Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy

Ji, Yong Bae; Song, Chang Myeon; Sung, Eui Suk; Jeong, Jin Hyeok; Lee, Chang Beom; Tae, Kyung

doi:10.21053/ceo.2016.00724

Cited by 22 publications

(18 citation statements)

References 28 publications

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“…This RCT studied the value of ICG angiography of the parathyroid glands during thyroid surgery in predicting postoperative hypoparathyroidism. The findings indicate that ICG angiography is a good predictor of the absence of hypoparathyroidism after thyroidectomy, in contrast to visual evaluation of the parathyroid glands 23,32,33 . In this consecutive series of 196 patients, a well vascularized parathyroid gland could be identified in 146 (74⋅5 per cent) and none of the subsequently randomized patients presented with hypocalcaemia.…”

Section: Discussionmentioning

confidence: 82%

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

Fortuny

Sadowski

Belfontali

et al. 2018

British Journal of Surgery

159

150

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BackgroundHypoparathyroidism, the most common complication after thyroid surgery, leads to hypocalcaemia and significant medical problems. An RCT was undertaken to determine whether intraoperative parathyroid gland angiography with indocyanine green (ICG) could predict postoperative hypoparathyroidism, and obviate the need for systematic blood tests and oral calcium supplementation.MethodsBetween September 2014 and February 2016, patients who had at least one well perfused parathyroid gland on ICG angiography were randomized to receive standard follow‐up (measurement of calcium and parathyroid hormone (PTH) on postoperative day (POD) 1 and systematic supplementation with calcium and vitamin D; control group) or no supplementation and no blood test on POD 1 (intervention group). In all patients, calcium and PTH levels were measured 10–15 days after thyroidectomy. The primary endpoint was hypocalcaemia on POD 10–15.ResultsA total of 196 patients underwent ICG angiography during thyroid surgery, of whom 146 had at least one well perfused parathyroid gland on ICG angiography and were randomized. None of these patients presented with hypoparathyroidism, including those who did not receive calcium supplementation. The intervention group was statistically non‐inferior to the control group (exact 95 per cent c.i. of the difference in proportion of patients with hypocalcaemia –0·053 to 0·053; P = 0·012). Eleven of the 50 excluded patients, in whom no well perfused parathyroid gland could be identified by angiography, presented with hypoparathyroidism on POD 1, and six on POD 10–15, which was significantly different from the findings in randomized patients (P = 0·007).ConclusionICG angiography reliably predicts the vascularization of the parathyroid glands and obviates the need for postoperative measurement of calcium and PTH, and supplementation with calcium in patients with at least one well perfused parathyroid gland. Registration number: NCT02249780 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 82%

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

Fortuny

Sadowski

Belfontali

et al. 2018

British Journal of Surgery

159

150

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“…35,36 Seroma occurred in only four (11.4%) patients despite the absence of drain tubes and was resolved by aspirating two to three times. This is comparable to what is found in conventional transcervical thyroidectomy.…”

Section: Discussionmentioning

confidence: 96%

Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

et al. 2018

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Background The aim of this study was to evaluate the feasibility, safety, and early surgical outcomes of transoral thyroidectomy and to compare robotic and endoscopic procedures. Methods A total of 37 patients underwent robotic (23 cases) or endoscopic (14 cases) transoral thyroidectomy. We compared the outcomes of the two procedures. Results Of the 37 patients, 2 were converted to the robotic facelift approach as a result of an intraoperative CO2 embolism and inability to remove the tumor. The mean operative time was 172.8 ± 37.5 minutes. Transient recurrent laryngeal nerve palsy occurred in one case, and transient hypoparathyroidism in two cases. Most of patients were satisfied with the postoperative cosmesis. There were no significant differences between the robotic and endoscopic procedures, except for operative time, which was significantly longer in the robotic group. Conclusion Robotic and endoscopic transoral thyroidectomies are both feasible and safe in appropriate patients.

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“…Among the operated patients, women predominated, they were 94 out of 130 (72.3%; 95% of Fiducial interval (FI) 63. 8 All the patients were performed a determination of general and ionized calcium, phosphorus according to the standard methods and ultrasound scanning of the thyroid gland.…”

Section: Methodsmentioning

confidence: 99%

“…So, PTG with unchanged color and unbroken blood supply had 0 points, 1 point -we have evaluated PTG, which somewhat changed the color (it became brown), but with a cut of which there was moderate bleeding, 2 points -a gland that changed its color to a dark brown color, and with the cut of which there is minimal bleeding, and 3 points we gave to the PTG which became dark brown or black and in which there was no bleeding from the place of the incision [8].…”

Section: Major Types Of Parahtyroid Glands Location and Their Relatiomentioning

confidence: 99%

Major Types of Parahtyroid Glands Location and Their Relationship with the Post-Operative Hypoparathyroidism

Pasko

2017

Arch. clin. med.

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We have performed 130 operations on the thyroid gland. The spectrum of surgical interventions on the thyroid gland was as follows: hemithyroidectomy was performed for 49.2% of patients, thyroidectomy -for 23.1% of patients and thyroidectomy with central and peripheral lymph node dissection -for 27.7% of patients. All patients were performed the determination of PTG type and their visual assessment. Types A and B1 are rarely traumatized during operations on thyroid gland, PTG of type B 2 and B 3 , C practically in almost all cases are damaged or become ischemic in a varying degree, therefore, types B 2 , B 3 and C can be considered as the risk factors for the development of postoperative HPT, and in case of type B 2 of PTG they were technically difficult to be isolated without damage, and in the B 3 and C types it is generally difficult to keep them intact. Determination of the type of PTG and their visual assessment is the basis for solution to the problem of preservation of PTG in place or of their autotransplantation.

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Postoperative Hypoparathyroidism and the Viability of the Parathyroid Glands During Thyroidectomy

Cited by 22 publications

References 28 publications

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery

Early experience of transoral thyroidectomy: Comparison of robotic and endoscopic procedures

Major Types of Parahtyroid Glands Location and Their Relationship with the Post-Operative Hypoparathyroidism

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