Abstract
Objective. To evaluate the incidence of accidental parathyroidectomy in our series of total thyroidectomies, to investigate its clinical and biochemical consequences, and to identify potential risk factors. Methods. Patients who underwent total thyroidectomy between January 2006 and December 2015 were retrospectively analyzed. Pathology reports were reviewed to identify those cases who had an incidental parathyroidectomy and these were compared to patients with no parathyroidectomy, in terms of clinical (age, sex, and symptoms of hypocalcemia), pathological (thyroid specimen weight, Hashimoto thyroiditis, and malignancy), and biochemical (serum calcium and phosphate levels) factors. Results. 281 patients underwent total thyroidectomy during the study period. Incidental parathyroidectomy was noticed in 24.9% of cases, with 44.3% of parathyroid glands found in an intrathyroidal location. Evidence of postoperative biochemical hypocalcemia was noticed in 28.6% of patients with parathyroidectomy, compared with 13.3% in the no-parathyroidectomy group (p = 0.003). Symptomatic hypocalcemia was observed in 5.7% and 3.8%, respectively (p = 0.49). Age, sex, thyroid specimen weight, Hashimoto thyroiditis, and malignancy did not differ significantly between the two groups. Conclusions. Our study found an association of incidental parathyroidectomy with transient postoperative biochemical hypocalcemia, but not with clinically symptomatic disease. Age, sex, thyroid gland weight, Hashimoto thyroiditis, and malignancy were not identified as risk factors.
Highlights
Standardization of the thyroidectomy technique and advances in perioperative management have led to significant decrease in the overall mortality and morbidity over the past decades
incidental parathyroidectomy (IPT) associated with biochemical hypocalcemia hypocalcemia [12, 25]
More than half of IPTs could theoretically have been avoided, since the parathyroid gland (PG) were found in extra- and subcapsular locations
Summary
Standardization of the thyroidectomy technique and advances in perioperative management have led to significant decrease in the overall mortality and morbidity over the past decades. Postoperative hypocalcemia remains the single most common complication of thyroid surgery, with a prevalence ranging between 16 and 55%, depending on the definition of low calcium levels [1,2,3]. Most cases are transient and asymptomatic, documented only biochemically; permanent hypocalcemia can be debilitating for the patient, causing life-long dependency on oral calcium supplementation, significant loss of quality of life, and medicolegal issues against surgeons. With an incidence of 3–30%, IPT is a relatively common finding in thyroid pathology reports, even in the hands of experienced endocrine surgeons [2, 4]. The aim of this study was to determine the incidence of IPT in our series, to evaluate its impact on postoperative calcium levels and to identify potential risk factors
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