Incidental Parathyroidectomy Research Articles

Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy.

BackgroundThe relationship between the number of parathyroid glands preserved and hypoparathyroidism is not well understood. We sought to determine the number of parathyroid glands that need to be preserved to prevent hypoparathyroidism.MethodsWe analyzed 454 patients who underwent total thyroidectomy for papillary thyroid carcinoma. We analyzed the frequency of hypoparathyroidism according to the number of parathyroid glands preserved.ResultsIncidental parathyroidectomy occurred in 19.8% of the patients; one parathyroid gland in 17.6%, two in 1.5%, and three in 0.7%. Transient hypoparathyroidism was increased when incidental parathyroidectomy occurred (odds ratio 1.83, 95% confidence interval 1.04 to 3.23, P = 0.036) on multivariate regression analysis, but was not influenced by the actual number of parathyroid glands removed. There was no relationship between the number of parathyroid glands preserved and permanent hypoparathyroidism (P = 0.147).ConclusionsPreservation of all parathyroid glands decreases transient hypoparathyroidism compared with when three or fewer glands are preserved, but does not affect permanent hypoparathyroidism. During total thyroidectomy, preserving at least one parathyroid gland with an intact blood supply appears to be sufficient to prevent permanent hypoparathyroidism when autotransplantation is not performed.

Vitamin D and Risk of Postoperative Hypocalcemia After Total Thyroidectomy

Transient hypocalcemia is a well-recognized occurrence after total thyroidectomy. It has been hypothesized that underlying vitamin D deficiency may increase the risk of this complication, although to date there are few data in the literature supporting this hypothesis. To investigate whether perioperative vitamin D levels have any effect on postthyroidectomy hypocalcemia. We performed a retrospective review of a prospectively maintained database of thyroidectomies from November 1, 2009, through September 30, 2012, at an academic teaching hospital. The study included 121 patients with available vitamin D levels undergoing total or completion thyroidectomy. Patients with preexisting hypercalcemia or hyperparathyroidism were excluded. All patients underwent total removal of all thyroid tissue by a capsular dissection technique. Routine calcium or vitamin D supplementation was not administered. Biochemical hypocalcemia was defined as any single postoperative corrected calcium level less than 8.0 mg/dL (to convert to millimoles per liter, multiply by 0.25) and symptomatic hypocalcemia as any symptoms of hypocalcemia. Outcome measures were incidence of postoperative hypocalcemia and association with vitamin D levels. A multivariate analysis was performed to study the effect of other variables, including performance of central neck dissection, incidental parathyroidectomy, and hyperthyroidism, on the incidence of postoperative hypocalcemia. The incidence of transient biochemical hypocalcemia was 24% (n = 29/121). There was no correlation between vitamin D levels and risk of postoperative hypocalcemia. On univariate analysis, performance of concomitant central compartment neck dissection revealed an increased risk of hypocalcemia (P = .06), but this finding was not significant on multivariate analysis. Vitamin D levels do not appear to have a significant effect on the risk of postthyroidectomy hypocalcemia.

Incidental Parathyroidectomy during Thyroid Surgery Using Capsular Dissection Technique

To identify incidence, preoperative features, surgical factors, and postoperative events of incidental parathyroidectomy (IP) during thyroidectomy. A total of 1068 consecutive patients who underwent thyroidectomy performed by a single surgeon between January 2003 and April 2012 were enrolled in retrospective study with prospectively collected data. University hospital. To assess the impact of IP on study variables, patients were stratified into 2 study groups: IP group and non-IP group. Univariate and multivariate analyses identified significant correlates of IP. In all, 5.4% patients experienced IP. Significant difference (P < .001) was in incidence of temporary hypocalcemia between IP group (36.2%) and non-IP group (16.8%). Multivariable logistic regression model identified total thyroidectomy (odds ratio 3.937, 95% confidence interval [CI] 1.462-10.601, P = .007) and Graves' disease (odds ratio 2.192, 95% CI 1.157-4.158, P = .016) as risk-adjusted factors associated with IP. Multivariate analysis of repeated measures identified statistically significant difference of repeated total calcium level (P < .001) and ionized calcium level (P = .020) between study groups. IP during thyroidectomy might be potential complication. Total thyroidectomy, Graves' disease, longer operation time, and identification 3 and more parathyroid glands seemed to be predictive factors for IP. IP is significantly associated with temporary hypocalcemia, but not with permanent hypoparathyroidism.

