian Chen and Shuyan Liu and Nuoxuan Niu and Xinyu Ban and Shiyang Wang and Jinfeng Yan and Ying Bi and Jing Liu and Jie Liu and Yanxia Bai},
  journal = {Frontiers in endocrinology},
  year = {2026},
  month = sep,
  doi = {10.3389/fendo.2026.1887201},
  url = {https://europepmc.org/article/PMC/PMC13661344},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Prediction of early postoperative hypocalcemia and hypoparathyroidism after thyroidectomy for papillary thyroid carcinoma: dual-outcome prediction models
AU  - Cuiping Zhou
AU  - Qian Chen
AU  - Shuyan Liu
AU  - Nuoxuan Niu
AU  - Xinyu Ban
AU  - Shiyang Wang
AU  - Jinfeng Yan
AU  - Ying Bi
AU  - Jing Liu
AU  - Jie Liu
AU  - Yanxia Bai
PY  - 2026
DA  - 2026/09/30
JO  - Frontiers in endocrinology
DO  - 10.3389/fendo.2026.1887201
UR  - https://europepmc.org/article/PMC/PMC13661344
AB  - Background: Postoperative hypocalcemia and hypoparathyroidism are two common complications after total or subtotal/near-total for papillary thyroid carcinoma (PTC). This study aimed to identify significant predictors of early postoperative hypocalcemia and hypoparathyroidism and develop prediction nomograms for risk stratification in PTC patients.  Methods: A total of 1036 PTC patients who underwent total or subtotal/near-total thyroidectomy were retrospectively enrolled. Multivariable logistic regression with prespecified variables was performed to identify independent predictors for two outcomes: (1) early postoperative hypocalcemia, and (2) hypoparathyroidism. Nomograms were constructed for each outcome. Model performance was assessed by area under the receiver operating characteristic curve (AUC), calibration plots and decision curve analysis (DCA). Bootstrap internal validation (500 resamples) was used to correct for optimism.  Results: Among 1,036 patients, 325 (31.4%) developed early postoperative hypocalcemia, and 228 (22.0%) met criteria for hypoparathyroidism. For hypocalcemia, independent predictors were preoperative calcium (per 0.1 mmol/L: OR 0.298, 95% CI 0.234-0.374, P < 0.001), thyroidectomy extent (subtotal vs. total: OR 0.75, 95% CI 0.025-0.709, P = 0.033), lateral neck dissection (LND) (OR 3.197, 95% CI 1.742-5.852, P < 0.001), and ultrasound risk score (central lymph node involvement: OR 4.013, 95% CI 2.559-6.323, P < 0.001; lateral lymph node involvement: OR 3.387, 95% CI 1.700-6.825, P < 0.001; primary nodule only: OR 1.899, 95% CI 1.119-3.198, P = 0.016). For hypoparathyroidism, independent predictors were preoperative calcium (per 0.1 mmol/L: OR 0.417, 95% CI 0.330-0.519, P < 0.001) and ultrasound risk score (central lymph node involvement: OR 3.388, 95% CI 2.137-5.360, P < 0.001; lateral lymph node involvement: OR 3.468, 95% CI 1.712-7.218, P<0.001; primary nodule only: OR 1.677, 95% CI 0.942-2.926, P = 0.073). The hypocalcemia model showed good discrimination (AUC 0.836, 95% CI 0.810-0.861), as did the hypoparathyroidism model (AUC 0.768, 95% CI 0.752-0.816).  Conclusions: Simple models integrating preoperative calcium, surgical extent, and ultrasound findings effectively predict early postoperative hypocalcemia and hypoparathyroidism in PTC patients undergoing total or subtotal/near-total, which may assist in preoperative risk stratification and guide prophylactic management.
SN  - 1664-2392
ER  -