Preservation Of Parathyroid Glands Research Articles

Application of Carbon Nanoparticles in Endoscopic Thyroidectomy via Bilateral Areola Approach: Total Thyroidectomy Plus Central Lymph Node Dissection.

Background: The aim of this report was dual: (a) to describe the step-by-step standardized intraoperative percutaneous injection of carbon nanoparticles (CNPs) procedure for CNP-stained central compartment lymph nodes (CLNs) and passive display of parathyroid gland by CNP-stained thyroid in endoscopic thyroidectomy via bilateral areola approach (ETBAA) and (b) evaluation and outcomes of percutaneous injection of CNPs in total thyroidectomy plus CLN dissection through ETBAA. Materials and Methods: Video describes the technique of intraoperative percutaneous injection of CNPs for central compartment LNs identification, dissection, and parathyroid glands preservation in ETBAA for papillary thyroid cancer. Results: Supplementary video shows that after intrathyroid injection of CNPs, black carbon can be seen rapidly along the lymphatic vessels to the surrounding LNs. Parathyroid gland can be passive display when the thyroid is black and the parathyroid gland is normal in color. Intraoperative neuromonitoring (Medtronic® NIM-Response 3.0) was applied to identify recurrent laryngeal nerve and external branch of superior laryngeal nerve. No patient had any side effects of CNPs from 152 patients followed up for an average of 19.6 months (6-34 months). LNs were easily found under ETBAA. The accuracy of black-dyed LN in thyroid cancers was 95.9% (1016/1059). The number of parathyroid glands passive display was 69.9% (267/382). Conclusions: It is feasible to use CNPs to show CLNs in thyroid cancer during ETBAA. CNP suspension is safe for thyroidal injection.

In situ preservation of parathyroid glands during thyroid surgery for prevention of hypoparathyroidism

Background: Hypoparathyroidism (HPT) is one of the most frequent and severe complications of thyroid surgery. It is caused by intraoperative damage, devascularization or accidental removal of the parathyroid glands (PTG). The incidence of postoperative HPT is directly proportional to surgery extent and surgeon’s experience. However, it can be significantly reduced by excellent surgical technique. The authors present original technique of in situ preservation of PTGs during thyroid surgery and 40-years-experience results in postoperative HPT.

A comparison of transoral vestibular and bilateral areolar endoscopic thyroidectomy approaches for unilateral papillary thyroid microcarcinomas.

IntroductionA transoral (TO) vestibular approach is a new remote access approach to avoid cutaneous scars in an endoscopic thyroidectomy (ET). And transoral endoscopic thyroidectomy (TOET) has been widely used in papillary thyroid microcarcinomas (PTMCs).AimTo evaluate and compare endoscopic thyroidectomies with central neck dissection using a bilateral areolar (BA) approach and TO approach in patients with unilateral PTMCs.Material and methodsIn total, 92 papillary thyroid cancer (PTC) patients undergoing an endoscopic unilateral thyroidectomy with central neck dissection via a TO (n = 48) or BA (n = 44) approach were retrospectively enrolled from August 2017 to December 2018. Differences in various factors, such as clinical characteristics, surgery-related parameters, including operative complications, and hospital durations and costs, were compared.ResultsNo significant between-group differences in the age and sex of the patients or the side, body mass index, total operative time, operative bleeding, superior parathyroid preservation in situ, operative complications, and postoperative day of discharge were found (all p > 0.05). The mean central neck dissection time, amount of postoperative drainage, extubation time, and inferior parathyroid preservation in situ were lower in the TO group as compared with these parameters in the BA group (all p < 0.05). The number of central lymph nodes resected and hospitalization costs were higher in the TO group as compared with those in the BA group (all p < 0.05).ConclusionsAn ET via the TO approach may be a good choice for unilateral PTMCs because of the shorter central neck dissection time, reduced postoperative drainage, better cosmetic satisfaction, and higher number of lymph nodes removed.