Analysis of the factors that have an effect on hypocalcemia following thyroidectomy.

The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this study. One hundred and ninety thyroidectomy patients were evaluated retrospectively for factors that might contribute to postoperative hypocalcemia; age, hyperthyroidism, malignancy, the extent of surgery (total/near total/subtotal thyroidectomy), cervical lymph node dissection, and incidental parathyroidectomy. The rate of transient hypocalcemia/hypoparathyroidism was 19.47%, with a permanent hypoparathyroidism rate of 4.74%. Factors affecting the development of transient hypocalcemia were found as being operated for hyperthyroidism, and use of total thyroidectomy as the surgical method. Total thyroidectomy increased the risk of postoperative hypocalcemia by 3.16 fold. Patients undergoing operations for hyperthyroidism had a 2.3 fold increase, and those undergoing total thyroidectomy had a 3.16 fold risk of postoperative hypocalcemia. Hyperthyroidism surgery and total thyroidectomy lead to a higher risk of developing early postoperative or transient hypocalcemia. According to our results, no significant relationship could be established between any of the study parameters and persistent hypocalcemia.

Incidental parathyroidectomy during thyroid surgery: risk factors, incidence, and outcomes

Incidental removal of the parathyroid glands is common in some cases. In this trial, we investigated the risk factors, incidence, and outcomes associated with incidental excision of the parathyroid glands during thyroid surgery. The records of patients who had undergone thyroid surgery in our department between January 2006 and December 2011 were retrospectively evaluated. A total of 801 patients were enrolled in the trial. The number of incidental parathyroidectomies was determined as 19 (2.3%). Statistical evaluation revealed that sex (P > 0.05) and type of surgical operation (P > 0.05) were not associated with a significant impact on incidental parathyroidectomies. However, the rate of incidental parathyroidectomies was determined to be statistically significantly high among patients with malignant conditions (P < 0.05). Hypocalcemia was observed to be statistically significant in patients with an incidental parathyroidectomy (P < 0.05). Incidental parathyroidectomy is a rare condition in centers specializing in endocrine surgery. Furthermore, the parathyroid glands should always be explored during dissection in patients with malignancies. The clinical manifestation of hypocalcemia is a common condition observed after incidental parathyroidectomy.

Incidental parathyroidectomy during total thyroidectomy

Aim — Background Total thyroidectomy is the procedure of choice in many diseases of the thyroid gland. This study measures the frequency of incidental parathyroidectomy during thyroidectomy in our department and values the possible correlation between certain clinical parameters, such as inflammation and malignancy, and the frequency of incidental parathyroidectomy.

Hypocalcaemia following total thyroidectomy: An analysis of 806 patients

Background:Permanent hypocalcaemia following thyroidectomy causes considerable morbidity. This prospective observational study aims to define the factors likely to predict hypocalcaemia following total thyroidectomy.Materials and Methods:Patients who were subjected to total thyroidectomy during January 2005 to December 2009 were followed up for a minimum period of 1 year. Efficacy of an intraoperative parathyroid hormone assay to predict hypocalcaemia was validated.Results:Overall incidence of hypocalcaemia was 23.6% (n = 190) and that of permanent hypocalcaemia was 1.61% (n = 13). Onset was delayed up to 3rd postoperative day in 13 patients. Hypocalcaemia was significantly associated with thyroidectomy for Grave's Disease (P = 0.001), Hashimoto's thyroiditis (P = 0.003), and with incidental parathyroidectomy (P = 0.006). The intraoperative assay of parathyroid hormone showed low sensitivity (0.5) and satisfactory specificity (0.9) in predicting hypocalcemia.Conclusion:Hypocalcemia could manifest late in the immediate postoperative period and this may explain latent hypocalcemia. High incidence of hypocalcaemia noted in Grave's Disease could be due to the autoimmunity since same feature was noted associated with Hashimoto's thyroiditis and the incidence of hypocalcaemia was not high in the subgroup with toxic nodular goiter. The incidence of hypocalcemia was not affected by age or sex.

