Parathyroid Injury Research Articles

Changes in thyroid antibody and T lymphocyte subsets after radiofrequency ablation of thyroid nodules in patients with autoimmune thyroiditis.

The aim was to study the changes in thyroid antibody and T lymphocyte subsets after radiofrequency ablation (RFA) of thyroid nodules in patients with autoimmune thyroiditis. Patients (n = 135) with autoimmune thyroiditis and thyroid nodules were treated by RFA. The indices of thyroid function and thyroid antibody and T lymphocyte subsets were examined preoperation and on the 1st day and the 1st month after ablation. Any complications were recorded. The software SPSS 17.0.0 (version: 2008-8-23) running under Windows 8 was used for statistical analysis. The measurement data were expressed as x ± s, with P < 0.01 indicating a significant difference in the statistical data. Levels of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were in the normal range before ablation, and no significant changes occurred on the 1st day or in the 1st month after ablation. The change in the percentage of CD8+T cells and the absolute value of B cells were not statistically significant (P > 0.01), and the values were in the normal range. Compared with values recorded preoperation, the value of TG-Ab, TPO-Ab, CD4+/CD8+, the percentage of CD4+T cells, the absolute values of lymphocytes, T cells, CD4+T cells, and CD8+T cells decreased significantly at the 1st day after ablation (P < 0.01) and then recovered to preoperative levels during the first 30 days after ablation (P > 0.01). Within 1 month after ablation, none of the patients had complications such as active bleeding, infection, recurrent laryngeal nerve injury, parathyroid gland injury, skin scald, and so on. After RFA of thyroid nodules in patients with autoimmune thyroiditis, thyroid function is not affected and no serious complications occurred. TG-Ab and TPO-Ab levels can be significantly decreased, and the distribution of T lymphocyte subsets can be changed in the short term after ablation.

Study of the risk factors for post-operative hypocalcemia after thyroid surgery

Background: Hypocalcemia is still a common post-operative consequence following total thyroidectomy, generating potentially serious symptoms and concern in patients and lengthening hospital stays. This study was conducted to evaluate the risk factors for post-operative hypocalcemia after thyroid surgery.Methods: In this study, 60 patients who underwent thyroidectomy were included. Patients with concomitant lymph node dissection and hypocalcemia were excluded from the study. Serial serum calcium measures were taken and information about the operation, such as the patient's age and gender, whether the inferior thyroid artery was ligated or not, and the pathological report.Results: In 60 patients, 17 patients were had post-operative hypocalcemia. 3 in 5 patients (60%) with Hashimoto thyroiditis had hypocalcemia, followed by toxic multinodular goiter (MNG) (37.5%), thyroid adenomas (33.33%) and Graves’ disease (33.33%) had hypocalcemia after thyroidectomy.Conclusions: To conclude, hypocalcemia is a common side effect of total thyroid surgery, and it is caused by the unintentional removal of parathyroid glands or injury or spasm of the blood arteries that supply them.

Analysis of Risk Factors for Surgical Complications of Endoscopic Thyroidectomy via Total Areola Approach.

BackgroundIncreased surgical technology has led broad acceptance endoscopic thyroidectomy and its application in the treatment of thyroid diseases, including thyroid carcinoma. Although the incidence of complications and mortality of thyroid surgery has been significantly reduced, serious complications still occur from time to time. The purpose of this retrospective study is to identify the factors that influence the complications of endoscopic thyroidectomy.MethodsThis study was carried out between January 2012 and December 2019, where a total of 630 patients undergoing endoscopic thyroidectomy via the total areola approach were retrospectively evaluated to identify the key influencing factors of complications.ResultsThe study established that the common complications included recurrent laryngeal nerve injury (3.33%), superior laryngeal nerve injury (2.54%), hypocalcemia (8.57%), and the incidence of complications was acceptable. Both univariate and multivariate analysis showed that thyroid carcinoma (P = 0.041), operation time lasting more than 150 minutes (P = 0.034) and operation before 2017 (P = 0.001) were risk factors of recurrent laryngeal nerve injury. We established that operation after 2017 (P < 0.005) was the only protective factor of superior laryngeal nerve injury. Thyroid carcinoma (P=0.04), operation mode (P=0.001), and surgery before 2017 (P<0.001) are risk factors for parathyroid injury. Among the clinical groups, operation before 2017 was an independent risk factor for all complications.ConclusionFor thyroid specialists, after the early learning curve, with the continuous improvement of endoscopic operation technology, high-definition equipment and more sophisticated operation equipment can be used in clinical practice, which can prevent and reduce the occurrence of complications.