A Clinical Study and Management of Hypocalcemia Following Thyroid Surgery

Background Post-thyroidectomy hypocalcaemia is a serious complication. Hypocalcaemia may occur secondarily to surgical trauma, devascularisation, unintentional removal of parathyroid glands, reoperation. Surgery has been seen as a risk factor, as in total thyroidectomy there is potential blood supply involvement resulting from bilateral surgical manipulation. This study aims to prospectively study and analyse the incidence and possible causes of hypocalcaemia following thyroid surgery, and its management. Method and Mateirals Data was collected from the patients undergoing subtotal and near total thyroidectomies from November 2012 to October 2014 by evaluating and investigating meticulous and planned for surgery. They were follow-up on day one after surgery, at the time of discharge and 6 months after surgery for post-operative hypocalcaemia. Observation 6 out of 50 patients (12%) developed postoperative hypocalcaemia, there was no incidence of permanent hypocalcaemia. Near total thyroidectomy was performed in 35(70%) patients, 1 from them (2.86%) developed hypocalcaemia and the other 5 out of 14 cases (35.71%) underwent total thyroidectomy. The hypocalcaemia was 9% in multinodular goitre (3 out of 33 patients), 20% in papillary carcinoma (1 out of 5 patients) and 40% in follicular neoplasm (2 out of 5 patients). Conclusion When preservation of parathyroid glands and their blood supply is enforced during thyroidectomy, the incidence of postoperative hypocalcaemia and permanent hypoparathyroidism can be consistently deceased.

Intraoperative rapid aspiration cytological method for parathyroid glands identification and protection.

To explore new methods for intraoperative identification of parathyroid glands, 86 thyroid cancer patients, admitted to Xijing hospital from July 2017 to July 2018, were included. During lymph node dissection, parathyroid glands were firstly judged by clinician eyeballing, based on his clinical experience. Then, cytological detection was used for rapid identification via Diff-quik staining. PTH monitoring was performed by PTH detection kit. Finally, frozen pathology was examined and regarded as the golden standard. In this study, 172 suspicious parathyroid glands were observed. According to frozen pathology outcome, the accuracy, sensitivity and specificity of clinician eyeballing were calculated as 63.3%, 100%, and 13.9%. Kappa test showed poor consistency (kappa = 0.156), AUC area was 0.569 ± 0.045, 95%CI = (0.480-0.658), p = 0.123. For cytological and PTH detection, the accuracy, sensitivity and specificity were 91.7% vs. 92.3%, 93.6% vs. 93.8% and 89.0% vs. 90.3%. Kappa value was 0.829 vs. 0.842, indicating good consistency. AUC area was 0.908 ± 0.027 vs. 0.918 ± 0.025, 95%CI = (0.856-0.960) vs. (0.869-0.966), p < 0.001, indicating higher diagnositic value. Besides, compared with frozen pathology, cytological detection was easily and rapid. The time-taking between frozen pathology and cytological detection or PTH detection were 39.0 ± 6.59 min vs. 5.02 ± 0.78 min and 39.0 ± 6.59 min vs. 6.1 ± 1.23 min, p < 0.001. In conclusion, intra-operative cytological detection maybe potential for in-situ preservation of parathyroid glands.

First report of in-situ preservation of a subcapsular parathyroid gland through super-meticulous capsular dissection during robotic radical thyroidectomy

