Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences

Manatakis, Dimitrios K.; Balalis, Dimitrios; Soulou, Vasiliki N.; Korkolis, Dimitrios; Plataniotis, G.; Gontikakis, Emmanouil

doi:10.1155/2016/7825305

Cited by 29 publications

(22 citation statements)

References 29 publications

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“…However, increased awareness during the dissection of the central compartment is necessary to avoid inadvertent excision of parathyroid tissue. In our study, there was no significant association between the individual risk factors with IP and non-IP cases in comparative analysis similar to few other studies [20,21]. Therefore, as proven by the past studies, knowledge of these factors may help the surgeon to be aware of the risk and be cautious during thyroidectomies.…”

Section: Discussionsupporting

confidence: 87%

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Alraddadi

Aldhahri

Almayouf

et al. 2019

Cureus

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Background: Incidental parathyroidectomy with subsequent hypoparathyroidism and postoperative hypocalcemia is thought to be one of the common complications of thyroidectomy. Current literature reports wide discrepancy in incidence and risk factors.Objectives: The aim of our study was to evaluate the incidence and risk factors of incidental parathyroidectomy in thyroid surgery.Methods: A retrospective study included 270 patients who had thyroid surgery that was performed over two years from January 2017 to December 2018 in two tertiary care hospitals. Preoperative and postoperative records were assessed. Factors such as gender, diagnosis, type of surgery, and usage of surgical loupes during the procedure were evaluated and were compared to find the association with incidental parathyroidectomy in thyroid surgery.Results: Incidental parathyroidectomy was noticed in 62 (23%) surgical specimens during histopathologic examination. There was no significant association between incidental parathyroidectomy and sex of patient, use of surgical loupes, pathology of thyroid disease, or neck dissection.Conclusion: Although the risk of incidental parathyroidectomy is inevitable, careful dissection and meticulous intraoperative identification of parathyroid gland during thyroidectomy can reduce the incidence of incidental parathyroidectomy, thereby minimizing the risk of postoperative hypoparathyroidism and hypocalcemia.

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Section: Discussionsupporting

confidence: 87%

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Alraddadi

Aldhahri

Almayouf

et al. 2019

Cureus

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“…However, a comparable rate of IP was observed in malignant and benign cases by several researchers. [ 10 , 11 , 54 , 62 ] We pooled these data and confirmed that malignancy is a risk factor for IP. Malignant lesions might invade the parathyroid gland along with adjacent tissue adhesions.…”

Section: Discussionsupporting

confidence: 53%

“…Some studies have found an increased risk of postoperative hypocalcemia in IP patients, particularly of biochemical hypocalcemia. [ 4 , 11 , 12 ] However, other studies have found no significant relationship between IP and postoperative hypocalcemia. [ 13 – 15 ] This difference might be caused by the use of different definitions for postoperative hypocalcemia and for biochemical or clinical hypocalcemia.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Bai

