Ligation Of Inferior Thyroid Artery Research Articles

Effect of Truncal Versus Branch Ligation of Inferior Thyroid Artery on Postoperative Hypocalcemia Patients Undergoing Thyroid Surgery: Rawalpindi

Objective: To investigate the effect of truncal or branch ligation of the inferior thyroid artery on postoperative hypocalcemia. Study Design: Quasi-experimental study.Place and Duration of Study: The study was conducted at the Department of Surgery, Pak Emirates Military Hospital (PEMH), Rawalpindi, Pakistan from July 2021 to June 2022.Methods: For this study, 60 patients were enrolled who underwent total thyroidectomy at the Department of Surgery from July 2021 to June 2022. Patients were divided into Group 'A' and Group 'B', with an equal number of 30 patients in each group. Patients in group 'A' underwent bilateral ITA ligation at the trunk, while patients in group 'B' underwent ligation of terminal branches of ITA on the gland capsule. The primary outcome was postoperative hypocalcemia on 1 postoperative day.Results: Our results showed a significant difference in hypocalcemia in both groups. Decreased incidence of biochemical hypocalcemia was found in branch ligation of ITA (3.33%) than trunk ligation (36.36%) P value 0.025.Conclusion: Branch ligation of ITA decreases the incidence of hypocalcemia after total thyroidectomy.
 How to cite this: Javed R, Butt MQ, Tariq M, Qamar R, Bukhari ST. Effect of Truncal Versus Branch Ligation of Inferior Thyroid Artery on Postoperative Hypocalcemia Patients Undergoing Thyroid Surgery: Rawalpindi. Life and Science. 2023; 4(4): 452-457. doi: http://doi.org/10.37185/LnS.1.1.366

Effect of Microdissection of Inferior Thyroid Artery on Post-operative Hypocalcemia in Total Thyroidectomy.

Hypocalcemia is one of the most common complication after bilateral thyroid surgery. Reported rates range from 5 to 35% and 0.5 to 4.4% for transient and permanent hypocalcemia respectively. Various methods have been devised to reduce the post-operative hypocalcemia and range from modification of surgical techniques to use of loops and avoidance of inadverant neck dissections. We conducted a randomised control trial of 50 patients divided into two groups, to evaluate the effect of microdissection and ligation of distal branches of inferior thyroid artery (group B) on incidence of temporary and permanent hypocalcaemia in patients of total thyroidectomy versus its ligation distally close to the thyroid capsule(group A). Postoperative mean total serum calcium levels were lower in group A as compared to group B (9.13mg/dl vs. 9.33mg/dl at 24h; 8.77 vs. 9.10 at 3rd day and 8.58 vs. 8.96mg/dl on 10 th day) with p > 0.05. The value of ionized serum calcium as recorded on 3rd day was 4.39mg/dl for group A and 4.72mg/dl for group B with p value ≤ 0.001 (Table 2). 19 patients in group A required calcium supplementation for 6months with incidence of transient hypocalcemia at 76% while 11 patients in group B had calcium supplementation for 6months with incidence of 40% and difference was significant statistically. Microdissection technique is better for preventing the temporary hypocalcemia and hence decreasing the hospital visits of the patient when compared to the ligation of inferior thyroid artery distally close to the thyroid gland. The incidence of permanent hypocalcemia doesn't varies significantly between both techniques.

Truncal Ligation of Inferior Thyroid Artery Does Not Affect the Incidence of Hypocalcaemia After Central Compartment Lymph Node Dissection.

Preserving all parathyroids with intact blood supply in situ is a desirable goal while performing total thyroidectomy (TT) and central compartment dissection (CCLND), but the same is not feasible in presence of bulky and/or matted lymph nodes in the central compartment. The aim of this study was to investigate the difference in incidence of postoperative hypocalcemia between the groups of papillary thyroid carcinoma (PTC) patients who had truncal ligation (TL) versus ligation of peripheral branches (PL) of inferior thyroid artery (ITA) during TT and CCLND. Retrospective review of prospectively kept data of PTC patients undergoing TT and CCLND. Patients were divided in two groups: Group 1-(n = 57) patients who had to undergo TL and Group 2-(n = 99) patients having PL. Clinico-pathologic profile, operative details and follow-up events were noted. Clinico-pathologic profile of both groups was comparable except for higher incidences of tumor multicentricity (p = 0.014) in Group 1. There was no significant difference in the number of parathyroids identified between the Groups (p = 0.556) but more parathyroids were auto-transplanted in Group 1 (p = 0.001). The incidence of temporary (77.2% vs 83.8, p = 0.304) and permanent hypocalcemia (7% vs 8.1%, p = 0.810) was not significantly different between the groups and neither was need for intravenous calcium. At discharge, Group 1 patients received lower dose of calcium (p = 0.001) but not of vitamin D (p = 0.769). TL of ITA during CCLND does not result in increased temporary or permanent hypocalcemia rate.