PurposeMeticulous capsular dissection can preserve the function of the parathyroid gland in most patients, but it is difficult to identify and preserve the subcapsular parathyroid gland. We performed in-situ preservation of the subcapsular parathyroid gland during robotic radical thyroidectomy using super-meticulous capsular dissection, and evaluated its effect on postoperative parathyroid function. MethodsA 45-year-old woman was admitted with bilateral thyroid nodules. Color Doppler ultrasound demonstrated a 7 × 7 × 6 mm hypoechoic area in the middle and inferior part of the right lobe and 3 × 3 × 3 mm hypoechoic nodule in the middle part of the left lobe. She was diagnosed with right thyroid papillary cancer by fine-needle aspiration. Robotic bilateral thyroidectomy plus right central lymph node dissection was performed. During the left thyroidectomy, we found that the left inferior parathyroid gland was just under the true capsule. Subsequently, the super-meticulous capsular dissection was performed for in-situ preservation of the parathyroid gland. ResultsThe patient's serum parathyroid hormone concentration was 43.77 pg/ml before and 37.98 pg/ml after surgery (normal: 15–65 pg/ml). Her blood calcium level was 2.21 mmol/l before and 2.18 mol/l after surgery (normal: 2.10–2.65 mmol/l). ConclusionsThe super-meticulous capsular dissection, which could cut through the true capsule to identify subcapsular parathyroid and protect its anatomic structure as well as blood supply, is recommend for in-situ preservation of subcapsular parathyroid gland during robotic radical thyroidectomy.

In situ preservation of parathyroid glands in thyroid surgery for prevention of hypoparathyroidism

In situ preservation of parathyroid glands in thyroid surgery for prevention of hypoparathyroidism

The Impact of Thyroiditis on Morbidity and Safety in Patients Undergoing Total Thyroidectomy.

Background:The indications for surgery in thyroiditis vary from compressive symptoms to cosmesis. We analyzed the complications in patients who underwent total thyroidectomy (TT) in goiters associated with thyroiditis.Materials and Methods:This retrospective study was done in an endocrine surgical center over 4 years. A total of 724 patients, who underwent TT for benign thyroid disorders, were included in the study. Patients were divided into two groups based on histopathology into Group A (nonthyroiditis cases) and Group B (thyroiditis cases); Group B is subdivided into Group B1 (nodular goiter with associated thyroiditis) and Group B2 (Hashimoto's thyroiditis). The preoperative parameters analyzed were serum calcium, serum Vitamin D, serum parathyroid hormone (PTH), and vocal cord status. The intraoperative parameters observed were operating time, parathyroid preservation, and autotransplantation and course of recurrent laryngeal nerve (RLN). Postoperative parameters monitored were serum calcium, serum PTH, serum magnesium, signs and symptoms of hypocalcemia, and vocal cord status. Follow-up was done at 6 months with serum calcium, serum PTH, and video laryngoscopy.Results:Both groups were age and sex matched. All preoperative and intraoperative parameters were comparable among groups. Both transient complications (<6 months) were higher in Group B than A. Transient hypocalcemia was higher in Group B (39.70%) than Group A (24.77%) (P = 0.001). Transient hypocalcemia was higher in Group B1 (36.58%) than Group B2 (44.44%) (P = 0.014). Transient RLN palsy was higher in Group B (9.55%) than Group A (7.52%) (P = 0.040). Transient RLN palsy was higher in Group B1 (8.53%) than Group B2 (11.11%) (P = 0.039). Permanent hypoparathyroidism and permanent RLN palsy were comparable between the Groups A and B and between Groups B1 and B2.Conclusion:The incidences of transient complications are higher in patients with thyroiditis. Careful analysis of surgical indications will avoid unnecessary surgery in thyroiditis cases.

In Situ Preservation Fraction of Parathyroid Gland in Thyroidectomy: A Cohort Retrospective Study.

Background and Objectives Parathyroid failure is the most common symptom after thyroidectomy. To prevent it, a gland was preserved in situ or an ischemic one was autotransplanted. This study explored the relationship between in situ preservation of the parathyroid gland and gland failure. Methods Consecutive patients who underwent initial total thyroidectomy were enrolled retrospectively in a prospectively maintained database. Patients were divided into groups by parathyroid gland remaining in situ fraction (PGRIF) (PGRIF = number of in situ glands/(total number of identified glands − number of glands in specimen). Patients were graded by tertiles and followed at least one year after surgery. Results 559 patients were included. PGRIF is significantly inversely associated with transient hypoparathyroidism, protracted hypoparathyroidism, and postoperative hypocalcemia. PGRIF was identified as an independent risk factor for transient hypoparathyroidism, protracted hypoparathyroidism, and postoperative hypocalcemia (OR = 0.177, 0.190, and 0.330, resp.). Autotransplantation of parathyroid gland would not affect the calcium level in the long term. Conclusion In situ preservation of parathyroid gland is crucial for parathyroid function. Less preserved is the independent risk factor for postoperative hypoparathyroidism and hypocalcemia, resulting in a worse function of parathyroid gland in the long term.

