The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: A multivariate analysis of 5846 consecutive patients

Thomusch, Oliver; Machens, Andreas; Sekulla, Carsten; Ukkat, Jörg; Brauckhoff, Michael; Dralle, Henning

doi:10.1067/msy.2003.61

Cited by 433 publications

(414 citation statements)

References 32 publications

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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: 53%

“…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%

“…Reoperative thyroid surgery or re-operations are associated with an increased risk for unintentional parathyroidectomy, probably resulting from the formation of scar tissue and fi brosis that cause operative diffi culty [16]. While the removal of a single parathyroid gland is not associated with postoperative hypocalcemia, the removal of at least two parathyroid glands increases the risk of permanent hypocalcemia [9]. 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].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Permanent hypocalcemia in patients operated for thyroid carcinoma

Turanlı¹,

Karaman

Ozgen

2009

Indian J Otolaryngol Head Neck Surg

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“…Over the long term, definitive hypoparathyroidism may lead to cerebral, vascular, ocular and renal damage, and to a significant reduction in quality of life26, 27, 28, 29. Knowing the anatomical position and vascular supply of the parathyroid glands is essential to avoid hypoparathyroidism after thyroid surgery30, 31.…”

Section: Discussionmentioning

confidence: 99%

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

Fortuny

Belfontali

Sadowski

et al. 2016

British Journal of Surgery

146

130

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BackgroundPostoperative hypoparathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative parathyroid gland angiography in predicting normal parathyroid gland function after thyroid surgery.MethodsAngiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified parathyroid glands.ResultsSome 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized parathyroid gland could be demonstrated developed transient hypoparathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoparathyroidism.Conclusion PTH levels on POD 1 were normal in all patients who had at least one well vascularized parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoparathyroidism.

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“…Untreated, hypoparathyroidism causes seizures, tetany, and death (Maeda et al, 2006). Common causes of hypoparathyroidism are injury to the gland during thyroid or parathyroid surgery (Thomusch et al, 2003) or autoimmune polyendocrine syndrome (Alimohammadi et al, 2008). Conventional therapy involves vitamin D analogs and calcium supplementation.…”

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confidence: 99%

Differential Sorting of Human Parathyroid Hormone After Transduction of Mouse and Rat Salivary Glands

et al. 2008

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Gene transfer to salivary glands leads to abundant secretion of transgenic protein into either saliva or the bloodstream. This indicates significant clinical potential, depending on the route of sorting. The aim of this study was to probe the sorting characteristics of human parathyroid hormone (hPTH) in two animal models for salivary gland gene transfer. PTH is a key hormone regulating calcium levels in the blood. A recombinant serotype 5 adenoviral vector carrying the hPTH cDNA was administered to the submandibular glands of mice and rats. Two days after delivery, high levels of hPTH were found in the serum of mice, leading to elevated serum calcium levels. Only low amounts of hPTH were found in the saliva. Two days after vector infusion into rats, a massive secretion of hPTH was measured in saliva, with little secretion into serum. Confocal microscopy showed hPTH in the glands, localized basolaterally in mice and apically in rats. Submandibular gland transduction was effective and the produced hPTH was biologically active in vivo. Whereas hPTH sorted toward the basolateral side in mice, in rats hPTH was secreted mainly at the apical side. These results indicate that the interaction between hPTH and the cell sorting machinery is different between mouse and rat salivary glands. Detailed studies in these two species should result in a better understanding of cellular control of transgenic secretory protein sorting in this tissue.

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The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: A multivariate analysis of 5846 consecutive patients

Cited by 433 publications

References 32 publications

Permanent hypocalcemia in patients operated for thyroid carcinoma

Permanent hypocalcemia in patients operated for thyroid carcinoma

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

Differential Sorting of Human Parathyroid Hormone After Transduction of Mouse and Rat Salivary Glands

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