Dissection and identification of parathyroid glands during thyroidectomy: Association with hypocalcemia

Praženica, Pavol; O'Keeffe, Leonard; Holý, Richard

doi:10.1002/hed.23613

Cited by 46 publications

(47 citation statements)

References 27 publications

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“…Previous studies have variably identified younger age [14, 19, 23], female sex [4, 9, 14], Hashimoto thyroiditis [18, 22], and malignancy [13, 15, 16, 19, 23, 30] as potential risk factors for IPT. Of notice, Sakorafas and Gourgiotis reported lower rates of IPT in patients with malignancy, owing probably to more meticulous dissection in cases of suspected malignancy [4, 10].…”

Section: Discussionmentioning

confidence: 99%

Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences

Manatakis

Balalis

Soulou

et al. 2016

International Journal of Endocrinology

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Objective. To evaluate the incidence of accidental parathyroidectomy in our series of total thyroidectomies, to investigate its clinical and biochemical consequences, and to identify potential risk factors. Methods. Patients who underwent total thyroidectomy between January 2006 and December 2015 were retrospectively analyzed. Pathology reports were reviewed to identify those cases who had an incidental parathyroidectomy and these were compared to patients with no parathyroidectomy, in terms of clinical (age, sex, and symptoms of hypocalcemia), pathological (thyroid specimen weight, Hashimoto thyroiditis, and malignancy), and biochemical (serum calcium and phosphate levels) factors. Results. 281 patients underwent total thyroidectomy during the study period. Incidental parathyroidectomy was noticed in 24.9% of cases, with 44.3% of parathyroid glands found in an intrathyroidal location. Evidence of postoperative biochemical hypocalcemia was noticed in 28.6% of patients with parathyroidectomy, compared with 13.3% in the no-parathyroidectomy group (p = 0.003). Symptomatic hypocalcemia was observed in 5.7% and 3.8%, respectively (p = 0.49). Age, sex, thyroid specimen weight, Hashimoto thyroiditis, and malignancy did not differ significantly between the two groups. Conclusions. Our study found an association of incidental parathyroidectomy with transient postoperative biochemical hypocalcemia, but not with clinically symptomatic disease. Age, sex, thyroid gland weight, Hashimoto thyroiditis, and malignancy were not identified as risk factors.

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Section: Discussionmentioning

confidence: 99%

Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences

Manatakis

Balalis

Soulou

et al. 2016

International Journal of Endocrinology

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“…In addition, the effort for this cause increases the possibility of postoperative transient hypocalcemia (28,29). Ideally, these glands should be preserved in their place without compromising vascularization.…”

Section: Discussionmentioning

confidence: 99%

The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy

Oran

Yetkın

Mihmanlı

et al. 2016

UCD

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Objective: Thyroidectomy is the most common cause of hypocalcemia. Preservation of parathyroid glands in situ is essential in preventing this complication. The aims of our study were to review patients who underwent parathyroid gland autotransplantation during thyroidectomy, and to compare hypocalcemia rates in patients with and without autotransplantation. Material and Methods:Parathyroid gland autotransplantation was performed in 43 (7.9%) of 543 patients who underwent thyroidectomy between 2008 and 2012.Results: Forty-four parathyroid glands were autotransplanted in 43 patients, including 36 women and 7 men. The median age was 55 (range: 30 to 68). The most common cause of autotransplantation was vascular comprise of the parathyroid gland. Early postoperative hypocalcemia developed in 37% of patients with autotransplantation, and none developed permanent hypocalcemia. Transient and permanent hypocalcemia rates were 9.6% and 0.4% in patients without autotransplantation, respectively. The risk of transient hypocalcemia was significantly high in patients with parathyroid autotransplantation (p<0.001). There was no difference between the two groups in terms of permanent hypocalcemia (p=0.156). Conclusion:Despite meticulous dissection, parathyroid glands can be devascularized or removed inadvertently during thyroidectomy. Parathyroid autotransplantation is the best method to maintain parathyroid gland function. Although the risk of transient hypocalcemia is increased following parathyroid autotransplantation, long-term results are satisfactory. INTRODUCTIONThyroid surgery is the most frequently performed operation in general surgery clinics, and constitute 1% of all medical diseases (1). The second most feared complication of thyroid surgery, following recurrent laryngeal nerve (RLN) injury, is the development of hypocalcemia. The most common cause of hypocalcemia is post-surgery hypoparathyroidism (2). Hypocalcemia may develop in the immediate postoperative period and may improve in several weeks (transient hypocalcemia), or it may persist for more than 6 months after surgery, in which case is called permanent hypocalcemia. Hypocalcemia manifests with paresthesia, mental status changes, neuromuscular irritability, and muscle spasm. Chronic hypocalcemia can lead to cataract formation, calcification in the cerebellum and basal ganglia, peripheral neuropathy, and cardiac problems. These patients require lifelong calcium and vitamin D supplements.

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“…Some papers have suggested the use of these devices may have an effect on parathyroid function, although no conclusive papers were found to date [18]. Intraoperative factors that have been shown in some series to be associated with increased risk of hypocalcaemia include: number of parathyroids identifies; parathyroids removed; autotransplantation of parathyroid tissue; and longer operative time [4,8,12,14]. Autotransplantation in particular is controversial with recently published papers suggesting it is either protective for parathyroid function or futile [12,19,20].…”

Section: Factors Not Included In the Analysismentioning

confidence: 94%

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

Harris

Prades

Ткачук

et al. 2016

Eur Arch Otorhinolaryngol

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Hypocalcaemia is the most common complication following thyroidectomy. This study aimed to establish the factors associated with increased risk of hypocalcaemia on day 1 following thyroidectomy. All patients who underwent thyroidectomy under a single consultant during a 5-year period were included. A multivariate analysis was undertaken to ascertain which variables had the most effect on the risk of hypocalcaemia. A prognosis table was constructed to allow risk to be predicted for individual patients based on these factors. Included in the analysis were 210 procedures and 194 patients. Eighty-two percent of patients had no calcium derangement postoperatively. Fourteen point nine percent were categorised as early hypocalcaemia, 1 % had protracted hypocalcaemia and 2.1 % had permanent hypocalcaemia. For hemi-thyroidectomies 2.8 % had postoperative hypocalcaemia and 0.9 % had permanent hypocalcaemia. The multivariate analysis revealed total thyroidectomy (risk ratio 26.5, p < 0.0001), diabetes (risk ratio 4.8, p = 0.07) and thyrotoxicosis (risk ratio 3.1, p = 0.04) as statistically significant variables for early postoperative hypocalcaemia. Gender as an isolated factor did not reach significance but was included in the model. The p value for the model was p < 1 × 10. Total thyroidectomy increases risk of early hypocalcaemia when compared to hemithyroidectomy. Gender, diabetes and thyrotoxicosis were also been found to influence the risk. All of these factors are available pre-operatively and can therefore be used to predict a more specific risk for individual patients. It is hoped that this can lead to better informed consent, prevention and better resource allocation.

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Dissection and identification of parathyroid glands during thyroidectomy: Association with hypocalcemia

Abstract: Identification of a higher number of parathyroid glands is associated with a higher incidence of postoperative temporary hypocalcemia and permanent hypoparathyroidism.

Cited by 46 publications

References 27 publications

Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences

Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences

The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

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