Incidental Parathyroidectomy During Thyroid Surgery Does Not Cause Transient Symptomatic Hypocalcemia

Sasson, Aaron R.; Pingpank, James F.; Wetherington, R. Wesley; Hanlon, Alexandra L.; Ridge, John A.

doi:10.1001/archotol.127.3.304

Cited by 154 publications

(194 citation statements)

References 7 publications

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“…(15) did not observe this relationship. Additionally, we found no relationship with the number of parathyroid glands identified or transplanted, which is in agreement with other authors (18,19,30).…”

Section: Discussionsupporting

confidence: 93%

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Vanderlei

Vieira

Hojaij

et al. 2012

Arq Bras Endocrinol Metab

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Objective: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. Subjects and methods: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. Results: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. Conclusion: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy. Arq Bras Endocrinol Metab. 2012;56(3):168-72 Keywords Thyroid gland; PTH; hypocalcemia; thyroidectomy; parathyroid gland RESUMO Objetivo: O objetivo deste estudo é avaliar se a medida perioperatória do hormônio da paratireoide (PTH) pode identificar os pacientes com maior risco de desenvolver sintomas de hipocalcemia. Sujeitos e métodos: Foram estudados quarenta pacientes submetidos à tireo diectomia total. A medida do cálcio sérico e do PTH foi feita após a indução anestésica, uma hora (PTH1) e um dia após a cirurgia. Os pacientes foram avaliados quanto à presença de sintomas de hipocalcemia e tratados com suplementação de cálcio e vitamina D quando necessário. Resultados: Dezesseis pacientes apresentaram sintomas de hipocalcemia. Os pacientes sintomáticos apresentaram PTH1 significantemente menor e queda no PTH significativamente maior. Usando o valor de 12,1 ng/L como corte, conseguimos distinguir pacientes com e sem sintomas de hipocalcemia com sensibilidade de 93,7% e especificidade de 91,6%. Utilizando como corte a queda de 73,5% no valor do PTH, temos sensibilidade de 91,6% e especificidade de 87,5%. Conclusão: O PTH1 e a queda no PTH são bons preditores de hipocalcemia no pós-operatório de tireoidectomia total Arq Bras Endocrinol Metab. 2012;56(3):168-72

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Section: Discussionsupporting

confidence: 93%

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Vanderlei

Vieira

Hojaij

et al. 2012

Arq Bras Endocrinol Metab

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“…In a study by Lin et al of the 25 repeat operations for recurrent or persistent malignancy, 5 (20%) were found to have unintentional parathyroid removal compared with 15 (7.7%) of 195 primary thyroidectomy patients [16]. However, there was no association between incidental parathyroidectomy and permanent hypocalcemia and there are many other studies in literature to support this occurrence [8,9]. In this series, the whole incidence of incidental parathyroidectomy was 5.9%.…”

Section: Discussionmentioning

confidence: 52%

“…In some other studies that compared total thyroidectomy with subtotal thyroid surgeries, permanent hypocalcemia rates were found to be higher in the former group and the conclusion was a correlation between the extent of surgery and the permanent hypocalcemia rates [6][7][8][9]. In a study by Thomusch et al more extensive surgery increased the relative risk of permanent hypocalcemia by 1.5-1.8 times [6].…”

Section: Discussionmentioning

confidence: 92%

Permanent hypocalcemia in patients operated for thyroid carcinoma

Turanlı¹,

Karaman

Ozgen

2009

Indian J Otolaryngol Head Neck Surg

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Aim and objective The incidence and risk factors for permanent hypocalcemia in thyroid carcinoma were investigated. Materials and methodsThe records of 417 patients were reviewed retrospectively at tertiary oncology referral center. Total or subtotal thyroidectomy patients constituted group I (n = 225), reoperative thyroid surgery patients constituted group II (n = 106), and therapeutic neck dissection cases constituted group III (n = 86). Age, gender, thyroid functions, pathologically verifi ed tumor type, differentiation, localization and size, multicentricity, thyroid capsule invasion, extrathyroidal soft tissue invasion, coexistence of lymphocytic thyroiditis, metastatic lymph nodes dissected, incidental parathyroidectomy, and the type of surgery were investigated.Re sults Permanent hypocalcemia was seen in 32 (7.7%) patients. The incidence of permanent hypocalcemia for each group was 1.7%, 10.3% and 19.7%, respectively. Related risk factors were hyperthyroidism for group I [adjusted relative risk (RR) = 21.1, 95% confi dence interval (CI) = 2.6-165, p = 0.01] incidental parathyroidectomy for group II (RR = 7.8, 95% CI = 1.9-31.0, p = 0.004), and extrathyroidal soft tissue invasion (RR = 3.1, 95% CI = 1.1-9.5, p = 0.03) for group III.Conclusion Permanent hypocalcemia rate was increased with reoperative thyroid surgery and neck dissection added to total thyroidectomy. Hyperthyroidism, incidental parathyroidectomy and extrathyroidal extension were related risk factors.

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“…Attempts to maintain relatively large oncological surgical margins in malignant cases, along with the extra dimensions of the thyroid, are designated as possible causes. Furthermore, another risk factor is the modified radical cervical lymph node dissection performed in thyroid malignancies (16)(17)(18). In a trial performed by Khairy and Al-Saif (19), neither the central nor the modified radical cervical dissections were reported to pose a risk in terms of incidental parathyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

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

Özoğul¹,

Akçay²,

Kısaoğlu³

et al. 2014

Turk J Med Sci

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Tin oxide nanoparticles were synthesized via hydrothermal method using a non-ionic surfactant, oleyl amine (OLM), in the presence of urea. The reactions were carried out at different calcination temperatures and varying concentrations of surfactant and urea. The effect of these reaction parameters on the particles' size, distribution, surface area, and the average pore diameter were investigated using X-ray diffraction analysis, transmission electron microscopy, scanning electron microscopy, energy dispersive X-ray analysis, thermogravimetric analysis, Brunauer-Emmett-Teller method, and Fourier transform infrared spectroscopy.Larger tin oxide nanoparticles were obtained with higher concentrations of urea. At the optimum experimental conditions, tin oxide nanoparticles with mean particle size of 9.92 nm and surface area of 31.82 m 2 g −1 were obtained. Particle size further decreased to 5.36 nm with the addition of surfactant having a concentration below CMC. Elimination of surfactant from tin-surfactant composites after calcination yielded mesoporous particles but the increase in calcination temperature resulted in larger and highly aggregated tin oxide particles.

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Incidental Parathyroidectomy During Thyroid Surgery Does Not Cause Transient Symptomatic Hypocalcemia

Cited by 154 publications

References 7 publications

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Parathyroid hormone: an early predictor of symptomatic hypocalcemia after total thyroidectomy

Permanent hypocalcemia in patients operated for thyroid carcinoma

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

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