539. Recurrent Laryngeal Nerve Reconstruction After Resection During the Operation of Locally Advanced Thyroid Cancer

539. Recurrent Laryngeal Nerve Reconstruction After Resection During the Operation of Locally Advanced Thyroid Cancer

541. Incidental Parathyroidectomy During Total Thyroidectomy

Objectives: A retrospective study of the Second Department of Surgery and ENT Department of METAXA Cancer Hospital, in order to identify the degree of correlation of the presence parathyroid tissue in the thyroid specimens after elective total thyroidectomy.

Risk factors for incidental parathyroidectomy during thyroidectomy

Incidental parathyroidectomy is a common event in thyroid surgery. The literature shows a finding of parathyroid glands ranging from 6.4% to 31% in pathological specimens of the thyroid gland. ObjectiveTo collect the amount of parathyroid glands found in surgical specimens of thyroidectomy and correlate with the histopathological and demographic variables. MethodsRetrospective study based on pathological reports of thyroidectomy from January 2007 to December 2008. Results442 patients were submitted to total thyroidectomy, and 2.93% had parathyroid glands, which corresponded to 13 of this total. The presence of papillary thyroid carcinoma associated with incidental parathyroidectomy was 10.11%, compared to the benign lesion: 1.4%. ConclusionPapillary thyroid carcinoma was the variable associated with increased number of incidental parathyroidectomy.

Incidental parathyroidectomy during thyroid resection: incidence, risk factors, and outcome

BACKGROUND AND OBJECTIVES:Thyroidectomy is a commonly performed procedure for thyroid problems. Inadvertent removal of the parathyroid glands is one of its recognized complications, which occurs more frequently in certain high-risk patients. The aim of this study was to identify the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery.DESIGN AND SETTING:A retrospective review of thyroid operations performed at a tertiary referral hospital between January 2004 and December 2008.METHODS:Pathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid pathology. Postoperative calcium levels were reviewed in these patients.RESULTS:During the study period, 287 thyroidectomies were performed and 47 (16.4%) patients had incidentally removed parathyroid glands. Risk factors for inadvertent parathyroid resection included total thyroidectomy (P=.0001), Hashimoto thyroiditis (P=.004), and extrathyroidal spread (P=.0003). Postoperative hypocalcemia occurred in 18 (38.3%) of the patients in whom the parathyroid gland was removed inadvertently and in 48 (20%) of the rest of the patients (P=.0123).CONCLUSION:The incidence of incidental removal of parathyroid tissue during thyroidectomy is 16.4%. Total thyroidectomy, extrathyroidal extension of the tumor, and thyroiditis were found to be the risk factors. Hypocalcemia was significantly higher among patients who had inadvertent parathyroidectomy.

Incidental Parathyroidectomy during Thyroid Resection: Incidence, Risk Factors, and Outcome

Incidental Parathyroidectomy during Thyroid Resection: Incidence, Risk Factors, and Outcome

Risk Factors and Clinical Outcomes of Incidental Parathyroidectomy during Thyroid Surgery

Risk Factors and Clinical Outcomes of Incidental Parathyroidectomy during Thyroid Surgery

Incidental extirpation of the parathyroid glands at thyroid surgery: risk factors and post-operative hypocalcemia

The objective of this study was to estimate the incidence of incidental extirpation of the parathyroid glands during thyroid operations, and to investigate possible risk factors and post-thyroidectomy complications using a descriptive design in a university hospital setting. Hospital records for all thyroidectomies performed in the period between 1st February 2004 and 31 January 2008 for Incidence of incidental extirpation of the parathyroid glands during thyroid operations and post-thyroidectomy hypocalcemia were reviewed. Results showed that incidental parathyroidectomy occurred in 8.6%. Most of the excised parathyroid tissues were extracapsular. Malignant thyroid disease was a risk factor. Extent of surgery, age and sex were not risk factors for incidental parathyroidectomy. Results also showed that incidental parathyroidectomy was associated with transient hypocalcemia.

