Risk Factors of Incidental Parathyroidectomy and its Relationship with Hypocalcemia after Thyroidectomy: A Retrospective Study.

Erdem Karadeniz,Mufide N Akcay

doi:10.7759/cureus.5920

Abstract

Background: The aim of this study was to determine the incidence of incidental parathyroidectomy, the relationship between incidental parathyroidectomy and postoperative hypocalcemia, and risk factors for incidental parathyroidectomy in patients undergoing thyroid surgery.Methods: The study was conducted by analyzing the records of patients who underwent thyroid surgery in a tertiary university hospital between January 2012 and December 2017 retrospectively. The risk factors of postoperative hypocalcemia were determined by comparing postoperative Ca values with age, sex, preoperative Ca value, dominant nodule diameter, type of surgery, and histopathological examination of the thyroidectomy material. According to the final pathology results, the patients were divided into two groups - the ones with and without incidental parathyroidectomy. The risk factors for incidental parathyroidectomy were determined by comparing the two groups in terms of age, sex, dominant nodule diameter, type of surgery, and histopathological results (malign/benign).Results: When the risk factors of postoperative hypocalcemia were examined, female gender, age <28.5 years old, low level of preoperative mean Ca value, and total thyroidectomy were found to be critical risk factors (p<0.05). When the risk factors of incidental parathyroidectomy were examined, total thyroidectomy and thyroid malignancy were found to be important risk factors (p<0.05).Conclusion: Female gender, age<28.5 years old, low level of preoperative Ca value, and total thyroidectomy were associated with postoperative hypocalcemia, but no relationship was found between incidental parathyroidectomy and postoperative hypocalcemia.

Highlights

Thyroid surgeries are considered to be secure operations when they are conducted by practiced hands
The aim of this study was to determine the incidence of incidental parathyroidectomy, the relationship between incidental parathyroidectomy, postoperative hypocalcemia, and risk factors for incidental parathyroidectomy in patients undergoing thyroid surgery in our clinic
Hypocalcemia lasting less than six months was accepted as transient hypocalcemia and hypocalcemia lasting longer than six months was accepted as permanent hypocalcemia

Summary

Introduction

Thyroid surgeries are considered to be secure operations when they are conducted by practiced hands. Serious complications may be seen in less than 5% of the patients [1]; the frequent ones being hypocalcemia, recurrent laryngeal nerve injury, and hematoma [2]. The transient hypocalcemia rate after thyroid surgery is 27% (19-38) while permanent hypocalcemia is about 1% (0-3). Careful dissections are performed in thyroid surgery, accidental extraction of the parathyroid gland happens frequently. It is stated that the incidental parathyroidectomy rate of thyroid surgeries is between 5.2% and 21.6% [5,6]. The aim of this study was to determine the incidence of incidental parathyroidectomy, the relationship between incidental parathyroidectomy and postoperative hypocalcemia, and risk factors for incidental parathyroidectomy in patients undergoing thyroid surgery

Objectives

Methods

Results

Conclusion