Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia

Lin, Yann-Sheng; Wu, Hsien-Ming; Yu, Ming–Chin; Chao, Tzu‐Chieh

doi:10.1002/lary.26448

Cited by 37 publications

(65 citation statements)

References 22 publications

(66 reference statements)

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“…Finding a parathyroid gland in postoperative thyroidectomy specimen without any intention to do parathyroidecomy is known as incidental parathyroidectomy (IP). The incidence ranges between 6.4% and 31.1% [5][6][7][8][9][10][11]. Over the past decades, standardization of the thyroidectomy technique and advances in perioperative management have led to significant reduction in the overall morbidity [5].…”

Section: Introductionmentioning

confidence: 99%

“…Over the past decades, standardization of the thyroidectomy technique and advances in perioperative management have led to significant reduction in the overall morbidity [5]. Although IP is considered a minor finding in final histopathology and not a life-threatening complication of thyroid surgery, it is important for the thyroid surgeon to be able to identify factors that increase the risk for IP during thyroidectomy and exercise appropriate caution in those patients [6]. Preoperative diagnosis, type of operation, and presence of nodal metastases may influence the likelihood of IP; however, there is no unanimity of risk factors agreed upon in the literature [7].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Alraddadi

Aldhahri

Almayouf

et al. 2019

Cureus

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Background: Incidental parathyroidectomy with subsequent hypoparathyroidism and postoperative hypocalcemia is thought to be one of the common complications of thyroidectomy. Current literature reports wide discrepancy in incidence and risk factors.Objectives: The aim of our study was to evaluate the incidence and risk factors of incidental parathyroidectomy in thyroid surgery.Methods: A retrospective study included 270 patients who had thyroid surgery that was performed over two years from January 2017 to December 2018 in two tertiary care hospitals. Preoperative and postoperative records were assessed. Factors such as gender, diagnosis, type of surgery, and usage of surgical loupes during the procedure were evaluated and were compared to find the association with incidental parathyroidectomy in thyroid surgery.Results: Incidental parathyroidectomy was noticed in 62 (23%) surgical specimens during histopathologic examination. There was no significant association between incidental parathyroidectomy and sex of patient, use of surgical loupes, pathology of thyroid disease, or neck dissection.Conclusion: Although the risk of incidental parathyroidectomy is inevitable, careful dissection and meticulous intraoperative identification of parathyroid gland during thyroidectomy can reduce the incidence of incidental parathyroidectomy, thereby minimizing the risk of postoperative hypoparathyroidism and hypocalcemia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Alraddadi

Aldhahri

Almayouf

et al. 2019

Cureus

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“…Surgical trauma, devascularization, extent of surgery, and incidental parathyroidectomy (IP) have been found to affect postoperative hypocalcemia. [ 2 , 4 , 6 ]…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have shown that pathology type, procedure extent, reoperation and central neck dissection are risk factors of IP in thyroidectomy. [ 4 , 8 ] However, these relationships have not been found in all studies. [ 9 – 11 ]…”

