Incidental parathyroidectomy during thyroid surgery: risk factors, incidence, and outcomes

Özoğul, Bünyami; Akçay, Müfide Nuran; Kısaoğlu, Abdullah; Atamanalp, Sabri Selçuk; Öztürk, Gürkan; Aydınlı, Bülent

doi:10.3906/sag-1211-56

Cited by 15 publications

(9 citation statements)

References 41 publications

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“…Thyroid surgeries of the present study were performed by experienced surgeons who do at least 50 thyroidectomies a year, and incidental parathyroidectomy rate is estimated at 13.4%, within the rates cited in the literature. In a study performed by Özoğul et al, it was reported that the risk of incidental parathyroidectomy and related postoperative hypocalcemia was higher in thyroidectomies performed because of presence of malignancy and in patients who had undergone neck dissection in compliance with oncological principles [3, 7]. In the same study, a statistically significant correlation was detected between incidental parathyroidectomy, and hypocalcemia.…”

Section: Discussionmentioning

confidence: 93%

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Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy

Özemir

Buldanlı

Yener

et al. 2016

North Clin Istanbul

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OBJECTIVE:The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia.METHODS:Patients who underwent thyroidectomy at İstanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who were found to have hypocalcemia (calcium ≤8.5 mg/dL) according to postoperative serum level and normocalcemic patients were placed in Group 2. Groups were compared statistically in terms of rate of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism.RESULTS:Mean age was 49.8±12.8 years (range: 20-88). A total of 417 patients were included in the study, 74 (17.7%) were male and 343 (82.3%) were female. Group 1 consisted of 205 (49.2%) patients who had hypocalcemia according to postoperative serum level, and remaining 212 (50.8%) patients were placed in Group 2. In Group 1, 38 (18.5%) patients had incidental parathyroidectomy, and with only 18 (8.5%) patients in Group 2, a statistically significant relationship was found between incidental parathyroidectomy and hypocalcemia (p=0.003). There was no statistically significant difference in terms of presence of thyroiditis or hyperthyroidism between groups. There was statistically significant decrease in postoperative hypocalcemia rate in patients with lobectomy compared to patients with bilateral total thyroidectomy or central neck dissection (p<0.01).CONCLUSION:Risk of postoperative hypocalcemia may be reduced with lobectomy for selected patients. In addition, delicate dissection during thyroidectomy is important in order to protect parathyroid glands and prevent hypocalcemia.

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Section: Discussionmentioning

confidence: 93%

“…Etiological considerations include postoperative alkalosis-induced hypocalcemia resulting from hyperventilation triggered by postoperative pain, and dilutional hypocalcemia [5]. Incidental rate of parathyroid organs in thyroidectomy specimens have been reported to range between 6.4–31% [6, 7]. …”

mentioning

confidence: 99%

Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy

Özemir

Buldanlı

Yener

et al. 2016

North Clin Istanbul

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“…Rates of IPE are not often well reported, especially in the pediatric population, ranging widely in the adult literature from 2.3% to 29%. 7 , 20 - 23 Multiple patient-specific and surgical aspects have been considered risk factors for IPE in the adult literature, such as pathologic diagnoses and extent of surgery (eg, paratracheal dissection), as well as surgeon experience and volume. 24 Familiarity with the anatomy of parathyroid gland location and blood supply and recognition of parathyroid tissue are of great importance in avoiding IPE.…”

Section: Discussionmentioning

confidence: 99%

Rate of Incidental Parathyroidectomy in a Pediatric Population

et al. 2021

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Objective Incidental parathyroidectomy is a relatively common occurrence in thyroid surgery, which may lead to hypoparathyroidism and postoperative hypocalcemia, but it is not well studied in children. The objectives of this study were to determine the rate of incidental parathyroidectomy, identify potential risk factors, and investigate postoperative complications in children undergoing thyroidectomy. Study Design Retrospective cohort study. Setting Patients who underwent thyroidectomy over a 10-year period at a tertiary children’s hospital. Methods Pathology reports were reviewed to determine incidental parathyroid gland tissue. Additional data collected included patient demographics, type of procedure, underlying thyroid pathology, as well as immediate and long-term postoperative clinical outcomes. Results Of 209 patients, 65 (31%) had incidental parathyroidectomy. Several variables were associated with incidental parathyroidectomy on univariable analysis. However, in the final multivariable model, only thyroidectomy with lymph node dissection was associated with increased odds of having incidental parathyroidectomy (odds ratio, 3.3; P = .04; 95% CI, 1.1-9.8). After a median follow up of 1 year, a significantly higher percentage of patients with incidental parathyroidectomy had evidence of long-term hypoparathyroidism (9/62 [15%] vs 3/144 [2%], P = .001). Conclusion Incidental parathyroidectomy was relatively common in our pediatric thyroidectomy population, which may be a result of several anatomic, clinical, and surgeon-related factors. Close attention to parathyroid preservation with meticulous surgical technique is the most practical method of preventing long-term hypoparathyroidism and hypocalcemia.

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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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Incidental parathyroidectomy during thyroid surgery: risk factors, incidence, and outcomes

Cited by 15 publications

References 41 publications

Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy

Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy

Rate of Incidental Parathyroidectomy in a Pediatric Population

Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences

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