Preliminary Study on the Clinical Significance and Methods of Using Carbon Nanoparticles in Endoscopic Papillary Thyroid Cancer Surgery.

Purpose The purpose of this study was to find the clinical significance and methods of using CN in endoscopic treatment for PTC. Materials and Methods A total of 108 cases were randomly enrolled and divided into two groups, with 50 cases in the CN injection group who were injected with CN and 58 cases in the control group with no CN injection. All cases were analyzed with the size of carcinoma, the number of lymph node, and parathyroid gland injury. Results All operations were successfully completed. The lymph node dissection number was 274 for the control group and 322 (the rate of black stained was 87%) for the CN injection group. The average number of lymph nodes in the CN injection group was 6.44 ± 2.08, which was significantly higher than that in the control group (4.72 ± 1.89). The control group had a relatively higher incidence of incidental parathyroidectomy, compared to the CN injection group (27.6% in the control group vs. 12% in the CN injection group, P=0.045). However, the incidence of hypoparathyroidism failed to show the significant difference between the two groups. Conclusion Using CN in endoscopic PTC surgery could increase the detection rate of lymph nodes and reduce the injury of parathyroid glands to a certain extent.

Parathyroid gland injury after total thyroidectomy in Fayoum University Hospitals, Egypt

Background/aim The incidences of transient and permanent hypocalcemia range from 2 to 32% (1–3) and 0.2 to 13% (3, 4), respectively, in patients who have undergone total thyroidectomy. The aim of the present work is to determine the incidence of parathyroid gland injury in total thyroidectomy operations in Fayoum University Hospitals. Patients and methods This study was carried out as a prospective study on 50 patients who presented with goiter with formal surgical indication for a total thyroidectomy operation. They were evaluated, operated and included in this study in the period from April 2019 to November 2019. Patients were examined at our outpatient general surgery clinic in Fayoum University. Results About nine patients (18.0%) developed manifestations of hypocalcemia within the first 24 h postoperatively after thyroidectomy; there was a statistically significant relation between recurrence and hypocalcemia status, with P=0.016. The incidence of hypocalcemia in patients with recurrent goiter was much higher than in those with de-novo goiter (75 vs. 13%). Conclusion Post-thyroidectomy hypoparathyroidism due to parathyroid gland injury is believed to have a multifactorial background including the experience of the operator, the surgical technique and some risk factors of the patients (age and sex); all these factors have contributed to its incidence in the current study.

Analysis of the factors for the lymph node metastasis in rⅥb region of thyroid micropapillary carcinoma and the application value of intraoperative nano-carbon

Objective:To investigate the relationship between lymph node metastasis in rⅥb region and pathological features of papillary thyroid microcarcinoma, and the application value of carbon nanoparticles in the operation for lymph node dissection in rⅥb region. Method:One hundred and seventy-five patients were divided into carbon nanoparticles group and the control group depending on whether carbon nanoparticles were used in the operation. The operation time, the number of central lymph node, the number of rⅥb region lymph node, hypocalcaemia symptom complex and hoarseness after the operaion were compared between the two groups. The lymph node metastasis in the rⅥb region and the pathological features of papillary thyroid microcarcinoma were statistically analyzed. Result:The amount of lymph nodes in Central District and rⅥb region was increased and the probability of parathyroid gland injury was decreased by using nano-carbon. The positive rate of lymph nodes in rⅥb region was not related to age, sex, aspect ratio of nodules and microcalcification, but was related to the tumor size, multifoci and the invasion of the capsule. The evaluation model of lymph node metastasis in rⅥb region was established based on the above three correlative features of color doppler ultrasound. The ROC curve analysis showed that the model had high application value . Conclusion:The tumor size, multiple foci and capsule invasion are risk factors for lymph node metastasis in rⅥb region of thyroid micropapillary carcinoma.