Section: Introductionmentioning

confidence: 99%

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Bai

Chen

2018

PLoS ONE

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IntroductionPostoperative hypocalcemia is the most common complication of thyroidectomy. Incidental parathyroidectomy (IP) was thought to be associated with postoperative hypocalcemia. However, according to previous studies, the risk factors and clinical outcomes of IP remain controversial.MethodsEligible studies were searched in databases including PubMed, Web of Science, and EMBASE from January 1990 to September 2017. Articles focusing on the relationship between IP and postoperative hypocalcemia were included. The risk of publication bias was assessed using Begg’s test and Egger’s regression asymmetry test. Pooled analysis was performed to evaluate the effect of IP on postoperative hypocalcemia and related risk factors. Sensitivity analysis was also conducted to test the stability of our results. The effects of hypocalcemia type, permanent definition, IP incidence, total thyroidectomy, and malignancy operation were also examined using a further subgroup analysis.ResultsThirty-five studies were finally included in the analysis after an exhaustive literature review. Pathology data demonstrate that incidental parathyroidectomy occurred in various locations: intrathyroidal (2.2–50.0%), intracapsular (16.7–40.0%) and extracapsular (15.7–81.1%) regions. Overall, the analysis found that malignancy (RR = 1.60, 95% CI: 1.27 to 2.02; p< 0.0001), central neck dissection (RR = 2.35, 95% CI: 1.47 to 3.75; p = 0.0004), total thyroidectomy (RR = 1.42, 95% CI: 1.20 to 1.67; p< 0.0001) and reoperation (RR = 1.81, 95% CI: 1.20 to 2.75; p = 0.005) were significant risk factors of IP in thyroid surgery. There was an obvious effect of IP on temporary/permanent (RR = 1.59, 95% CI: 1.37 to 1.84; p< 0.0001) and permanent (RD = 0.0220, 95% CI: 0.0069 to 0.0370; p = 0.0042) postoperative hypocalcemia. Sensitivity analysis showed that these results were robust. The subgroup analysis found that IP played a significant role in both biochemical and clinical hypocalcemia in thyroidectomy (p < 0.0001 and p = 0.0003, separately). The association of IP and permanent hypocalcemia using different definitions (6 months or more than 12 months) was also confirmed by the analysis. IP increased the incidence of temporary/permanent and permanent hypocalcemia for cases undergoing total thyroidectomy (40.4% vs 24.8% and 5.8% vs 1.4%, respectively). Thyroidectomy with IP was associated with more permanent hypocalcemia (RR = 3.10, 95% CI: 2.01 to 4.78; p< 0.0001) in malignant cases but was not associated with temporary/permanent hypocalcemia.ConclusionsMalignancy, central neck dissection, total thyroidectomy and reoperation were found to be significant risk factors of IP. IP increases the risk of postoperative hypocalcemia after thyroidectomy. We recommend a more meticulous intraoperative identification of parathyroid gland in thyroidectomy to reduce IP, particularly for total thyroidectomy and malignancy cases.

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“…The importance of preserving well-vascularized glands has been reconfirmed by recent studies using indocyanine green fluorescence angiography that showed PTH levels on postoperative day 1 were normal in all patients who had at least one well vascularized parathyroid gland and none of these patients required treatment for hypoPT [ 3 ]. In addition, inadvertent removal of the parathyroid glands during thyroid surgery is reported to occur in as little as 6% of patients [ 4 ] or as high as 25% [ 2 , 5 ]. More recently, intraoperative infrared imaging has been used to identify parathyroid glands based on their autofluorescence [ 6 ] but it is yet to be demonstrated whether routine use of this technique will decrease the risk of postthyroidectomy hypoPT.…”

Section: Introductionmentioning

confidence: 99%

Patients’ views about parathyroid transplantation for post-thyroidectomy hypoparathyroidism

Schmeißer

Mihai

2018

Langenbecks Arch Surg

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BackgroundPermanent hypoparathyroidism (hypoPT) represents the most common postoperative complication associated with total thyroidectomy. Current treatment relies on high-dose calcium and/or vitamin D supplementation, but often this is insufficient and some patients remain symptomatic. Parathyroid allotransplantation is a new therapeutic option described recently in the literature. This study aims to investigate the patients’ acceptability of parathyroid transplantation as a potential new treatment for hypoPT.MethodOnline survey of members of HypoParaUK, a support group for individuals affected by hypoPT.ResultsResponses were received from 252 hypoPT patients. Majority declared to experience severe symptoms despite regular medical treatment. On a severity scale of 0–5, symptoms that were most troublesome were fatigue (3.8), low sense of well-being (3.5), and numbness/tingling (2.9). On a scale of 0–10, on average, their current quality of life (QoL) was 5 ± 3 and they expected this would improve to 7 ± 2 with correction of their hypoPT. Forty-four percent of patients were extremely interested in a potential technique involving intramuscular injection of parathyroid cell suspension compared to just 14% who were interested in the more invasive procedure of implantation of a parathyroid allograft into the forearm. The main concerns expressed were related to the possible need for immunosuppressive therapy.ConclusionPatients with severe symptomatic hypoPT seem interested to consider participation in a clinical trial exploring the feasibility and success rate of parathyroid transplantation.Electronic supplementary materialThe online version of this article (10.1007/s00423-018-1693-y) contains supplementary material, which is available to authorized users.

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Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia

Abstract: 4. Laryngoscope, 127:2194-2200, 2017.

Cited by 37 publications

References 22 publications

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Patients’ views about parathyroid transplantation for post-thyroidectomy hypoparathyroidism

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