Chen

2018

PLoS ONE

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IntroductionPostoperative hypocalcemia is the most common complication of thyroidectomy. Incidental parathyroidectomy (IP) was thought to be associated with postoperative hypocalcemia. However, according to previous studies, the risk factors and clinical outcomes of IP remain controversial.MethodsEligible studies were searched in databases including PubMed, Web of Science, and EMBASE from January 1990 to September 2017. Articles focusing on the relationship between IP and postoperative hypocalcemia were included. The risk of publication bias was assessed using Begg’s test and Egger’s regression asymmetry test. Pooled analysis was performed to evaluate the effect of IP on postoperative hypocalcemia and related risk factors. Sensitivity analysis was also conducted to test the stability of our results. The effects of hypocalcemia type, permanent definition, IP incidence, total thyroidectomy, and malignancy operation were also examined using a further subgroup analysis.ResultsThirty-five studies were finally included in the analysis after an exhaustive literature review. Pathology data demonstrate that incidental parathyroidectomy occurred in various locations: intrathyroidal (2.2–50.0%), intracapsular (16.7–40.0%) and extracapsular (15.7–81.1%) regions. Overall, the analysis found that malignancy (RR = 1.60, 95% CI: 1.27 to 2.02; p< 0.0001), central neck dissection (RR = 2.35, 95% CI: 1.47 to 3.75; p = 0.0004), total thyroidectomy (RR = 1.42, 95% CI: 1.20 to 1.67; p< 0.0001) and reoperation (RR = 1.81, 95% CI: 1.20 to 2.75; p = 0.005) were significant risk factors of IP in thyroid surgery. There was an obvious effect of IP on temporary/permanent (RR = 1.59, 95% CI: 1.37 to 1.84; p< 0.0001) and permanent (RD = 0.0220, 95% CI: 0.0069 to 0.0370; p = 0.0042) postoperative hypocalcemia. Sensitivity analysis showed that these results were robust. The subgroup analysis found that IP played a significant role in both biochemical and clinical hypocalcemia in thyroidectomy (p < 0.0001 and p = 0.0003, separately). The association of IP and permanent hypocalcemia using different definitions (6 months or more than 12 months) was also confirmed by the analysis. IP increased the incidence of temporary/permanent and permanent hypocalcemia for cases undergoing total thyroidectomy (40.4% vs 24.8% and 5.8% vs 1.4%, respectively). Thyroidectomy with IP was associated with more permanent hypocalcemia (RR = 3.10, 95% CI: 2.01 to 4.78; p< 0.0001) in malignant cases but was not associated with temporary/permanent hypocalcemia.ConclusionsMalignancy, central neck dissection, total thyroidectomy and reoperation were found to be significant risk factors of IP. IP increases the risk of postoperative hypocalcemia after thyroidectomy. We recommend a more meticulous intraoperative identification of parathyroid gland in thyroidectomy to reduce IP, particularly for total thyroidectomy and malignancy cases.

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“…The importance of more sensitive detection of parathyroid tissue during thyroidectomies is largely a patientsafety issue because enhanced, earlier identification of these small glands before rather than after thyroid dissection should reduce the incidence of postoperative hypocalcemia from the accidental parathyroid devascularization or resection that often occurs during total thyroidectomy procedures. 26,27 In our trial, because virtually as many parathyroid glands were observed before thyroidectomy with NIRL as after thyroidectomy when WL was used, less dissection was required in the former group, logically reducing the surgical risk of disrupting parathyroid circulation and likely saving considerable time. This apparent increased safety was reflected in non-statistically significant halving of the rate of hypocalcemia; but also a dramatic reduction in the number of patients who had a postoperative serum calcium level of 7.5 mg/dL, from 10 subjects in the WL group to just a single patient in the NIRL group (p ¼ 0.005); and in zero calcium levels <7.5 mg/dL in the NIRL group vs 6 in their WL counterparts (p ¼ 0.009).…”

Section: Discussionmentioning

confidence: 88%

Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

Dip

Falcó

Verna

et al. 2019

Journal of the American College of Surgeons

124

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BACKGROUND: Parathyroid glands are difficult to identify during total thyroidectomies, and accidental resection can lead to problematic postoperative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) autofluorescence intraoperatively for parathyroid gland identification and to measure its impact on postoperative hypocalcemia incidence. STUDY DESIGN: Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1:1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared. RESULTS: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels 7.5 mg/dL were one-tenth as common in the NIRL group (p ¼ 0.005). The adjusted odds of hypocalcemia developing increased by 15% for every 5-g increase in thyroid gland weight (odds ratio 1.15; 95% CI 1.06 to 1.25). All hypocalcemia resolved within 6 months. CONCLUSIONS: Using NIRL during thyroidectomy increases intraoperative identification of parathyroid glands, enhances their detection before thyroid dissection, and decreases the incidence of postoperative hypocalcemia.

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Incidental Parathyroidectomy during Total Thyroidectomy: Risk Factors and Consequences

Cited by 29 publications

References 29 publications

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis

Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy

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