Clinical application of carbon nanoparticles suspension in operation of papillary thyroid carcinoma

Objective:The aim of this study is to evaluate the application of carbon nanoparticle lymphatic tracer in total thyroidectomy and bilateral Central District's thyroidectomy for papillary thyroid carcinoma. Method:Sixty-four patients with cN0 papillary thyroid carcinoma that primary treated were random divided into two groups: Trial group and control group. Carbon nanoparticles suspension was injected into the thyroid gland of trial group patients.After ten minutes, total thyroidectomy plus bilateral central neck dissection was performed in the all patients. The black stained tissue in the dissection specimen of trial group was separated. The control group underwent total thyroidectomy plus bilateral central neck dissection. Total lymph node and parathyroid gland in the black stained tissue，and non-black stained tissue in the central compartment dissection specimen of trial group and central compartment dissection specimen of control group were counted respectively.Total lymph node, the mis-cut parathyroid glands in the adipose tissue of central lymph node，post-operative blood calcium and parathyroid hormone（PTH）of two groups were contrasted and analyzed. Result:There are 235 lymph nodes in the black-stained tissue of central compartment dissection specimen of trial group.No parathyroid gland was found in the black-stained tissue.Five lymph nodes and 2 parathyroid glands were found in the non-black stained tissue of central compartment dissection specimen of trial group. There were 164 lymph nodes and 9 parathyroid glands in central compartment dissection specimen of control group. There is statistic difference between the number of lymph nodes in black stain tissue and that of control group（t=8.291, P=0.000）.Rate of staining lymph node were 97.9 percent. No parathyroid glands were found in the black stained tissue. Nine mis-cut parathyroid glands（7.0%） were observed in the control group，while 2（1.6%） in the trial group（P<0.05）.None permanent hypocalcemia and PTH decrease were observed in the two groups.There were 10 patients（31.3%） with temporary hypocalcemia and 9 patients（28.1%）with temporary PTH decrease respectively in the control group，and there was 1 patient（3.1%） and 1 patient（3.1%） respectively in the trial group（P<0.05）. Conclusion:The effect of nano-carbon is ideal, and the parathyroid gland can not be stained black. It can distinguish the thyroid tissue from the surrounding lymphoid adipose tissue and clearly mark the Central District lymph nodes, reduce the risk of parathyroid gland injury during thyroid cancer. Neck dissection in the central region can improve the efficiency of lymph node dissection, protect the parathyroid gland and reduce the risk of postoperative complications.

Comparison of Harmonic Scalpel versus conventional hemostasis in Thyroid surgery in terms of per-operative and postoperative outcome.

Harmonic scalpel is popular for use in a variety of surgical procedures including thyroid surgery. Proposed advantages of the harmonic scalpel include less lateral thermal tissue damage with no electrical energy transferred to the patient, no neuromuscular stimulation, less smoke formation as compared with electrocautery. Objectives: Our aim was to compare outcomes following thyroid surgery in terms of operative time, postoperative pain, drainage volume, recurrent laryngeal nerve and parathyroid gland injury with the use of the Harmonic Scalpel compared to conventional methods of hemostasis. Study Design: Randomized control trial. Setting: Surgical Department Lahore General Hospital. Period: Twelve Months June 2016 to June 2017. Material &amp; Methods: 60 patients, 30 in each group. Patients were randomized in each group by balloting method. Operative time, postoperative pain and drainage volume was assessed during hospital stay. Recurrent laryngeal nerve and parathyroid gland injury was assessed during hospital stay and follow-up. Results: There was no significant difference in development of hoarseness of voice in both groups, p-value &gt; 0.05. The mean operative time for group A was 69.47 ± 15.44 minutes and for group B it was 54.93 ± 11.56 minutes, p-value &lt;0.05. The overall blood loss in group-A and group-B was 118.73 ± 50.72 ml and 44.60±10.70 ml, p-value&lt;0.05. The mean post-op pain observed at 2nd day for group B was 2.93 ±3.57 and for group A it was 3.57±0.77, p-value &lt; 0.05. Conclusion: Use of Harmonic Scalpel has better results in thyroid surgery in terms of less operative time, less postoperative pain, less drainage volume, while no RLN &amp; parathyroid injury detected in either group.

