{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:22:01Z","timestamp":1789730521432,"version":"4.0.1"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"\n Importance<\/jats:title>\n A greater proportion of older patients (age \u226565 years) are undergoing thyroidectomy amidst an aging population. Given the elusive results in the literature, clarifying whether older patients face different thyroidectomy safety profiles is crucial for optimizing risk assessment and patient counseling.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between older age (age \u226565 years) and thyroidectomy safety by comparing endocrine-related complications, including recurrent laryngeal nerve injury, hypocalcemia, hematoma, and mortality in older compared with younger patients.<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n Ovid MEDLINE, CINAHL, Ovid Embase, and the Cochrane Library were systematically searched from inception to May 29, 2025; only English-language studies were included.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Cohort studies comparing thyroidectomy outcomes between older and younger patients and reporting endocrine-related complications were included. Two independent reviewers screened abstracts and full texts. Of 3192 studies identified, 11 met inclusion criteria.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n Two independent reviewers extracted data following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias across studies was evaluated using the ROBINS-I (Risk of Bias in Nonrandomized Studies of Interventions) tool. Random-effects models were used to pool data.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Incidence of recurrent laryngeal nerve injury, hypocalcemia, and hematoma; odds ratios (ORs) with 95% CIs were calculated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The analysis included 11 studies with a total of 427\u202f886 patients of whom 104\u202f232 (24.4%) were older adults (\u226565 years). Older adults had greater odds of overall recurrent laryngeal nerve injury (2.3% vs 1.0%; OR, 1.58; 95% CI, 1.15-2.16;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200976%), hematoma (2.4% vs 1.0%; OR, 2.32; 95% CI, 1.70-3.16;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090%), and mortality at last follow-up (0.3% vs 0.01%; OR, 11.09; 95% CI, 1.77-69.52;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200990%) compared with younger patients. However, rates of overall hypocalcemia (OR, 0.80; 95% CI, 0.61-1.05;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200971%) and wound complications (OR, 1.38; 95% CI, 0.92-2.06;\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090%) were similar.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This systematic review and meta-analysis found that thyroidectomy is safe in older patients, with only small absolute increases in recurrent laryngeal nerve injury, hematoma, and mortality despite statistical significance. These findings support individualized counseling and perioperative planning while acknowledging the overall safety of thyroidectomy in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoto.2025.5345","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T16:30:30Z","timestamp":1770309030000},"page":"357","source":"Crossref","is-referenced-by-count":4,"title":["Thyroidectomy Outcomes in Older Adults"],"prefix":"10.1001","volume":"152","author":[{"given":"Ahmed","family":"Ghani","sequence":"first","affiliation":[{"name":"School of Medicine, University College Dublin, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah R.","family":"Ayesh","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nicosia, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harisanth","family":"Rajaram","sequence":"additional","affiliation":[{"name":"Royal Berkshire NHS Foundation Trust, Reading, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherwin M.","family":"Ganegoda","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios","family":"Alogakos","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nicosia, Nicosia, Cyprus"},{"name":"School of Medicine, St George\u2019s University of London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alma","family":"Sato","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Nicosia, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Hage","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian A.","family":"Than","sequence":"additional","affiliation":[{"name":"Cambridge University Hospitals NHS Foundation Trust, Cambridgeshire, United Kingdom"},{"name":"School of Biomedical Sciences, The University of Queensland, St Lucia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Nakanishi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Romero-Velez","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Integrated Surgical Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"3","key":"ooi250097r1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003735","article-title":"The American Association of Endocrine Surgeons guidelines for the definitive surgical management of thyroid disease in adults.","volume":"271","author":"Patel","year":"2020","journal-title":"Ann Surg"},{"key":"ooi250097r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2024.02.037","article-title":"Clinical outcomes of outpatient thyroidectomy: a systematic review and single-arm meta-analysis.","volume":"236","author":"Nakanishi","year":"2024","journal-title":"Am J Surg"},{"issue":"4","key":"ooi250097r4","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.jviscsurg.2013.04.003","article-title":"Complications after total thyroidectomy.","volume":"150","author":"Christou","year":"2013","journal-title":"J Visc Surg"},{"issue":"11","key":"ooi250097r6","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1001\/archsurg.137.11.1243","article-title":"Thyroid