Location, number and morphology of parathyroid glands: results from a large anatomical series

Lappas, Dimitrios; Noussios, George; Anagnostis, Panagiotis; Adamidou, Fotini; Chatzigeorgiou, Antonios; Skandalakis, Panagiotis

doi:10.1007/s12565-012-0142-1

Cited by 80 publications

(53 citation statements)

References 18 publications

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“…Humans usually have four parathyroids; a large cadaveric study reported finding four in 93 %, five in 5 % and three in 2 % [3]. Embryologically, the parathyroid glands arise in the third and fourth pharyngeal arches before descending into the neck.…”

Section: Introductionmentioning

confidence: 99%

“…Embryologically, the parathyroid glands arise in the third and fourth pharyngeal arches before descending into the neck. Their final position is variable, with 8.5 % located ectopically, 6.3 % in the mediastinum and 0.2 % within the thyroid tissue itself [3,4]. This variation makes identification challenging but experienced thyroid surgeons should be able to recognise and preserve the parathyroids in most cases.…”

Section: Introductionmentioning

confidence: 99%

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Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

Harris

Prades

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et al. 2016

Eur Arch Otorhinolaryngol

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Hypocalcaemia is the most common complication following thyroidectomy. This study aimed to establish the factors associated with increased risk of hypocalcaemia on day 1 following thyroidectomy. All patients who underwent thyroidectomy under a single consultant during a 5-year period were included. A multivariate analysis was undertaken to ascertain which variables had the most effect on the risk of hypocalcaemia. A prognosis table was constructed to allow risk to be predicted for individual patients based on these factors. Included in the analysis were 210 procedures and 194 patients. Eighty-two percent of patients had no calcium derangement postoperatively. Fourteen point nine percent were categorised as early hypocalcaemia, 1 % had protracted hypocalcaemia and 2.1 % had permanent hypocalcaemia. For hemi-thyroidectomies 2.8 % had postoperative hypocalcaemia and 0.9 % had permanent hypocalcaemia. The multivariate analysis revealed total thyroidectomy (risk ratio 26.5, p < 0.0001), diabetes (risk ratio 4.8, p = 0.07) and thyrotoxicosis (risk ratio 3.1, p = 0.04) as statistically significant variables for early postoperative hypocalcaemia. Gender as an isolated factor did not reach significance but was included in the model. The p value for the model was p < 1 × 10. Total thyroidectomy increases risk of early hypocalcaemia when compared to hemithyroidectomy. Gender, diabetes and thyrotoxicosis were also been found to influence the risk. All of these factors are available pre-operatively and can therefore be used to predict a more specific risk for individual patients. It is hoped that this can lead to better informed consent, prevention and better resource allocation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

Harris

Prades

Ткачук

et al. 2016

Eur Arch Otorhinolaryngol

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“…About 1% of the superior PT were located behind the junction of hypopharynx and upper esophagus. 10 The position of inferior PT is more variable. 42% were found on the anterior or lateral surfaces of the lower lobe of the thyroid, often hidden by vessels or creases in the thyroid.…”

Section: Resultsmentioning

confidence: 99%

“…The inferior PT are variable in location. 3 The blood supply of parathyroid are by ITA with some variable component from superior thyroid artery (STA). 4 To preserve the PT with intact blood supply, a medial to lateral dissection is advocated, with plane of dissection along the thyroid capsule.…”

Section: Introductionmentioning

confidence: 99%

Hypoparathyroidism, an innate risk of thyroidectomy

2017

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Background: The identification and preservation of parathyroid glands (PT) with its intact blood supply is of utmost importance during thyroid surgery. To preserve the PT with intact blood supply, a medial to lateral dissection is advocated, with plane of dissection along the thyroid capsule. One of the earliest and feared complications of thyroidectomy is hypoparathyroidism (HPT). Aim was to study the incidence of temporary and permanent hypoparathyroidism during thyroidectomy.Methods: This was a hospital based prospective study, from 2008 to 2015. 472 cases who underwent thyroidectomy (182 near total and 290 total thyroidectomies) for any indications in general surgery department of a tertiary care centre were included.Results: The incidence of permanent and transient HPT after total thyroidectomy was 3.8 and 09%, where as it was 2.75 and 3.85% after near total thyroidectomy. The results of present study were comparable with other studies.Conclusions: Meticulous dissection, absolute hemostasis, and a thorough knowledge of neck anatomy are the key in reducing the post thyroidectomy complications. Transient or permanent hypo parathyroidism is due to inadvertent gland removal or injury to its vascular pedicle. Dissection close to the thyroid capsule and ligation of capsular branches of thyroid avoiding the main trunk of inferior thyroid artery holds the key.

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“…1 The use of medication and biochemical tests is increased by postoperative hypoparathyroidism and hospital stay is prolonged thus adding to the overall cost of thyroidectomy. 2,3,4 The key to minimizing hypoparathyroidism following thyroidectomy is preserving the parathyroid gland and its blood supply. However, the relationship between the hypoparathyroidism and the number of parathyroid glands preserved is not well understood.…”

Section: Introductionmentioning

confidence: 99%

The number of parathyroid glands preserved during thyroidectomy and relationship between hypoparathyroidism

et al. 2017

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Background: The aim of the study was to determine the number of parathyroid glands that need to be preserved to prevent hypoparathyroidism and to understand the relation between the number of parathyroid glands preserved and hypoparathyroidism.Methods: A retrospective study was performed on 350 patients who had undergone trans cervical total thyroidectomy with or without neck dissection for papillary thyroid carcinoma between July 2010 to August 2015.Results: Incidental parathyroidectomy occurred in 19.1% of patients, one parathyroid gland in 17.8%, two in 2% and 3 in 0.5%. Transient hypoparathyroidism increased when incidental parathyroidectomy occurred on multivariate regression analysis, but it was not influenced by the actual number of parathyroid glands removed. There was no relationship between the number of parathyroid glands preserved and hypoparathyroidism.Conclusions: It is not compulsorily required to prevent permanent hypoparathyroidism, but the preservation of all the four parathyroid glands during thyroidectomy decreases the incidence of transient hypoparathyroidism. When auto transplantation is not performed, to prevent permanent hypoparathyroidism, preserving at least one parathyroid gland with an intact blood supply is sufficient.

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Location, number and morphology of parathyroid glands: results from a large anatomical series

Cited by 80 publications

References 18 publications

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

Hypoparathyroidism, an innate risk of thyroidectomy

The number of parathyroid glands preserved during thyroidectomy and relationship between hypoparathyroidism

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