Ultrasonography of Injury to the Parathyroids During a Thyroidectomy

Objective: Explore the characteristics of parathyroid injury during thyroid surgery and the potential for sonography to reduce the risk of parathyroid injury. Methods: Retrospective analysis was conducted on 39 patient cases, with parathyroid injury (including 29 cases of total thyroidectomy plus central lymph node dissection and 10 cases of total thyroidectomy). Sonography and related medical laboratory testing were performed pre- and postsurgery. Clinical symptoms and associated postsurgical gland changes were compared and analyzed according to the relevant laboratory values. Results: The patient case review demonstrated that the total number of glands decreased by 43 compared with preoperation, with 25 glands in the upper pair and 18 glands in the lower. There were 33 glands with uneven echo and blurred edges, with 20 in the upper pair and 13 in the lower pair. The damage rate of the upper gland (45/76) was higher than that of the lower gland (31/76) ( P &lt; .05). A total of 69.7% (23/33) of gland blood flow signals were reduced compared with preoperation, of which 10 showed uneven enhancement when the contrast-enhanced ultrasound reached its peak. Conclusion: Thyroid surgery can easily damage parathyroid glands, especially during a total thyroidectomy, with lymph node dissection. Sonography of the parathyroid glands in patients with postoperative hypocalcemia can provide imaging surveillance and mitigate the damage of these glands postsurgically.

Evaluation of intracapsular total thyroidectomy as a safe method in benign thyroid diseases

Background: Intracapsular total thyroidectomy is a rising new technique in management of benign thyroid disease seeking for safety. Our aim in this study is to evaluate safety and effectiveness of intracapsular technique in treatment of benign thyroid disease.Methods: this prospective study was carried out in department of general surgery, Menoufia University hospital and department of general surgery, Tala central hospital; from June 2018 to April 2019 on 58 patients with benign thyroid disease all had undergone intracapsular total thyroidectomy.Results: 58 patients underwent intracapsular total thyroidectomy. There was no recurrent laryngeal nerve injury either transient or permanent and no external laryngeal nerve injury. There was no parathyroid injury or hypoparathyriod complications.Conclusions: Intracapsular total thyroidectomy is a safe method in treatment of benign thyroid disease and can be done easily in central hospitals and non-highly specialized centres.

Hypothyroidism following hemithyroidectomy: a study in a tertiary care hospital, Chittagong, Bangladesh

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hypothyroidism results from insufficient production and secretion of thyroid hormones. This may be due to disturbance within the thyroid gland itself (primary hypothyroidism) or within the hypothalamic-pituitary-thyroid axis (secondary hypothyroidism). The objective of this study is to determine the incidence, risk factors and management of hypothyroidism occurring after hemithyroidectomy for benign non-toxic thyroid disease.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We conducted a prospective cross sectional study of 50 euthyroid patients with benign non-toxic thyroid disease who had undergone hemithyroidectomy from January 2012 to December 2012 admitted in the department of otolaryngology and Head Neck Surgery, Chittagong Medical College Hospital. All patients were evaluated for age, sex, pre-operative and post-operative TSH levels, histopathology and follow up. Time of diagnosis and therapeutic dose of thyroid hormone were determined for patients with hypothyroidism. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; As per this study, the incidence of permanent nerve damage was zero whereas the incidence of temporary neuropraxia was found to be around 0.5%. The incidence of temporary and permanent hypocalcemia was found to be around 0.7% and 0.2% respectively. These complications were found more in obese patients and those with malignancies.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.&lt;/p&gt;

