Preservation of parathyroid glands during thyroid and neck surgery

Abstract

The parathyroid glands are situated in close proximity to the thyroid gland. They have an important endocrine function maintaining calcium and phosphate homeostasis in the body by the secretion of parathormone (PTH), which is responsible for this function. The parathyroid glands are commonly damaged during thyroid surgeries. This could lead to transient or permanent hypoparathyroidism in 30% of cases. Preservation of the parathyroid glands, is an important and integral part of thyroidectomy and other surgical interventions in the neck. The main principle underlying this is a thorough understanding of parathyroid anatomy in relation to the thyroid gland and other important structures in the area. There can also be significant variation in the anatomical location of the glands. Various techniques and methods have been described for parathyroid preservation. They include intraoperative identification utilizing indocyanine green (ICG) fluorescence, carbon nanoparticles, loupes, and microscopes. The techniques of surgery (meticulous capsular dissection), expertise, central compartment neck dissection, preoperative vitamin D deficiency, extent and type of thyroidectomy are the risk factors associated with damaged thyroids, inadvertent parathyroidectomy and subsequent hypoparathyroidism. Parathyroid Autotransplantation is a treatment option for inadvertent parathyroidectomy. Ultimately, the best way to assure normal parathyroid function is to preserve them in situ intraoperatively undamaged.

Silicon-Rhodamine Functionalized Evocalcet Probes Potently and Selectively Label Calcium Sensing Receptors In Vitro, In Vivo, and Ex Vivo

“…For example, during thyroidectomy, which is performed approximately 100,000 times annually in just the US, transient and persistent damage to the parathyroid glands represent a major complication in up to 30 and 3% of the cases, respectively. 48 Currently the relatively high far-red autofluorescence of the parathyroid glands compared to the surrounding tissues is used for parathyroid gland identification, which does not inform surgeons about the perfusion and the vitality of the glands during the operation. 49 For parathyroid gland perfusion, indocyanine green angiography can be applied, which is an aspecific label.…”

“…On the translational perspective, the visualization of CaSR in the human parathyroid glands could enhance the localization and thus preservation of the tissue, which is an integral objective during various head and neck surgical procedures. For example, during thyroidectomy, which is performed approximately 100,000 times annually in just the US, transient and persistent damage to the parathyroid glands represent a major complication in up to 30 and 3% of the cases, respectively . Currently the relatively high far-red autofluorescence of the parathyroid glands compared to the surrounding tissues is used for parathyroid gland identification, which does not inform surgeons about the perfusion and the vitality of the glands during the operation .…”

5-year Follow-up of Reimplanted Parathyroid Glands in Forearm Subcutaneous Tissue During Thyroidectomy. A Confirmation of Graft Vitality in a Large Series of Patients

“…Clear gland identification and meticulous capsular dissection are required to avoid parathyroid damage during neck surgery, in order to preserve the mild vascular supply derived from the terminal branches of the thyroid arteries. 4…”

“…This is based on the surgeon’s subjective experience and acquired anatomical and embryological knowledge. 4…”

“…3 This is mainly due to the anatomical variability of the parathyroid glands and their vascular support, making their detection challenging. 4 The best way to avoid this complication remains the clear identification of the parathyroid glands by meticulous tissue dissection and careful ligation of the terminal arterial branches of the thyroid gland, in order to avoid devascularization of the parathyroid gland. 5…”