Use of methylene blue and near-infrared fluorescence in thyroid and parathyroid surgery

PurposeIntraoperative localisation and preservation of parathyroid glands improves outcomes following thyroid and parathyroid surgery. This can be facilitated by fluorescent imaging and methylene blue; a fluorophore is thought to be taken up avidly by parathyroid glands. This preliminary study aims to identify the optimum dose of methylene blue (MB), fluorescent patterns of thyroid and parathyroid glands and develop a protocol for the use of intravenous MB emitted fluorescence to enable parathyroid identification.MethodsThis is a phase 1b, interventional study (NCT02089542) involving 41 patients undergoing thyroid and/or parathyroid surgery. After exposure of the thyroid and/or parathyroid gland(s), intravenous boluses of between 0.05 and 0.5 mg/kg of MB were injected. Fluobeam® (a hand held fluorescence real-time imager) was used to record fluorescence from the operating field prior and up to 10 min following administration.ResultsThe optimum dose of MB to visualise thyroid and parathyroid glands was 0.4 mg/kg body weight. The median time to onset of fluorescence was 23 and 22 s and the median time to peak fluorescence was 41.5 and 40 s, respectively. The peak fluorescence for thyroid and parathyroid glands compared to muscle were 2.6 and 4.3, respectively. Parathyroid auto-fluorescence prior to methylene blue injection was commonly observed.ConclusionsA clinical protocol for detection of fluorescence from MB during thyroid and parathyroid surgery is presented. Parathyroids (especially enlarged glands) fluoresce more intensely than thyroid glands. Auto-fluorescence may aid parathyroid detection, but MB fluorescence is needed to demonstrate viability.

The use of ICG enhanced fluorescence for the evaluation of parathyroid gland preservation.

Indocyanine green (ICG) enhanced fluorescence imaging is recent innovation as the "real-time intraoperative imaging" technique. Many clinical studies have been reported in the literature which use different devices and techniques that employ various doses and usages of ICG as a non-specific contrast agent. Several groups have performed studies in endocrine surgery, especially with regards to parathyroid-related outcomes after thyroid and parathyroid surgery. However, there is no consensus on the technical details that should be applied. With this study, we aimed to review the current literature on potential use of intraoperative ICG angiography for evaluating parathyroid gland (PTG) preservation.

In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma.

Postoperative hypocalcaemia due to dysfunction of the parathyroid glands is the most common complication after total thyroidectomy plus central neck dissection (CND). There is a lack of surgical techniques described to help preserve the inferior parathyroid gland in situ during CND. The objective of this study was to introduce the 'TBP layer' (layer of thymus-blood vessel-inferior parathyroid gland) concept for preserving the inferior parathyroid gland in situ during CND, and to evaluate its effectiveness. The study group included patients with primary papillary thyroid cancer who underwent total thyroidectomy with CND using the new surgical concept between January and December 2014. The control group included sex- and age-matched patients who underwent conventional total thyroidectomy with CND between January 2012 and December 2013. The proportion of inferior parathyroid glands preserved in situ and postoperative hypoparathyroidism rates in the two groups were compared. There were 181 patients in the study group and 306 in the control group. There were no significant differences between the groups in tumour size, multifocality, extrathyroidal extension, and number of harvested and metastatic central lymph nodes. The rate of inferior parathyroid gland preservation in situ was significantly improved from 37·9 to 76·3 per cent on the left side (P < 0·001), and from 52·0 to 77·9 per cent on the right side (P < 0·001), in the study group compared with the control group. The incidence of transient hypoparathyroidism decreased significantly from 35·0 to 7·2 per cent (P < 0·001). Applying the proposed surgical concept improved the rate of inferior parathyroid gland preservation in situ and decreased the incidence of transient postoperative hypoparathyroidism.

