The Relationship between the Number of Preserved Parathyroid Glands and Clinical Aspects after Total Thyroidectomy and Central Lymph Node Dissection in Papillary Thyroid Carcinoma

Abstract

Received March 27, 2013 Revised May 17, 2013 Accepted June 8, 2013 Address for correspondence Jin-Choon Lee, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel +82-51-240-7335 Fax +82-51-246-8668 E-mail ljc0209@hanmail.net Background and ObjectivesZZTo identify the relation between the preservation status of the parathyroid glands and the risk of hypoparathyroidism after total thyroidectomy and central lymph node dissection in papillary thyroid carcinoma. Subjects and MethodZZA retrospective review was carried out for the medical records of 63 patients with papillary thyroid carcinoma (PTC), who satisfied our inclusion criteria and received treatment at the Department of Otolaryngology-Head and Neck Surgery, Hospital from May 2010 to December 2011. Patients with PTC who underwent total thyroidectomy with central lymph node dissection (CLND) were included and grouped according to the number of preserved parathyroid glands as follows: Group 1 (with four intact glands), Group 2 (three intact glands), Group 3 (less than two intact glands). The total and ionized serum calcium and intact parathyroid hormone levels of each group were monitored after the surgery. Patients with postoperative symptomatic hypocalcemia were considered to have postoperative hypoparathyroidism and received calcium/vitamin D therapy. The hypoparathyroidism was considered to be permanent when calcium/vitamin D therapy was still required six months after surgery. ResultsZZOut of 63 cases of total thyroidectomy with CLND, 31 (49.2%) showed postoperative hypoparathyroidism as demonstrated by laboratory findings. Permanent hypoparathyroidism, however, was not observed in these cases. The development of hypoparathyroidism was not significantly related with the number of preserved parathyroid glands. ConclusionZZTo prevent postoperative hypoparathyroidism following total thyroidectomy and CLND, at least two parathyroid glands should be preserved in situ with an intact blood supply in order to prevent permanent hypoparathyroidism after the surgery. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:431-5