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 Newcastle-Ottawa Scale (NOS). The results of included studies were summarised and meta-analyses were performed where appropriate.Results: Five randomised controlled trials (RCTs) and thirteen interventional cohort studies were included. Thirteen studies assessed the role of IONM in primary thyroid surgery, three in re-do procedures and two in minimally-invasive video-assisted thyroidectomy (MIVAT).Meta-analysis demonstrated: marginally significant lower rates of transient RLN palsy associated with the use of IONM in primary thyroid surgery (OR 0.71; 95% CI 0.50 -1.00; p ¼ 0.05); significant lower rates of transient RLN palsy associated with the use of IONM in revision thyroid surgery (OR 0.59; 95% CI 0.36 -0.97; p ¼ 0.04); no significant effect on permanent RLN injury in primary thyroid surgery (OR 0.84; 95% CI 0.47 -1.50; p ¼ 0.55); and no significant effect on transient RLN injury in MIVAT (OR 0.55; 95% CI 0.17 -1.74; p ¼ 0.31).Conclusion: This systematic review has shown that IONM can aid the surgeon to reduce the rates of transient RLN injury in primary and revision thyroid surgery. The wide variability in study design, definitions of RLN palsy and methods of assessing nerve injury were the main limitations encountered in this study.http://dx.

Objective: Post-surgical hypoparathyroidism (PoSH) usually settles within few months after thyroid surgery, but several require long-term supplementation with calcium/activated vitamin D. When PoSH persists beyond 6 months, it is considered ‘chronic’ or ‘permanent’, however, late recovery has been reported. The aim of this study was to determine the frequency of late recovery and explore factors predicting late recovery of parathyroid function. Methods: Adult patients undergoing total/completion thyroidectomy between 2009-18 were included in this retrospective cohort observational study. The records of patients with evidence of PoSH were reviewed to identify those with persisting PoSH at 6 months. Demographic, biochemical, surgical, pathological, and clinical follow-up data was collected and analysed. Results: Out of 911 patients undergoing thyroidectomy, 270 were identified with PoSH. Of these, 192 were started on supplements and 138 (71.9%) recovered within six months. Of the remaining 54 patients, 35 had ongoing PoSH with median (range) follow-up of 3.4 (0.5-11.1) years. Nineteen patients were weaned off supplements and achieved remission at median (range) follow-up of 1.3 (0.6-4.8) years. All of those who recovered had a PTH of ≥1.6 pmol/L at 6 months. There was no difference in age, gender, diagnosis, type, and extent of surgery between those who did and did not show late recovery. Conclusions: Recovery from PoSH is common beyond 6 months, raising question whether 6-month threshold to define ‘long term’ PoSH is appropriate. The chances of recovery are high (~50%) in patients with PTH level ≥1.6 pmol/L at 6 months, where attempts at weaning may be focussed.

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Objectives To evaluate the incidence of inadvertent parathyroidectomy, identify risk factors, determine the location of inadvertently excised glands, review pathology reporting in inadvertent parathyroidectomy, and explore relationships between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia. Methods A retrospective cohort study of 899 thyroidectomies between 2015 and 2020 was performed. Histopathology slides of patients who had an inadvertent parathyroidectomy and a random sample of patients without a reported inadvertent parathyroidectomy were reviewed. Results Inadvertent parathyroidectomy occurred in 18.5 per cent of thyroidectomy patients. Central neck dissection was an independent risk factor (inadvertent parathyroidectomy = 49.4 per cent with central neck dissection, 12.0 per cent without central neck dissection, p < 0.001). Most excised parathyroid glands were extracapsular (53.3 per cent), followed by subcapsular (29.1 per cent) and intrathyroidal (10.9 per cent). Parathyroid tissue was found in 10.2 per cent of specimens where no inadvertent parathyroidectomy was reported. Inadvertent parathyroidectomy was associated with a higher incidence of six-month post-surgical hypoparathyroidism or hypocalcaemia (19.8 per cent who had an inadvertent parathyroidectomy, 7.7 per cent without inadvertent parathyroidectomy). Conclusion Inadvertent parathyroidectomy increases the risk of post-surgical hypoparathyroidism or hypocalcaemia. The proportion of extracapsular glands contributing to inadvertent parathyroidectomy highlights the need for preventative measures.