Hypoparathyroidism, an innate risk of thyroidectomy

Background: The identification and preservation of parathyroid glands (PT) with its intact blood supply is of utmost importance during thyroid surgery. To preserve the PT with intact blood supply, a medial to lateral dissection is advocated, with plane of dissection along the thyroid capsule. One of the earliest and feared complications of thyroidectomy is hypoparathyroidism (HPT). Aim was to study the incidence of temporary and permanent hypoparathyroidism during thyroidectomy.Methods: This was a hospital based prospective study, from 2008 to 2015. 472 cases who underwent thyroidectomy (182 near total and 290 total thyroidectomies) for any indications in general surgery department of a tertiary care centre were included.Results: The incidence of permanent and transient HPT after total thyroidectomy was 3.8 and 09%, where as it was 2.75 and 3.85% after near total thyroidectomy. The results of present study were comparable with other studies.Conclusions: Meticulous dissection, absolute hemostasis, and a thorough knowledge of neck anatomy are the key in reducing the post thyroidectomy complications. Transient or permanent hypo parathyroidism is due to inadvertent gland removal or injury to its vascular pedicle. Dissection close to the thyroid capsule and ligation of capsular branches of thyroid avoiding the main trunk of inferior thyroid artery holds the key.

Bilateral Hurthle cell adenoma of thyroid: a rare case report

&lt;p class="abstract"&gt;Hurthle cell of adenoma of thyroid gland is rare neoplasms of the thyroid. Size more than 4 cm is rare finding and moreover the occurrence of a multifocal Hurthle cell adenoma is not supported by antecedents in literature. Sonography fails to identify its potentials for malignancy while fine needle aspiration cytology couldn’t differentiate it from Hurthle cell carcinoma of thyroid. The management of Hurthle cell adenoma and Hurthle cell carcinoma is quite different and hence diagnostic dilemma should be sorted out early. A 26 year old female presented with bilateral thyroid swelling. Ultrasonography of thyroid gland showed complex solid cystic nodules in bilateral thyroid lobes with right thyroid lobe measuring 4.1×3.4×2.5 cm and left thyroid lobe measure 3.1×1.7×1.6 cm. Fine needle aspiration cytology (FNAC) was suggestive of papillary malignancy with extensive Hurthle cell changes (Class V, Bethesda classification). The patient underwent total thyroidectomy with bilateral parathyroid gland preservation. Histopathology revealed it as Hurthle cell adenoma (HCA) involving bilateral lobe and multifocal in nature. The treatment of choice for Hurthle cell carcinoma is total thyroidectomy with neck dissection depending on the nature of the lesions. However the treatment of Hurthle cell adenoma is only hemithyroidectomy or lobectomy as it is a benign condition. Differentiation of these two entirely different conditions warrants more studies&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Hypocalcemia: What a Surgeon should know

ABSTRACT Hypocalcemia is one of the sequelae following thyroidectomy (TT) and becomes a complication when it becomes permanent. Parathyroid preservation is a crucial step in the skillful operative procedure of TT. When due care is not taken, the surgeon and the treating physician are faced with the issue of treating the dreaded complication of permanent hypocalcemia. In this article, we address the issue of hypocalcemia following thyroid surgery and its management. How to cite this article Kolly A, Sarathi V, Bothra S, Chekavar A, Sabaretnam M, Agarwal A. Hypocalcemia: What a Surgeon should know. World J Endoc Surg 2017;9(2):72-77.

A prospective cohort study of novel functional types of parathyroid glands in thyroidectomy: In situ preservation or auto-transplantation?