Changes in the hearing threshold using high frequency audiometry in medical personnel exposed to ionizing radiation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Effect on sensorineural hearing loss by low dose ionizing radiation exposure in radiation workers has been rarely evaluated. A case control study was done among the radiation associated workers and normal subjects.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was designed in low dose of radiation exposing healthy medical personnel. Age and sex matched healthy control group of subjects were selected. Groups were evaluated by normal otoscopic evaluation; normal tuning fork test and normal standard pure tone audiogram at frequencies from 250 to 8000 Hz. They underwent impedance audiometry, transient evoked otoacoustic emissions, and high frequency audiometry (from frequencies 10000 to 20000 Hz) was done. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; No statistically significant difference was found in the results of impedance audiometry, transient evoked otoacoustic emissions and standard pure tone audiogram from 250 to 8000 Hz between cases and controls. In the high frequency range, statistically significant difference was observed (p=0.0001). Mean thresholds were higher at all frequencies in cases compared to controls, except at 4000 Hz. A statistically significant correlation was found between duration of exposure and thresholds at 500 Hz (p=0.014) and 10000 Hz (p=0.048). Tinnitus, vertigo, ear block, hard of hearing and loss of appetite were seen more in cases, but was not significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.&lt;/p&gt;

Application of carbon nanoparticle in neck Ⅵ lymph node dissection for papillary thyroid carcinoma

Objective:To investigate the application value of carbon nanoparticle lymph tracer in Ⅵ lymph node dissection for papillary thyroid cancer.Method:One hundred and forty-eight patients with papillary thyroid cancer from October 2015 to May 2016 were enrolled into the retrospective analysis. Seventy-five cases with carbon nanoparticle injected in operation were divided into observation group, while the other seventy-three cases without lymph tracer were divided into control group. The number of neck Ⅵ lymph nodes and metastatic lymph nodes between the two groups were compared, as well as the incidence of parathyroid injury and postoperative hypocalcemia. Result:There were no significant difference in age, gender, tumor size, pathology or type of operation between the two groups(P>0.05). Parathyroid injury incidence in the observation group significantly lower than the control group (5.33% vs 5.33%, P< 0.05). There was significant difference in the number of neck Ⅵ lymph node dissection between the two groups (observation group: 6.51±4.65, control group: 4.42±3.10, P< 0.05).Conclusion:Carbon nanoparticle injected as a lymph tracer in thyroid surgery is helpful, the characteristics of the parathyroid gland negative imaging can effectively decrease the rate of parathyroid gland injury.

Hypoparathyroidism after thyroidectomy: prevention, assessment and management.

Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy and it can cause significant morbidity and increased costs. Its incidence varies from 30% to 60%. The surgical technique and the extent of thyroidectomy are related to parathyroid injury and hypoparathyroidism. The glands should be identified in situ, carefully manipulated and preserved, as well as their vascularization. In case of incidental removal, routine autotransplantation is advocated. Low calcium levels, identification of fewer than two parathyroid glands at surgery, reoperation for bleeding, Graves disease and heavier thyroid specimens were considered independent predictors of permanent hypocalcemia. Intraoperative parathyroid hormone (PTH) measurements allows the early detection of hypocalcemia. Treatment is recommended for patients with symptoms of hypocalcemia or corrected serum calcium < 7.5 mg/dL. Acute hypocalcemia is treated with either oral calcium or an intravenous infusion. The goal is to preserve serum calcium in the low normal or mildly subnormal levels. Hypocalcemia symptoms should be considered a medical emergency. Treatment with PTH has been recently performed for the management of cases not adequately controlled with conventional therapy. Hypoparathyroidism is the most common long-term complication after total thyroidectomy. Adequate recognition and management decrease its morbidity and costs.

