Careful Examination of Thyroid Specimen Intraoperatively to Reduce Incidence of Inadvertent Parathyroidectomy During Thyroid Surgery

Abstract

Setting: University hospital. Patients: Consecutive patients who underwent thyroidectomy from 1999 to 2005, divided into 2 groups (group 1, those with inadvertent parathyroidectomy; and group 2, those without inadvertent parathyroidectomy). Patients who underwent surgical procedures for recurrent thyroid disease, intentional parathyroidectomy, and resection of central compartment viscera were excluded. Interventions: All pathology reports were reviewed for the presence of any parathyroid tissue in the resected specimen. Age, sex, preoperative diagnosis, thyroid hormonal status, substernal thyroid extension, number of parathyroid glands identified and spared at the time of surgery, autotransplantation of parathyroid gland, and final histologic findings were recorded. Main Outcome Measures: Identification of parathyroid tissue in resected specimens and postoperative symptomatic hypocalcemia. Results: A total of 307 patients were included. Surgical procedures included bilateral or unilateral thyroidectomy (95% and 5% of procedures, respectively). Central neck lymph node dissection was performed in 5% of cases. Pathologic findings showed inadvertent parathyroidectomy in 12% of cases. Of these, 32% were recognized intraoperatively. The parathyroid tissue was found in extracapsular locations in 37% of cases, intracapsular locations in 39%, and intrathyroidal locations in 24%. There was no statistical difference between the 2 groups in terms of sex, preoperative diagnosis, substernal extension, extent of surgery, pathologic diagnosis, and occurrence of postoperative hypocalcemia, except for the presence of thyroiditis. Conclusion: Careful examination of the surgical specimen intraoperatively decreases the incidence of inadvertent parathyroidectomy during thyroidectomy.

Inadvertent parathyroidectomy risk factors in 1,373 thyroidectomies—male gender and presence of lymphadenopathy, but not size of gland, independently increase the risk

“…The IP rate in our large cohort of patients was 11.3% which falls within the range of IP rates published previously (3.7-28.0%) (5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Our study is the first study, to our knowledge, to investigate in depth the effect of the presence of LN to the incidence of IP.…”

“…(50 patients with thyroiditis) did not find any significant correlation between thyroiditis and IP (9,26,27). In our study with 386 patients with thyroiditis, documented in the histopathology report, there was no significant correlation with IP.…”

“…The correlation of female gender with a higher incidence of IP has been previously reported (14,25). On the contrary, Manouras et al and Sakorafas et al have reported a lower incidence of IP in males and 2 other studies found that sex did not affect the IP rate (9,23,24,26). Females in our study had less intrathyroidal inadvertently removed PG compared to males (14% vs. 20%).…”

“…A number of studies in the literature have published conflicting evidence on the factors that influence IP, a result of the small number of patients included, differences in practises between centres and variations in the population included in the studies (5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The purpose of this study was to evaluate the incidence of IP during thyroid operations in a large single centre case series during a period of 6 years and identify the risk factors involved.…”

Incidence of post-operative hypocalcaemia after thyroidectomy - a retrospective study

“…The incidence of inadvertent parathyroidectomy was reported to be 12-16.4% in the literature. The risk factors include total thyroidectomy, extra thyroidal extension and thyroiditis [1,2,3]. The response to calcium replacement therapy for transient hypocalcaemia after thyroidectomy can be seen in a few days to weeks [4].…”