ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1628453
Development and Validation of a Nomogram for Predicting Postoperative Hypocalcemia in Patients Undergoing Surgery for Differentiated Thyroid Cancer
Provisionally accepted
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Objective: This study aimed to identify risk factors for hypocalcemia following differentiated thyroid cancer (DTC) surgery and develop and validate a nomogram model to predict its occurrence. Methods: A retrospective cohort study included 315 DTC patients who underwent surgery between January 2023 and January 2025. Clinical data encompassing demographics, surgical parameters (e.g., central lymph node dissection, capsular invasion, operation time), comorbidities (e.g., diabetes), and preoperative biomarkers (albumin, Lp-PLA2, Nesfatin-1) were analyzed. Variables were screened using univariate analysis, followed by multivariate logistic regression with a backward stepwise selection procedure to identify independent predictors. A nomogram was constructed using RStudio (version 3.4), and its performance was assessed for discrimination and calibration. Internal validation was performed using a bootstrapping technique. Results: Postoperative hypocalcemia occurred in 32.06% of patients (101/315). Multivariate analysis identified diabetes (OR=2.1, 95%CI: 1.4–3.3), central lymph node dissection (OR=3.4, 95%CI: 2.1–5.6), capsular invasion (OR=2.8, 95%CI: 1.7–4.7), prolonged operation time (OR=1.9, 95%CI: 1.3–3.0), elevated preoperative albumin (OR=1.7, 95%CI: 1.2–2.5), and Lp-PLA2 (OR=2.3, 95%CI: 1.5–3.7) as significant risk factors. Serum Nesfatin-1 emerged as a protective factor (OR=0.6, 95%CI: 0.4–0.9). The nomogram demonstrated excellent discrimination, with an area under the curve (AUC) of 0.850 (95%CI: 0.825–0.930), which remained robust after bootstrap validation (bias-corrected AUC = 0.845). The model showed good calibration, confirmed by a calibration plot and the Hosmer-Lemeshow test (P=0.30). Decision curve analysis indicated a strong clinical utility. Conclusion: This study developed and internally validated a nomogram integrating clinical, surgical, and biochemical predictors to quantify individualized risk of hypocalcemia after DTC surgery. The model shows robust predictive accuracy, offering clinicians a practical tool for preoperative risk stratification and targeted interventions. However, external validation in multicenter cohorts is necessary to enhance generalizability.
Keywords: Hypocalcemia, Thyroid Neoplasms, Risk factors, Nomograms, Postoperative Complications
Received: 14 May 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Zhou, Tu, Qin, Zhang, Ba and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ping Wang, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.