The Effect of Truncal/Terminal Ligation of Inferior Thyroid Artery on Hypocalcemia after Total Thyroidectomy

Hypocalcemia following thyroidectomy is often associated with iatrogenic injury to the blood supply of or inadvertent removal of parathyroid glands. Blood supply of all parathyroids mainly comes from inferior thyroid artery (ITA). Truncal ligation of ITA may cause an ischemic injury to the parathyroid glands theoretically. The aim of this study is to investigate the effect of truncal/terminal ligation of ITA on postoperative hypocalcemia. A total of 139 patients who underwent total thyroidectomy were included in the study. The patients were classified as terminal ligation of ITA (group 1) and truncal ligation of ITA (group 2). The development of hypocalcemia was compared between the two groups. Seventy-one (45.7%) patients were in group 1, while 68 (48.9%) patients were in group 2. The two groups were similar in terms of age, gender, preoperative calcium and vitamin D levels, and final histopathology (p > 0.05). Both biochemical (p = 0.017) and symptomatic (p = 0.028) hypocalcemia were found less in group 1 than in group 2. Terminal ligation of ITA is associated with higher postoperative parathormon and calcium levels. Ligation of ITA close to the thyroid capsule seems to be important to reduce the chance of postoperative hypocalcemia.

Terminal or truncal ligation of the inferior thyroid artery during thyroidectomy? A prospective randomized trial

IntroductionThyroidectomy is a common procedure in general and endocrine surgery. The technique of ligation of inferior thyroid artery (ITA) has been invoked as a possible cause of appearance of postoperative hypocalcemia. MethodsWe performed a prospective randomized study involving 184 patients undergoing total thyroidectomy to evaluate the differences of truncal ligation versus distal ligation of ITA in terms of postoperative hypocalcemia, vocal fold palsy, voice and swallowing impairment. The patients were divided into group A (trunk ligation of ITA) and group B (terminal branches ligation of ITA). ResultsWe evaluated postoperative PTH and calcemia (immediate, 6 and 12 months after thyroidectomy), postoperative day of discontinuation of calcium and vitamin D supplementation, voice and swallowing complaints, evaluated by mean of two specific tests available in literature, day of hospital discharge. ConclusionThe only significant differences between the two groups were a higher immediate postoperative calcemia and a greater number of patients discharged without calcium and vitamin-D supplementation in the group B. In conclusion, no substantial differences were found between the two groups. The choice depends on the experience of the surgeon.

Prevention and treatment of emergencies in thyroid patients

Aim To evaluate the surgical treatment outcomes for patients with acute complications of thyroid disease (compression syndrome, early postoperative complications - like bilateral recurrent laryngeal nerve injure, bleeding (PB) in thyroid bed and others) performed in the single medical center. Material and methods Anaplastic Thyroid Cancer (243 patients), multiglandular retrosternal goiter (25 cases), and purulent acute thyroiditis (9 observations) made heavy compression of neck and mediastinal aerodigestive organs and were the reason for emergent thyroid surgery. Were estimated intraoperative recurrent nerve (RLN) injures consequences and postoperative bleeding, made necessary for reoperations after 25663 thyroid surgeries during 36 years of the Center practice. Results Surgical intervention for Anaplastic Thyroid Cancer in all of patients has got palliative character only. Postop. lethality rate made 21,0% after emergency interventions, and 2,5% - after routine procedure. Combinations of it with radiochemotherapy has prolonged survival rate up to 13 month in 25% of cases. Follow up results of thyroid surgery in 23777 patients has found unexpected and relevant unilateral RLN injures in 251 (1.0%) and bilateral – in 91 (0.38%) cases. Recurrent laryngeal nerves and larynges reconstruction surgery allow us to decanulate more that 75% those patients. Postoperative bleeding (PB) and thyroid bad hematomas were found in 138 больных (0.58%) patients. The most often PB happened in initial and recurrent DTG (1.07%, 0.94%), TC (0.82%) patients. In most (65.5%) of cases PB began during the first 6 hours. In case of PB we parted wound edges anywhere, intubated repeatedly trachea, inspected wound; performed hemostasis and drained wound. Main sources of PB were inferior (40.38%) or superior (17.30%) thyroid artery. Source was not found in 13.35%. PB prevention included: careful hemostasis with control lavage of the wound; fascia covering of the thyroid bed and high pressure test, ligation of inferior thyroid artery in doubtful cases. Conclusion Thyroid Surgery needs precise knowledge of skull base, neck and mediastinum anatomy, safety resection of thyroid, parathyroid, under RLN visual control, thorough hemostasis and closely postoperative watching for patients.

Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis.

A variety of measures have been proposed to reduce the incidence of post-thyroidectomy hypocalcemia. The aim of this study was to perform a systematic review and meta-analysis of preventive and other surgical measures on post-thyroidectomy hypocalcemia as reported in the literature. Comprehensive searches of the PubMed, EMBASE, and Cochrane databases were performed, and the quality of included papers was assessed using the Cochrane risk of bias tool or a modified Newcastle-Ottawa Scale (NOS). The results of all included studies were summarized, and meta-analyses were performed where appropriate. Thirty-nine randomized controlled trials (RCTs) and 37 observational studies were included. Measures studied included hemostatic techniques, extent of thyroidectomy and central neck dissection, surgical approach, calcium/vitamin D/thiazide diuretic supplements, parathyroid gland autotransplantation (PGAT) and intraoperative parathyroid gland (PG) identification, truncal ligation of inferior thyroid artery (ITA), preoperative magnesium infusion, and use of magnification loupes and Surgicel. Measures associated with significantly lower rates of transient hypocalcemia in meta-analysis were postoperative calcium and vitamin D supplementation compared to either calcium supplements alone (odds ratio (OR) 0.66; p=0.04) or no supplements (OR 0.34; p=0.007), and bilateral subtotal thyroidectomy (BST) compared to Hartley Dunhill (HD) procedure (OR 0.35; p=0.01). Meta-analyses did not demonstrate any measure to be significantly associated with a reduction in permanent hypocalcemia. This review identified postoperative calcium and vitamin D supplementation and bilateral subtotal thyroidectomy (over HD) as being effective in prevention of transient hypocalcemia. However, the majority of RCTs were of low quality, primarily due to a lack of blinding. The wide variability in study design, definitions of hypocalcemia, and methods of assessment prevented meaningful summation of results for permanent hypocalcemia.

Effectiveness of preventative and other surgical measures on hypocalcaemia following bilateral thyroid surgery: A systematic review and meta-analysis

Background: Hypocalcaemia following bilateral thyroid surgery is common and is associated with significant short and long term morbidity. The aim of this study was to perform a systematic review and meta-analysis of preventive and other surgical measures on post-thyroidectomy hypocalcaemia as reported in the literature. Methods: Comprehensive searches of PubMed, EMBASE, and Cochrane databases were performed and quality of included papers was assessed using the Cochrane risk of bias tool and a modified NewcastleOttawa Scale (NOS). The results of all included studies were summarised and meta-analyses were performed where appropriate. Results: 39 randomised controlled trials (RCTs) and 37 cohort studies were included. Measures studied included haemostatic techniques, extent of thyroidectomy and central neck dissection, surgical approach, calcium/vitamin D supplements, parathyroid gland auto-transplantation (PGAT) and intra-operative parathyroid gland (PG) identification, truncal ligation of inferior thyroid artery (ITA), and use of magnification loupes and surgical. Measures associated with significantly lower rates of transient hypocalcaemia in meta-analysis were postoperative calcium and vitamin D supplementation compared to either calcium supplements alone (odds ratio (OR) 0.66; 95 per cent confidence interval (CI) 0.45-0.98; p=0.05) or no supplements (OR 0.34; 95 per cent CI 0.15-0.75; p=0.007) and bilateral subtotal thyroidectomy (BST) compared to Hartley Dunhill procedure (HD) procedure (OR 0.35; 95 per cent CI 0.15-0.79; p=0.01). Meta-analyses did not demonstrate any measure to be significantly associated with a reduction in permanent hypocalcaemia. Conclusion: The review identified post-operative calcium and vitamin D supplementation and bilateral subtotal thyroidectomy (over HD) as being effective in prevention of transient hypocalcaemia. However, the majority of RCTs were of low quality, primarily due to lack of blinding. The wide variability in study design, definitions of hypocalcaemia and methods of assessment prevented meaningful summation of results for permanent hypocalcaemia.

The Role of Ligation of Inferior Thyroid Artery on Hypocalcemia in Thyroidectomies

The Role of Ligation of Inferior Thyroid Artery on Hypocalcemia in Thyroidectomies