Preoperative vitamin D level as predictor of post-thyroidectomy hypocalcemia in patients sustaining transient parathyroid injury.

Several studies have sought to identify predictors of postoperative hypocalcemia after total thyroidectomy; however, there have been conflicting results regarding the impact of preoperative vitamin D deficiency. The medical records of patients undergoing total thyroidectomy were retrospectively reviewed. The number of parathyroid glands identified or reimplanted at the time of surgery was used as a marker of transient parathyroid gland damage. Sixty-seven patients were included in the study. Vitamin D deficiency was a significant predictor of hypocalcemia in patients in whom ≥3 parathyroid glands were identified, but not in patients in whom 0-2 parathyroid glands were identified intraoperatively (odds ratio [OR] 5.8; P = .036). Vitamin D deficiency is a significant predictor of postoperative hypocalcemia in patients in whom ≥3 parathyroid glands are identified intraoperatively, but not in patients who sustain minimal transient damage to the parathyroid glands.

Review of Hypoparathyroidism.

Hypoparathyroidism is a rare endocrine disorder in which parathyroid hormone (PTH) production is abnormally low or absent, resulting in low serum calcium and increased serum phosphorus. The most common cause of hypoparathyroidism is parathyroid gland injury or inadvertent removal during thyroid surgery. Current treatments include supplementation with calcium and active vitamin D, with goal albumin-corrected serum calcium level in the low-normal range of 8–9 mg/dl. Complications of the disease include renal dysfunction, nephrocalcinosis, kidney stones, extracellular calcifications of the basal ganglia, and posterior subcapsular cataracts, as well as low bone turnover and increased bone density. Until January 2015, hypoparathyroidism was the only classic endocrine disease without an available hormone replacement. Recombinant human PTH 1-84, full-length PTH, is now available for a selected group of patients with the disease who are not well controlled on the current standard therapy of calcium and active vitamin D. In addition, the role of PTH replacement on quality of life, intracerebral calcifications, cataracts, improving bone turnover, and reduction of renal complications of the disease remains to be further investigated.

Recognition of sentinel lymph nodes in patients with papillary thyroid cancer by nano-carbon and methylene blue.

Objective:To compare the accuracy and feasibility of methylene blue and nano-carbon in clinical tracing of sentinel lymph nodes (SLNs) in patients with papillary thyroid cancer (PTC).Methods:Ninety-six PTC patients were selected and randomly divided into a methylene blue group and a nano-carbon group (n=48). During surgery, tracer agent was injected around the tumor, and SLNs were resected and subjected to frozen pathological examination. The results were compared with those of routine pathological examination after surgery.Results:Latent lymph node metastasis (level VI and lateral neck) was detected in both groups, with neck distribution of SLNs. There was no significant difference in the detection rate or accuracy of SLNs between two groups (P>0.05). The incorrect resection rate of parathyroid gland and incidence of temporary hypoparathyroidism in the methylene blue group were significantly higher than those of the nano-carbon group (t=4.137, P<0.05).Conclusions:The state of PTC lymph nodes can be well evaluated by SLN biopsy using both methylene blue and nano-carbon as tracers, but using nano-carbon has a lower incidence rate of parathyroid injury, with great clinical prospects accordingly.

Identifying Parathyroid Glands With Carbon Nanoparticle Suspension Does Not Help Protect Parathyroid Function in Thyroid Surgery: A Prospective, Randomized Control Clinical Study.

