Hypoparathyroidism After Total Thyroidectomy: Importance of the Intraoperative Management of the Parathyroid Glands

Abstract

Background Total thyroidectomy is the most common surgical procedure for the treatment of thyroid diseases. Postoperative hypocalcemia/hypoparathyroidism is the most frequent complication after total thyroidectomy. The aim of this study was to evaluate the rate of postoperative hypocalcemia and permanent hypoparathyroidism after total thyroidectomy in order to identify potential risk factors and to evaluate the impact of parathyroid autotransplantation. Patients and MethodsWe performed a retrospective analysis of 1018 patients who underwent total thyroidectomy at our institution between 2000 and 2016. Medical records were reviewed to analyze patient features, clinical presentation, management and postoperative complications. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Statistical significance was set at p B 0.05. Results Mean ± SD age was 46.79 ± 15.9 years; 112 (11.7%) were males and 844 (88.3%) females. A total of 642 (67.2%) patients underwent surgery for malignant disease. The rate of postoperative hypocalcemia, transient, protracted and permanent hypoparathyroidism was 32.8%, 14.43%, 18.4% and 3.9%, respectively. Permanent hypoparathyroidism was significantly associated with the number of parathyroid glands remaining in situ (4 glands: 2.5%, 3 glands: 3.8%, 1-2 glands: 13.3%; p \ 0.0001) [OR for 1-2 glands in situ = 5.32, CI 95% 2.61-10.82]. Other risk factors related to permanent hypoparathyroidism were obesity (OR 3.56,, concomitant level VI lymph node dissection (OR 3.04, CI 95% 1.46-6.37) and incidental parathyroidectomy without autotransplantation (OR 3.6, CI 95% 1.85-7.02). Conclusions Identification and in situ preservation of at least three parathyroid glands were associated with a lower rate of postoperative hypocalcemia (30.4%) and permanent postoperative hypoparathyroidism (2.79%).

The Effect of Parathyroid Gland Autotransplantation on Hypoparathyroidism After Thyroid Surgery for Papillary Thyroid Carcinoma

“…Patients with three or more ISPGs scarcely underwent permanent hypoparathyroidism, nor did patients with 3 or more APGs. 3 , 31 …”

“…1,2 Among the complications of thyroid surgery, postoperative hypoparathyroidism was the most common. 3,4 The incidence of transient hypoparathyroidism ranged from 10.8% to 64.4%, and the incidence of permanent hypoparathyroidism varied from 0 to 31.1% across different researches. [5][6][7][8] Hypoparathyroidism was the consequence of the reduction of the functional parathyroid parenchyma for mechanical or thermal trauma, devascularization, and inadvertent resection.…”

“…Patients with three or more ISPGs scarcely underwent permanent hypoparathyroidism, nor did patients with 3 or more APGs. 3,31 It was also controversial whether the parathyroid gland with potential injury of blood supply (parathyroid gland with some degree of discolored) should be preserved in site or autotransplanted. Su et al and Lorente-Poch et al indicated that when three parathyroid glands were preserved in site, the fourth parathyroid gland did not significantly affect the incidence of permanent hypoparathyroidism regardless of whether it was preserved in site or autotransplanted.…”

The inferior parathyroid glands preserved in site recover faster than the superior parathyroid glands preserved in site after thyroid surgery for carcinoma

“…Ponce de Leon-Ballesteros and his colleagues discovered that 3 or more PGs should be preserved in site to decrease the risk of permanent hypoparathyroidism. [ 30 ] And de Jong et al and Lorente-Poch et al believed that the more the PGs were preserved in site, the lower the incidence of permanent hypoparathyroidism was. [ 31 , 32 ] However, several other studies suggested that autotransplantation of 2 or more PGs could prevent permanent hypoparathyroidism.…”

Relationship between the extent of central node dissection and parathyroid function preservation in thyroid cancer surgery

“…Hypocalcemia following operation for differentiated thyroid carcinoma (DTC) remains one of the most common postoperative complications, it may prolong hospitalization and require medical intervention (1). A series of studies have reported incidences of 20-80% (2,3).…”