Permanent hypoparathyroidism after completion total thyroidectomy as a second surgery: How do we avoid it?

Abstract

A permAnent hypopArAthyroidism is one of the prominent complications of total thyroidectomy. To prevent it, some attempts have been performed such as carefully preserving the parathyroid gland with blood supply [1][2][3] and parathyroid autotransplantation to the sternocleidomastoid muscle or the pectoralis major muscle after mincing [1,2,[4][5][6]. The incidence of permanent hypoparathyroidectomy of total thyroidectomy with and without central dissection was reported to be 0-4.6% [7][8][9] and 0-3.4% [10][11][12], respectively, but one report demonstrated that the incidence increased in reoperation of bilateral central dissection (from 0 to 23%) [13].In this study, we investigated the risk factors of permanent hypoparathyroidism of patients who underwent completion total thyroidectomy as the second surPermanent hypoparathyroidism after completion total thyroidectomy as a second surgery: How do we avoid it?Yasuhiro Ito, Minoru Kihara, Kaoru Kobayashi, Akihiro Miya and Akira Miyauchi Department of Surgery, Kuma Hospital, Kobe 650-0011, JapanAbstract. A permanent hypoparathyroidism is a problematic complication of total thyroidectomy. In this study, we investigated its incidence and how to avoid it at the time of completion total thyroidectomy after hemithyroidectomy. Eight of the 154 patients who underwent completion total thyroidectomy as the second surgery (5%) after hemithyroidectomy (two-surgery group) showed a permanent hypothyroidism. Patients without parathyroid autotransplantation either at initial or second surgery were more likely to show a permanent hypoparathyroidism. In the subset of 74 patients in two-surgery group, who underwent bilateral central dissection, 6 (8%) had a permanent hypoparathyroidism. The incidence was higher than those in control group who underwent total thyroidectomy with bilateral central dissection at one time, which was 2%. However, all 6 patients showing a permanent hypoparathyroidsm underwent bilateral central dissection in initial surgery and none of the patients who underwent bilateral central dissection in twice had a permanent hypoparathyroidism. Taken together, we can conclude that 1) in initial surgery of hemithyroidectomy, we have to carefully search the parathyroid glands and if dissected, they should retrieved and autotransplanted to save the patients from a permanent hypoparathyroidism when they undergo second surgery in future, and 2) hemithyroidectomy with bilateral central dissection significantly increases the risk of permanent hypoparathyroidism and only ipsilateral dissection is better when we do not perform total thyroidectomy.

The Epidemiology of Hypoparathyroidism in Italy: An 8-Year Register-Based Study

“…These cases account for all the procedures of the neck region that resulted in impaired parathyroid function and involved a mean of 1.3/100,000 inhabitants per year during the observation. Overall, the prevalence of postsurgical hypoparathyroidism in previous reports varied according to centers of different expertise and experience [1][2][3][4][5][9][10][11][12][13][14]. The type and extension of surgery of the neck structures and, consequently, the underlying disease, as well as repeated surgeries, can also affect the rate of postoperative hypoparathyroidism [1,11,15].…”

Is Morbıdıty Hıgh in Completıon Thyroıdectomy?

“…Diğer korkulan bir komplikasyon kalıcı hipoparatiroidizmdir (19)(20)(21). Literatürde geçici hipoparatiroidizm oranları %3-15 arası değişmektedir.…”

Hypocalcemia posthyroidectomy: prevention, diagnosis and management

“…Anterior central neck compartment surgery is the leading cause of hypoparathyroidism [9,[21][22][23][24][25] and is one of the most common complications in patients undergoing thyroidectomy, with a prevalence of 10 to 46% [9,26,27].…”

“…Large size and weight of the thyroid gland [17,21] Retro-sternal extension of the thyroid [32] Dissection of the central neck nodal compartment [15,25,31] Re-interventions [17] Deficit or insufficiency of VD [33] Surgeon expertise [26] Graves-Basedow disease [26,31] Extent of surgery [15,34] Female sex [15,31] Presurgical use of β Blockers [31] Less than 2 PGs identified [15] Parathyroid tissue on the final pathology report [35] Predictive factors of postsurgical hypoparathyroidism:…”