Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma

Sitges‐Serra, Antonio; Gallego-Otaegui, Lander; Suárez, S.; Lorente-Poch, Leyre; Munné, Assumpta; Sancho, Juan José Alegre

doi:10.1016/j.surg.2016.08.021

Cited by 66 publications

(75 citation statements)

References 20 publications

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“…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.…”

Section: Discussionsupporting

confidence: 85%

“…Most studies have reported that IP doesn't significantly affect post-operative serum calcium levels (1,4,5,11,12,(14)(15)(16)19,21,22). Only a small number of studies have positively correlated the occurrence of IP with a higher incidence of hypocalcaemia (8,20,24,27 (29). This study is limited by the well-known biases and limitations of its retrospective nature.…”

Section: Discussionmentioning

confidence: 98%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Background: Inadvertent parathyroidectomy (IP) during thyroid operations is a recognised phenomenon.We evaluated the incidence of IP during thyroid operations in a large case-series and identified the risk factors involved. Results: One thousand three hundred and seventy-three patients were included in our study, 1,149 of them females (84%). IP rate was 11.3%. Univariate analysis showed that gender, thyroid gland weight, thyroid activity pre-operatively and type of operation are associated with IP. Logistic regression analysis has shown that female gender and the absence of LN in pathology were associated with less likelihood in developing IP than males and patients with presence of LN (P=0.051 and 0.014 respectively). IP occurs 2.14 and 2.28 times more often in TT and NTT when compared to the combination of TT and NTT (P=0.047 and 0.048 respectively). Conclusions:We present the largest single-centre case series on this topic, to our knowledge. The presence of LN, female gender and the type of operation are positively correlated to the IP rate. These factors could alert the surgeon to consider early calcium supplementation if the parathyroid glands (PG) have not been identified intraoperatively.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…Similarly, those who undergo peripheral ligation of the inferior thyroid artery at the thyroid capsule are more prone to develop hypoparathyroidism than those who undergo subcapsular dissection (10). Parathyroid auto-transplantation, inadvertent excision of PGs and presence of PGs in the thyroid specimen have also been shown to increase the risk of post-operative hypoparathyroidism (1,(11)(12)(13)(14)(15)(16)(17). This is because they all lower the number of in situ PGs and therefore, the residual parathyroid function is immediately compromised.…”

Section: Risk Factors Leading To Postoperative Hypoparathyroidismmentioning

confidence: 99%

“…Some suggested that an early postoperative decrease in serum iPTH concentrations (8,10), combining with serum Ca concentration may predict hypoparathyroidism and guide the administration of Ca or vitamin D supplements (18,19). Post-operative hypoparathyroidism results from a reduction of functioning parathyroid parenchyma, which could be secondary to intraoperative damages caused by mechanical or thermal trauma, gland devascularization, obstruction of venous outflow, and inadvertent parathyroid excision (14,15,17). Therefore, the question has been whether there are strategies or approaches a surgeon could follow intra-operatively to minimize PG injuries and hypoparathyroidism.…”

Section: Risk Factors Leading To Postoperative Hypoparathyroidismmentioning

confidence: 99%

To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

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Hypoparathyroidism is one of the most common complications after total thyroidectomy and may impose a significant burden to both the patient and clinician. The extent of thyroid resection, surgical techniques, concomitant central neck dissection, parathyroid gland (PG) autotransplantation and inadvertent parathyroidectomy have long been some of the risk factors for postoperative hypoparathyroidism. Although routine identification of PGs has traditionally been advocated by surgeons, recent evidence has suggested that perhaps identifying fewer number of in situ PGs during surgery (i.e., selective identification) may further lower the risk of hypoparathyroidism. One explanation is that visual identification may often lead to subtle damages to the nearby blood supply of the in situ PGs and that may increase the risk of hypoparathyroidism.However, it is worth highlighting the current literature supporting either approach (i.e., routine vs. selective) remains scarce and because of the significant differences in study design, inclusions, definitions and management protocol between studies, a pooled analysis on this important but controversial topic remains an impossible task. Furthermore, it is worth nothing that identification of PGs does not equal safe preservation, as some studies demonstrated that it is not the number of PGs identified, but the number of PG preserved in situ that matters. Therefore a non-invasive, objective and reliable way to localize PGs and assess their viability intra-operatively is warranted. In this aspect, modern technology such as the indocyanine green (ICG) as near-infrared fluorescent dye for real-time in situ PG perfusion monitoring may have a potential role in the future.

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Impact of prophylactic central lymph node dissection on the complications and recurrence rates in papillary thyroid carcinoma—An AFCE (French‐speaking Association of Endocrine Surgery) multicentre study based on the EUROCRINE® national data

Chereau,

Christou,

Caiazzo

et al. 2024

Cancer Reports

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BackgroundProphylactic central neck dissection (pCND) remains controversial during the initial surgery for preoperative and intraoperative node‐negative (cN0) papillary thyroid carcinoma (PTC).MethodsPatients undergoing thyroidectomy with or without pCND (Nx) for PTC in nine French surgical departments, registered in the EUROCRINE® national data in France between January 2015 and June 2021, were included in a cohort study. Demographic and clinicopathological characteristics, complications, and recurrence rates were compared using multivariate regression analysis.ResultsA total of 1905 patients with cN0 PTC were enrolled, including 1534 who had undergone pCND and 371 who hadn't (Nx). Of these, 1546 (81.2%) were female, and the median age was 49 years (range: 15–89 years). Patients who had undergone pCND were more likely to have multifocal tumors (n = 524 [34.2%] vs. n = 68 [18.3%], p < .001) and larger tumors (15.3 vs. 10.2 mm, p = .01) than patients with Nx. Of the patients with pCND, 553 (36%) had positive central LN (N1a), with a median of 1 N1 (IQR 0–5). pCND was associated with a higher temporary hypocalcemia rate (n = 25 [8%] vs. n = 15 [4%], p < .001). The rates of permanent hypocalcemia and temporary and permanent recurrent laryngeal nerve (RLN) palsy were not significantly different between the two groups (p > .2). After adjusting for covariates (age, sex, multifocality, and pathological T stage) in a multivariable Cox PH model, the performance of lymph node dissection (pCND vs. no‐pCND) was not associated with PTC recurrence (p = .2).ConclusionpCND in PTC does not reduce recurrence and is associated with a two‐fold increase in the incidence of transient hypoparathyroidism. These data should be considered while issuing further guidelines regarding the treatment of patients with cN0 PTC.

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Inadvertent parathyroidectomy during total thyroidectomy and central neck dissection for papillary thyroid carcinoma

Cited by 66 publications

References 20 publications

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

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

To identify or not to identify parathyroid glands during total thyroidectomy

Impact of prophylactic central lymph node dissection on the complications and recurrence rates in papillary thyroid carcinoma—An AFCE (French‐speaking Association of Endocrine Surgery) multicentre study based on the EUROCRINE® national data

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