surgery in the geriatric patient.","volume":"137","author":"Passler","year":"2002","journal-title":"Arch Surg"},{"issue":"1","key":"ooi250097r7","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.surg.2023.02.003","article-title":"Thyroid surgery outcomes in octogenarians: a national analysis.","volume":"174","author":"Sakowitz","year":"2023","journal-title":"Surgery"},{"key":"ooi250097r8","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.2147\/CIA.S107881","article-title":"Comparative clinicopathological and outcome analysis of differentiated thyroid cancer in Saudi patients aged below 60 years and above 60 years.","volume":"11","author":"Al-Qahtani","year":"2016","journal-title":"Clin Interv Aging"},{"issue":"11","key":"ooi250097r9","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1093\/jjco\/hyu132","article-title":"Clinicopathologic characteristics and surgical outcomes of elderly patients with thyroid cancer.","volume":"44","author":"Park","year":"2014","journal-title":"Jpn J Clin Oncol"},{"issue":"2","key":"ooi250097r10","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s13304-011-0060-0","article-title":"Features of papillary thyroid carcinoma in patients older than 75 years.","volume":"63","author":"Toniato","year":"2011","journal-title":"Updates Surg"},{"issue":"4","key":"ooi250097r11","first-page":"172","article-title":"Operative mortality with elective surgery in older adults.","volume":"4","author":"Finlayson","year":"2001","journal-title":"Eff Clin Pract"},{"issue":"3","key":"ooi250097r12","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.surg.2012.06.038","article-title":"Advanced age is an independent predictor for increased morbidity and mortality after emergent surgery for diverticulitis.","volume":"152","author":"Lidsky","year":"2012","journal-title":"Surgery"},{"key":"ooi250097r13","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.jss.2018.03.057","article-title":"Thyroidectomy in older adults: an American College of Surgeons National Surgical Quality Improvement Program study of outcomes.","volume":"229","author":"Sahli","year":"2018","journal-title":"J Surg Res"},{"issue":"5","key":"ooi250097r14","first-page":"465","article-title":"Perioperative care in older adults.","volume":"12","author":"Baquero","year":"2015","journal-title":"J Geriatr Cardiol"},{"issue":"3","key":"ooi250097r15","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.otot.2020.07.005","article-title":"Thyroid surgery in the elderly.","volume":"31","author":"Ruszkay","year":"2020","journal-title":"Oper Tech Otolaryngol\u2013Head Neck Surg"},{"issue":"5","key":"ooi250097r16","doi-asserted-by":"publisher","first-page":"587","DOI":"10.21037\/gs.2017.10.01","article-title":"Thyroidectomy in elderly patients aged =70 years.","volume":"6","author":"Inversini","year":"2017","journal-title":"Gland Surg"},{"issue":"7","key":"ooi250097r17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"ooi250097r18","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"issue":"4","key":"ooi250097r19","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.","volume":"64","author":"Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"issue":"10","key":"ooi250097r20","doi-asserted-by":"publisher","first-page":"879","DOI":"10.28982\/josam.738466","article-title":"Comparative outcomes of thyroid surgery in elderly patients: a retrospective cohort study.","volume":"4","author":"Atas","year":"2020","journal-title":"Journal of Surgery and Medicine"},{"issue":"5","key":"ooi250097r21","doi-asserted-by":"publisher","first-page":"389","DOI":"10.2298\/VSP220319054K","article-title":"Short-stay thyroid surgery for older patients: is it safe?.","volume":"80","author":"Kalezic","year":"2023","journal-title":"Pharmaceutical Journal of Serbia"},{"issue":"3","key":"ooi250097r22","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1007\/s00423-004-0521-8","article-title":"Surgical treatment for multinodular goitres in geriatric patients.","volume":"390","author":"R\u00edos","year":"2005","journal-title":"Langenbecks Arch Surg"},{"issue":"5","key":"ooi250097r23","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1159\/000351197","article-title":"Thyroid surgery in the elderly.","volume":"59","author":"Schwartz","year":"2013","journal-title":"Gerontology"},{"key":"ooi250097r24","doi-asserted-by":"publisher","first-page":"S159","DOI":"10.1016\/j.ijsu.2016.07.001","article-title":"Differentiated thyroid cancer in patients =75 years: histopathological features and results of surgical treatment.","volume":"33","author":"Longheu","year":"2016","journal-title":"Int J Surg"},{"issue":"1","key":"ooi250097r25","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1007\/s00423-023-02982-6","article-title":"Thyroid surgery in the elderly: a surgical cohort.","volume":"408","author":"Van den Eynde","year":"2023","journal-title":"Langenbecks Arch Surg"},{"key":"ooi250097r26","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1016\/j.ijsu.2014.08.386","article-title":"Total thyroidectomy in geriatric patients: a retrospective study.","volume":"12","author":"Tartaglia","year":"2014","journal-title":"Int J Surg"},{"issue":"7414","key":"ooi250097r27","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses.","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"issue":"10","key":"ooi250097r28","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/S0895-4356(01)00377-8","article-title":"Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis.","volume":"54","author":"Sterne","year":"2001","journal-title":"J Clin Epidemiol"},{"issue":"2","key":"ooi250097r29","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/j.0006-341X.2000.00455.x","article-title":"Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"issue":"5","key":"ooi250097r31","doi-asserted-by":"publisher","first-page":"523","DOI":"10.9738\/INTSURG-D-14-00030.1","article-title":"Thyroid