Outcome of protracted hypoparathyroidism after total thyroidectomy

Although the variables that influence the development of post-thyroidectomy hypocalcaemia are now better understood, the risk factors and long-term outcome of persistent hypoparathyroidism (HPP) are poorly defined. A retrospective review of a prospective protocol for the management of post-thyroidectomy hypocalcaemia was performed. Patients with a serum calcium level below 8 mg/dl (2 mmol/l) 24 h after total thyroidectomy were prescribed oral calcium with or without calcitriol and followed for at least 1 year. Protracted HPP was defined as an intact parathyroid hormone (iPTH) level below 13 pg/ml and need for calcium medication at 1 month after thyroidectomy. Of 442 patients (343 with goitre, 99 with carcinoma) undergoing total thyroidectomy, 222 (50.2 per cent) developed postoperative hypocalcaemia. Eleven patients were lost to follow-up. Parathyroid function recovered in 131 patients within 1 month and 80 developed protracted HPP, which was associated with lymphadenectomy, fewer than three glands left in situ and incidental parathyroidectomy. Parathyroid function recovered within 1 year in 78 per cent of patients with protracted HPP. Factors associated with late recovery of parathyroid function were higher serum calcium and low but detectable iPTH levels 1 month after surgery. These factors were associated with higher calcitriol and calcium dosages at hospital discharge. Parathyroid autotransplantation did not protect against permanent HPP. Higher serum calcium levels at 1 month after total thyroidectomy are associated with recovery of parathyroid function. It is hypothesized that intensive medical treatment of hypocalcaemia-'parathyroid splinting'-may improve the outcome of patients with protracted HPP.

Risk Factors and Consequences of Incidental Parathyroidectomy during Thyroidectomy

The objectives of this retrospective study were to investigate the incidence, risk factors, and clinical significance of incidental parathyroidectomy during thyroidectomy. In this study, there were 315 patients who underwent thyroidectomy between 1996 and 2006. All the operations were performed by a single experienced surgeon (J.S.). Pathology reports on all specimens were reviewed and information regarding patient demographics, diagnosis, operative details, and postoperative complications were collected. A total of 315 thyroidectomies were performed: 101 total thyroidectomies (32.1%) and 214 subtotal thyroidectomies (67.9%). Two hundred and eighty patients were operated on for benign disease (88.9%) and 35 for malignant disease (11.1%). Incidental parathyroidectomy was identified in 32 cases (10.2%). Preoperative diagnosis of malignant disease (P = 0.009) and duration of the disease (P = 0.001) were significant predictors of incidental parathyroidectomy. Incidental parathyroidectomy was significantly correlated with postoperative hypoparathyroidism (P = 0.03). Transient postoperative hypoparathyroidism occurred in 18 cases (6%) and permanent in three cases (1%). The duration of the disease was the sole significant predictor of postoperative hypoparathyroidism (P < 0.001). Incidental parathyroidectomy seems to be the result of the use of extensive surgical procedures. The preoperative diagnosis of malignant disease and the delay of the operation, which leads to a more advanced thyroid disease, make the use of extensive surgical procedures necessary.

