Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism

Mayer, A W; Sharp, Abigail; Aziz, Shaniar; Balasubramanian, Saba

doi:10.1017/s002221512300035x

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…Likewise, it seemed like Graves’ disease and heavy specimen weight also were associated with an increased risk of permanent hypoPT, although not statistically significant. Other studies have found the same risk factors to be associated with an increased risk of hypoPT ( 1 , 2 , 13 , 16 , 18 , 37 ), and the lack of statistical significance in our study may be due to the small population size.…”

Section: Discussioncontrasting

confidence: 73%

“…In contrast, the definition based on active vitamin D treatment reflects a more severe immediate hypoPT. Another potential explanation for the low rate of recovery following PG damage could be the low PG identification rate (61.2%) and the high proportions of patients experiencing PG autotransplantation (19.1%) and inadvertent PG excision (21.3%), as all these events are associated with an increased risk of hypoPT ( 1 , 2 , 18 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

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Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution

Abood,

Ovesen,

Rolighed

et al. 2024

Front. Endocrinol.

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BackgroundHypoparathyroidism following total thyroidectomy is globally the most common complication to thyroid surgery. The reported complication rates vary widely and might be highly dependent on the surgical experience. In this study we aimed to evaluate the rate of hypoparathyroidism following primary total thyroidectomy at a low-volume institution that only performs thyroid surgery and does not have any experience with parathyroid surgery.MethodsRetrospective cohort study. All patients undergoing primary total thyroidectomy at the ENT-Department, Goedstrup Hospital, Denmark, over a 5-year period (2016-2020) were identified through the procedure codes for total thyroidectomy. Medical records, pathology reports, biochemical and medical histories were fully assessed for each patient. The primary endpoint was the rate of hypoparathyroidism- both immediate and permanent. Secondary outcomes were parathyroid gland identification rates, rates of parathyroid gland autotransplantation, and rates of inadvertent parathyroid gland excision.ResultsA total of 89 patients were included in the final analysis. A total of 33 patients (37.1%) experienced immediate hypoparathyroidism following surgery, while 30 patients (33.7%) still were on active vitamin D two months postoperatively. One year following surgery, 28 patients (31.5%) were still on active vitamin D and were considered as having permanent hypoparathyroidism. Sixty-one percent of the parathyroid glands were identified intraoperatively, and 19% of the patients experienced parathyroid autotransplantation. Inadvertent parathyroid gland excision occurred for 21% of the patients and was associated with a significantly increased risk of permanent hypoparathyroidism (RR = 2.99; 95% CI: 1.36 – 6.62, p = 0.005).ConclusionBoth transient and permanent hypoparathyroidism following total thyroidectomy at a low-volume, non-parathyroid institution occurred with much higher frequencies than previously reported. The elevated rates were most likely due to the low-volume, non-parathyroid nature of the surgeons which in part was mirrored in low parathyroid gland identifications rates, and high rates of autotransplantation and inadvertent parathyroid gland excision.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution

Abood,

Ovesen,

Rolighed

et al. 2024

Front. Endocrinol.

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Incidence of post-surgical hypoparathyroidism (POSH) after total thyroidectomy

Roberts,

El-Shikh,

Alam

et al. 2023

British Journal of Oral and Maxillofacial Surgery

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Autofluorescence-guided hemithyroidectomy in a low-volume thyroid institution with no experience in parathyroid surgery: randomized clinical trial

Abood,

Rolighed,

Ovesen

et al. 2024

British Journal of Surgery

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Background Recent studies suggest that low-volume surgeons with no experience in parathyroid surgery are at increased risk of causing parathyroid gland damage during thyroid surgery. The aim of this RCT was to evaluate the impact of using autofluorescence in hemithyroidectomy on parathyroid gland identification and preservation in a low-volume institution with no experience in parathyroid surgery. Methods Patients referred for hemithyroidectomy were randomized 1 : 1 to either autofluorescence-guided hemithyroidectomy (the near-infrared autofluorescence group) or conventional hemithyroidectomy (the control group). The primary outcome was parathyroid gland identification rate. Secondary outcomes were the rate of parathyroid gland autotransplantation and the rate of inadvertent parathyroid gland excision. Results A total of 170 patients were randomized to either autofluorescence-guided hemithyroidectomy (84 patients) or conventional hemithyroidectomy (86 patients). In the near-infrared autofluorescence group, 81.0% of parathyroid glands were identified, compared with 57.0% in the control group (P < 0.001). Autofluorescence enabled parathyroid gland visualization before the naked eye in 46.3% of cases. Surgeons had lower confidence in the parathyroid gland identification process in the control group than in the near-infrared autofluorescence group (59.1% versus 87.5% respectively; P < 0.001). In the near-infrared autofluorescence group, the parathyroid gland autotransplantation rate was initially high, but declined over time. There was no difference in the rate of inadvertent parathyroid gland excision. Conclusion Autofluorescence guidance significantly improved the parathyroid gland identification rate in hemithyroidectomy in a low-volume institution with no experience in parathyroid surgery and provided an increase in surgical confidence. The pattern of parathyroid gland autotransplantation in autofluorescence-guided surgery indicates the presence of a learning curve. Registration number NCT05044351 (http://www.clinicaltrials.gov).

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Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism

Cited by 3 publications

References 33 publications

Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution

Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution

Incidence of post-surgical hypoparathyroidism (POSH) after total thyroidectomy

Autofluorescence-guided hemithyroidectomy in a low-volume thyroid institution with no experience in parathyroid surgery: randomized clinical trial

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