The best method of preventing hypoparathyroidism after thyroidectomy is to keep parathyroid glands in situ. However, hypoparathyroidism still regularly occurs with the existing parathyroid classification system, and the incidence of permanent hypoparathyroidism has not been reduced. We created a novel system for classifying parathyroid glands that can guide parathyroid preservation in thyroidectomy.We prospectively observed parathyroid glands using the new system in 218 neck surgeries, compared with 132 under the traditional system from January 2014 to September 2015 at a single clinic center. Briefly, we classified parathyroid glands as follows: Type A, no dependency on the thyroid; B1, partial blood supply from the thyroid but retains adequate blood supply after removal of the thyroid; B2, partial blood supply from the thyroid and becomes devascularized after the removal of the thyroid; B3, blood supply mostly from the thyroid; and C, blood supply completely dependent on the thyroid. The classifications were used to decide between in situ preservation or auto-transplantation.The most common type of parathyroid gland was type B1 (53.77%), followed by type A (20.89%), which are the perfect categories for in situ preservation. Type B2 (17.52%) and type B3 (1.21%) have a chance to be kept in situ. For type C (6.61%), in situ preservation is impossible. When in-situ preservation is ruled out, parathyroid auto-transplantation is an alternative, with partial or total gland tissue, depending on the classification and the surgeon's discretion. Among the patients who were classified under the new system, 43.6% presented with transient hypoparathyroidism (symptoms lasting ≤6 months) after surgery, versus 42.4% in the old system, which was not a significant difference. However, permanent hypothyroidism (symptoms lasting >6 months) was not detected in the applied group, but in 3.0% of patients in the nonapplied group (P = 0.01).Our novel functional nomenclature system for parathyroid glands can provide a guide for preserving parathyroid function. For certain types, such as type B2 and C, instead of being kept in situ, auto-transplantation of partial or total parathyroid tissue is a prudent choice to ensure continued function.

A Rare Presentation of Papillary Thyroid Carcinoma

Introduction Papillary thyroid carcinomas are one of the most common endocrine neoplasms. It is well known for its low malignant potential. Papillary carcinomas mostly metastases to lymph nodes of level six. Recent advances in the pathology that is with proper ultra sound guided FNAC, early diagnosis can be made. Here we are presenting a patient with a huge neck mass that presented to our medical college hospital and how we managed the same. Case Blog 53 years old male patient, presented to a tertiary hospital with complaints of swelling in front of neck for the past 7 years. The patient was having a progressive swelling, it started as a small pea shaped swelling and it slowly progressed and has reached the present size (Figure 1). The patient was having no difficulty in respiration. CT scan of the neck region with chest was taken as the lower extent was not palpable and the FNAC of the swelling was taken. FNAC revealed papillary thyroid carcinoma. CT scan showed a huge soft tissue mass over left supra clavicular region with solid and cystic attenuation extending to the superior aspect of the thoracic inlet. The mass was shifting trachea to the right side (Figure 2). There were no palpable neck nodes. The patient was planned for surgical exploration of the tumour with sternotomy as the tumour was extending in to the thoracic inlet. A total thyroidectomy with central compartment neck dissection was done. The mass was proved to be papillary thyroid carcinoma of intra cystic variant. Discussion Papillary thyroid carcinoma is the most common thyroid cancer. Papillary thyroid cancer also has an excellent prognosis. Total thyroidectomy is done once histo pathological diagnosis is established [1]. This patient to begin with presented with a small pea shaped swelling on front of left side of neck and it started slowly progressing in size. Once the size of the tumour is more than 10 mm, total thyroidectomy is indicated. These papillary carcinomas mostly metastases to central neck nodes [2]. Hence for a better outcome it is always mandatory to go for central neck node dissection for proven cases of lymphatic spread. Biochemical analysis of free T4 and TSH is necessary before surgery. This patient was euthyroid before surgery was planned. Surgery of total thyroidectomy and neck dissection of central compartment was done [3]. Recurrent laryngeal nerve was identified during the procedure. Parathyroid glads were identified and preserved on the right side. The patient was kept on regular followup. Histopathological diagnosis confirmed it to be a papillary thyroid carcinoma. Conclusion Total thyroidectomy with central compartment dissection appears to be adequate treatment even for masses that are extending upto supra clavicle also with extension to thoracic inlet. CT scan plays a very important role in pre-operative planning for huge neck mass. Preservation of recurrent laryngeal nerve and parathyroid glands are very important in this surgery. Though it is controversial in the absence of neck node one should go for central node dissection, from our institutional experience, it is always safer to go for central node dissection, so that recurrence of the tumour can be avoided.