Objective We aim to evaluate the technique of identifying parathyroid glands with carbon nanoparticle suspension (CNPS) in thyroid surgeries from the perspectives of degrees of declining intact parathyroid hormone (iPTH), operation time, and time of postoperative stay. Methods A total of 156 patients who underwent thyroid surgeries in General Surgical Department of Xiangya Hospital between May 2012 and May 2015 were involved in the study. A total of 78 patients were injected with CNPS during the surgery (CNPS group); the other 78 patients received normal saline (control group). Cases were classified into 3 surgical approaches: conventional partial thyroidectomy, conventional total thyroidectomy, and endoscopic partial thyroidectomy. Degrees of declining iPTH were tested to determine the severity of parathyroid injury. Operation time and postoperative hospital stay time were recorded. A P value of less than .05 was considered statistically significant. Results For levels of declining iPTH, there was no statistically significant (ss) difference in conventional thyroid surgery. In endoscopic partial thyroidectomy, it was 23.37 ± 16.20 versus 11.94 ± 11.23 pg/mL (P = .02, ss). The operation time of conventional total thyroidectomy was 210.10 ± 83.75 versus 164.84 ± 69.22 minutes (P = .03, ss), while it was 193.04 ± 75.53 versus 127.67 ± 60.06 minutes (P = .007, ss) in endoscopic thyroidectomy. Conclusions CNPS is not beneficial for protecting the function of parathyroid gland in thyroid surgery from the perspective of declining iPTH. Applying CNPS in conventional total thyroidectomy and endoscopic partial thyroidectomy will also lead to significantly prolonged operation time.

Towards automated spectroscopic tissue classification in thyroid and parathyroid surgery

In (para-)thyroid surgery iatrogenic parathyroid injury should be prevented. To aid the surgeons' eye, a camera system enabling parathyroid-specific image enhancement would be useful. Hyperspectral camera technology might work, provided that the spectral signature of parathyroid tissue offers enough specific features to be reliably and automatically distinguished from surrounding tissues. As a first step to investigate this, we examined the feasibility of wide band diffuse reflectance spectroscopy (DRS) for automated spectroscopic tissue classification, using silicon (Si) and indium-gallium-arsenide (InGaAs) sensors. DRS (350-1830 nm) was performed during (para-)thyroid resections. From the acquired spectra 36 features at predefined wavelengths were extracted. The best features for classification of parathyroid from adipose or thyroid were assessed by binary logistic regression for Si- and InGaAs-sensor ranges. Classification performance was evaluated by leave-one-out cross-validation. In 19 patients 299 spectra were recorded (62 tissue sites: thyroid = 23, parathyroid = 21, adipose = 18). Classification accuracy of parathyroid-adipose was, respectively, 79% (Si), 82% (InGaAs) and 97% (Si/InGaAs combined). Parathyroid-thyroid classification accuracies were 80% (Si), 75% (InGaAs), 82% (Si/InGaAs combined). Si and InGaAs sensors are fairly accurate for automated spectroscopic classification of parathyroid, adipose and thyroid tissues. Combination of both sensor technologies improves accuracy. Follow-up research, aimed towards hyperspectral imaging seems justified. Copyright © 2016 John Wiley & Sons, Ltd.

Outcomes of Capsular Dissection Technique with Use of Bipolar Electrocautery in Total Thyroidectomy: A Rural Tertiary Center Experience.

Total thyroidectomy is one of the most routinely performed head and neck surgical procedures with extremely low mortality. This procedure has been associated with two major complications such as recurrent laryngeal nerve injury and hypocalcaemia due to parathyroid insufficiency. The use of bipolar electrocautery has not been widely accepted in view of thermal damage to adjacent structures. To study the outcomes and complications of capsular dissection technique along with use of bipolar electrocautery in total thyroidectomy. The study was conducted from May 2013 to May 2016. The study was performed at Department of ENT Otorhinolayngology, DM WIMS Hospital, Wayanad, Kerala, India. This retrospective descriptive study analysed the outcome of 130 patients who underwent total thyroidectomy by capsular dissection technique along with use of bipolar electrocautery for cauterization of vascular pedicles, at our institution over a 3 year period. The incidence of permanent unilateral vocal cord palsy was 1.5% and permanent hypocalcaemia was 2.3%. There was no case of haemorrhage or haematoma in this study. Total thyroidectomy by capsular dissection technique along with the use of bipolar electrocautery has very low incidence of recurrent laryngeal nerve and parathyroid injury, as per our data. Hence, we recommend this technique along with routine use of bipolar electrocautery for total thyroidectomy.