Inadvertent Parathyroidectomy during Thyroid Surgery for Papillary Thyroid Carcinoma and Postoperative Hypocalcemia

Abstract

Background and Objectives:The aim of this article is to report our experience of inadvertent parathyroidectomy during thyroid surgery and to analyze its associated factors and clinical implications. In addition, we attempted to determined causative factors that result in permanent hypocalcemia after thyroid surgery. Materials and Methods: We performed a retrospective review of 500 patients who underwent thyroid surgery for the treatment of papillary thyroid carcinoma from 2004 to 2008. Results: Inadvertent parathyroidectomy was identified in 7.4% of patients and only 1 parathyroid gland was inadvertently removed in most cases. The incidence of inadvertent parathyroidectomy was not associated with gender, age, type of surgical procedure, tumor size, coexisting Hashimoto's thyroiditis (HT), extra-thyroidal extension (ETE), lymph node (LN) metastasis, and surgeon's experience. Nor was inadvertent parathyroidectomy associated with permanent postoperative hypocalcemia. Although operating time >120 min, ETE, and total thyroidectomy (TT) with central neck dissection (CND) were found to be related to permanent hypocalcemia on univariate analysis, tumor size ≥1 cm and surgeon's experience ≤5 years was statistically associated with permanent hypocalcemia on both univariate and multivariate analyses. Conclusion: Although inadvertent parathyroidectomy is not an uncommon complication of thyroid surgery, it appears to have only modest clinical implications. Permanent hypocalcemia was significantly associated with tumor size ≥1 cm and short surgical experience of surgeons, especially in the case of TT with CND. Therefore, we suggest that more accurate risk stratification should be made for routine CND, when it is performed by young surgeons.

Evaluation of clinical significance and risk factors of incidental parathyroidectomy due to thyroidectomy

“…[ 17 ] Univariate analysis of our results indicated that total thyroidectomy, although positively correlated ( P = .016) with increased incidence of parathyroidectomy, was not an independent risk factor in multivariate analysis. In contrast to previous reports, [ 18 ] in our study, preoperative diagnosis of malignant disease, duration of the disease prior to thyroidectomy, and concomitant CND were significantly correlated with increased risk of incidental parathyroidectomy in multivariate analysis. However, preoperative diagnosis of malignancy was also found to be an independent predictor by some of the most recent related reviews.…”

Intraoperative real-time localization of parathyroid gland with near infrared fluorescence imaging

“…Even for highly-experienced surgeons, inadvertent parathyroid excision has been reported to be up to 15% of thyroidectomy cases. Moreover, the incidence of temporary hypoparathyroidism is up to 46% and that of permanent hypoparathyroidism is up to 6.6% after total thyroidectomy (3,20).…”

Real-time localization of the parathyroid gland in surgical field using Raspberry Pi during thyroidectomy: a preliminary report

“…Although various procedures have been introduced to preserve the parathyroid glands, they have not been widely applied because they are what to be gained from the long experience [4][5][6]. After surgery, 46% of patients experience temporary discomfort due to the previous reason, and 6% of patients undergo further treatment with permanent impairment [3,4,7].…”