Early prediction of hypocalcaemia following total thyroidectomy by serial parathyroid hormone and ionized calcium assay

Background: Total thyroidectomy is an accepted treatment modality for benign and malignant thyroid disease. Postoperative transient hypoparathyroidism leading to hypocalcaemia is one of the most frequent morbidities following total thyroidectomy. Methods: 30 patients were included in this study, underwent total thyroidectomy and completion thyroidectomy. All measures for the preservation of parathyroid glands were taken. Intra-operative venous sample was taken after careful dissection of the parathyroid glands and post operatively at 6 hours, 24 hours, and 48 hours. Samples were analyzed for PTH, ionized calcium, total calcium and albumin levels. Patients were followed up for a period of one year. Results: Nine patients (30%) developed clinical hypocalcaemia in this study. Out of thirty patients, PTH values were below normal in 14 (46.67%) intra-operatively, 13 (43.33%) at 6 hours, 16 (53.33%) at 24 hours, 12 (40.0%) at 48 hours postoperatively. PTH had a sensitivity of 100% in predicting hypocalcaemia in these entire time interval. Ionized calcium values were below normal in 10 (33.33%) patients intra operatively, 12 (40%) at 6 hours, 8 (26.67%) at 24 hours and 10 (30%) at 48 hours post-operatively. It had a sensitivity of 55.6%, 55.6%, 66.7% and 100% respectively in predicting hypocalcaemia at these time interval. Conclusions: Serum PTH proved to be a safe, convenient and easily available biomarker which can be measured to predict post-total thyroidectomy hypocalcaemia before the onset of serious symptoms.

Electrical Impedance Spectroscopy to Aid Parathyroid Identification and Preservation in Central Compartment Neck Surgery: A Proof of Concept in a Rabbit Model.

Accurate identification of parathyroid glands during thyroid surgery is crucial to avoid postthyroidectomy hypocalcemia. Electrical impedance spectroscopy has the potential to differentiate between tissues of different morphology. The aim of this study was to determine the electrical impedance patterns of the thyroid, parathyroid, and other soft tissue structures in the rabbit neck. The central compartments were exposed in 9 freshly culled New Zealand White rabbits. In situ and ex vivo electrical impedance was measured from thyroid lobes, external parathyroid glands, adipose tissue, and strap muscle using the APX100 device. Specimens of all identified glands were sent for histopathology examination. Histology confirmed correct identification of all excised thyroid and parathyroid glands. The impedance was higher for thyroid tissue at lower frequencies and for parathyroid tissue at higher frequencies. Ex vivo electrical impedance spectra were significantly higher compared with the in situ spectra across all frequencies for thyroid and parathyroid tissues (P < .001). The ratio of low to high frequency in situ impedance of thyroid, parathyroid, and muscle was significantly different (P < .001), allowing for differentiation between these tissues. The electrical impedance spectra of rabbit thyroid and parathyroid glands are distinct and different from each other and from skeletal muscle. If these results are replicated in human tissue, they have the potential to improve patient outcomes by achieving early identification and preservation of parathyroid glands.

The Best Surgical Tips for Parathyroid Preservation in Thyroid Surgery

Abstract Introduction: When thyroidectomy is in need, the first golden standard of thyroid surgery is to remove the appropriate extent of thyroid according to the disease status.1 Second, is to red...