surgery in the elderly: a comparative experience of 400 patients from an Italian university hospital.","volume":"99","author":"Canonico","year":"2014","journal-title":"Int Surg"},{"issue":"47","key":"ooi250097r32","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000005450","article-title":"Prognosis of papillary thyroid carcinoma in elderly patients after thyroid resection: a retrospective cohort analysis.","volume":"95","author":"Chereau","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"3","key":"ooi250097r33","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1177\/0194599818825455","article-title":"Age-related trends of patients undergoing thyroidectomy: analysis of US inpatient data from 2005 to 2013.","volume":"160","author":"Echanique","year":"2019","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"6","key":"ooi250097r34","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.1007\/s00268-020-05422-4","article-title":"Frailty is more predictive than age for complications after thyroidectomy for multinodular goiter.","volume":"44","author":"Finnerty","year":"2020","journal-title":"World J Surg"},{"issue":"2","key":"ooi250097r35","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1002\/ca.22804","article-title":"The effect of aging on the anatomic position of the thyroid gland.","volume":"30","author":"Bann","year":"2017","journal-title":"Clin Anat"},{"issue":"2","key":"ooi250097r36","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1097\/BRS.0b013e31816044e8","article-title":"Quantifying the effects of age, gender, degeneration, and adjacent level degeneration on cervical spine range of motion using multivariate analyses.","volume":"33","author":"Simpson","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"issue":"8","key":"ooi250097r37","doi-asserted-by":"publisher","first-page":"3209","DOI":"10.1007\/s00423-022-02651-0","article-title":"Intra-operative nerve monitoring and recurrent laryngeal nerve injury during thyroid surgery: a network meta-analysis of prospective studies.","volume":"407","author":"Cleere","year":"2022","journal-title":"Langenbecks Arch Surg"},{"issue":"4","key":"ooi250097r38","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1111\/j.1529-8027.2000.00026.x","article-title":"Influence of aging on peripheral nerve function and regeneration.","volume":"5","author":"Verd\u00fa","year":"2000","journal-title":"J Peripher Nerv Syst"},{"issue":"3","key":"ooi250097r39","first-page":"144","article-title":"Identification of patients at high risk for hypocalcemia after total thyroidectomy.","volume":"31","author":"Tredici","year":"2011","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"ooi250097r40","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2025.109598","article-title":"Clinical impact of obesity on thyroidectomy outcomes: a systematic review and meta-analysis.","volume":"186","author":"Ghani","year":"2025","journal-title":"Surgery"},{"issue":"9868","key":"ooi250097r41","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people.","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet"},{"issue":"1","key":"ooi250097r42","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s40463-020-00450-5","article-title":"Impact of frailty on inpatient outcomes in thyroid cancer surgery: 10-year results from the US national inpatient sample.","volume":"49","author":"Xu","year":"2020","journal-title":"J Otolaryngol Head Neck Surg"},{"issue":"4","key":"ooi250097r43","first-page":"313","article-title":"The problems of vitamin D insufficiency in older people.","volume":"3","author":"Boucher","year":"2012","journal-title":"Aging Dis"},{"issue":"4","key":"ooi250097r44","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1002\/bjs.9384","article-title":"Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia.","volume":"101","author":"Edafe","year":"2014","journal-title":"Br J Surg"},{"key":"ooi250097r45","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2024.109142","article-title":"Postoperative and permanent hypocalcemia after indocyanine green (ICG) angiography-guided total thyroidectomy and central neck dissection: a retrospective cohort study.","volume":"181","author":"Moreno Llorente","year":"2025","journal-title":"Surgery"},{"issue":"5","key":"ooi250097r46","doi-asserted-by":"publisher","first-page":"505","DOI":"10.3390\/diagnostics14050505","article-title":"Lower rates of hypocalcemia following near-infrared autofluorescence use in thyroidectomy: a meta-analysis of RCTs.","volume":"14","author":"Rao","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"ooi250097r47","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/j.jss.2020.11.081","article-title":"Predictors and consequences of hematoma after thyroidectomy: an American College of Surgeons National Surgical Quality Improvement Program database analysis.","volume":"260","author":"Mahoney","year":"2021","journal-title":"J Surg Res"},{"key":"ooi250097r2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/978-3-319-72102-6_1","volume-title":"The Thyroid and Its Diseases: A Comprehensive Guide for the Clinician","author":"Stathatos","year":"2019"},{"key":"ooi250097r5","author":"Colby","year":"2015"},{"key":"ooi250097r30","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2020","edition":"Second ed"}],"container-title":["JAMA Otolaryngology\u2013Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2844562\/jamaotolaryngology_ghani_2026_oi_250097_1775660470.54881.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T15:00:35Z","timestamp":1775746835000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2844562"}},"subtitle":["A Systematic Review and Meta-Analysis"],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2025.5345","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}