Assessment of risk factors of incidental parathyroidectomy during thyroid surgery: A prospective study

Objectives To determine the incidence, risk factors and clinical relevance of incidental parathyroidectomy during thyroidectomy. Methods A total of 207 consecutive patients with benign and malignant thyroid disorders undergoing unilateral or bilateral thyroidectomy were included prospectively in the present study. Patients were divided into two groups according to incidental parathyroidectomy. Results Two hundred and ten thyroidectomies were performed. Group A included 26 patients with incidental parathyroidectomy and group B included 181 patients without incidental parathyroidectomy. The parathyroid tissue in the resected specimens was found in intrathyroid (57.7%), extrathyroid (23.1%) and central node compartment (19.2%) sites. On multivariate analysis, two factors sustained their significance independently; reoperation for recurrent goitre ( p = 0.001) and concomitant central neck dissection ( p = 0.001). There was no statistically significant difference regarding the occurrence of postoperative hypocalcemia between the two groups ( p = 0.55). Conclusion Reoperation for recurrent goitre and concomitant central neck dissection for cancer thyroid may increase the risk of incidental parathyroidectomy. Incidental parathyroidectomy is not associated with symptomatic postoperative hypocalcemia. Most of removed parathyroid glands were intrathyroid, so incidental parathyroidectomy may be unavoidable.

Permanent hypocalcemia in patients operated for thyroid carcinoma

The incidence and risk factors for permanent hypocalcemia in thyroid carcinoma were investigated. The 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 verified 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% confidence 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. 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.

Alternative Surgery for Low Grade Thyroid Malignancies

Traditional surgery for thyroid nodule is usually performed via anatomic localization of the recurrent laryngeal nerve (RLN), inferior thyroid artery and parathyroid glands (PTGs) initially. Due to the RLN constantly lying beneath the thyroid gland and low grade malignancy of well-differentiated thyroid cancer (WDTC), it is not necessary to find the nerve initially and impossible to make too deep resection. From May 1998 to July 2005, 33 patients with WDTC underwent total thyroidectomy along the capsule with or without modified radical neck dissection without identifying the RLN and PTGs initially. The isthmus, capsular vessels and Berry's ligament were cut from above and the RLN could be found lying in the surgical bed. The PTGs could be found when the thyroid was retracted medially and removed. The patients were followed-up until December 2007. The safety of the method, complications and clinical outcomes were evaluated. For the patients with WDTC, only one patient (3%) had transient vocal palsy. Incidental parathyroidectomy was found in six (18%) patients, resulting in two (6%) with temporary and two (6%) with permanent hypocalcemia. Only one 86-year-old woman died of disease recurrence; the other patients remained disease-free. Total thyroidectomy for WDTC without identifying the RLN and PTGs initially is an easy and safe alternative method.

The impact of age, vitamin D 3 level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy

Background Hypocalcemia caused by transient or definitive hypoparathyroidism is the most frequent complication after thyroidectomy. We aimed to compare the impact of incidental parathyroidectomy and serum vitamin D 3 level on postoperative hypocalcemia after total thyroidectomy (TT) or near total thyroidectomy (NTT). Patients Two hundred consecutive patients with nontoxic multinodular goiter treated by TT and NTT were included prospectively in the present study. Group 1 (n = 49) consisted of patients with a postoperative serum calcium level ≤8 mg/dL, and group 2 (n = 151) had a postoperative serum calcium level greater than 8 mg/dL. Patients were evaluated according to age, preoperative serum 25-hydroxy vitamin D (25-OHD) levels, postoperative serum calcium levels, incidental parathyroidectomy, and the type of thyroidectomy. Results Patients in group 1 (n = 49) were hypocalcemic, whereas patients in group 2 (n = 151) were normocalcemic. Preoperative serum 25-OHD levels in group 1 were significantly lower than in group 2 ( P < .001). The incidence of hypoparathyroidism was significantly higher following TT (13.5%) than following NTT (2.5%) ( P < .05). The risk for postoperative hypocalcemia was increased 25-fold for patients older than 50 years, 28-fold for patients with a preoperative serum 25-OHD level less than 15 ng/mL, and 71-fold for patients who underwent TT. Incidental parathyroidectomy did not have an impact on postoperative hypocalcemia. The highest risk of postoperative hypocalcemia was found in the patients with all of the above variables. Conclusions Age, preoperative low serum 25-OHD, and TT are significantly associated with postoperative hypocalcemia. Patients with advanced age and low preoperative serum 25-OHD levels should be placed on calcium or vitamin D supplementation after TT to avoid postoperative hypocalcemia and decrease hospital stay.