Risk Factors and Consequences of Incidental Parathyroidectomy during Thyroidectomy

Abstract

The objectives of this retrospective study were to investigate the incidence, risk factors, and clinical significance of incidental parathyroidectomy during thyroidectomy. In this study, there were 315 patients who underwent thyroidectomy between 1996 and 2006. All the operations were performed by a single experienced surgeon (J.S.). Pathology reports on all specimens were reviewed and information regarding patient demographics, diagnosis, operative details, and postoperative complications were collected. A total of 315 thyroidectomies were performed: 101 total thyroidectomies (32.1%) and 214 subtotal thyroidectomies (67.9%). Two hundred and eighty patients were operated on for benign disease (88.9%) and 35 for malignant disease (11.1%). Incidental parathyroidectomy was identified in 32 cases (10.2%). Preoperative diagnosis of malignant disease ( P = 0.009) and duration of the disease ( P = 0.001) were significant predictors of incidental parathyroidectomy. Incidental parathyroidectomy was significantly correlated with postoperative hypoparathyroidism ( P = 0.03). Transient postoperative hypoparathyroidism occurred in 18 cases (6%) and permanent in three cases (1%). The duration of the disease was the sole significant predictor of postoperative hypoparathyroidism ( P < 0.001). Incidental parathyroidectomy seems to be the result of the use of extensive surgical procedures. The preoperative diagnosis of malignant disease and the delay of the operation, which leads to a more advanced thyroid disease, make the use of extensive surgical procedures necessary.

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

“…Finally, 35 articles were included in the systematic review and meta-analysis. [ 3 – 5 , 8 – 18 , 47 – 67 ] Details on first author, year of publication, location, study type, pathology, procedure extent, the definition of permanent hypocalcemia and NOS score were recorded. ( Table 1 ) Two prospective cohorts and 33 retrospective cohorts were included in our study.…”

“…[ 2 ] Among these, hypocalcemia is the most common complication, with an incidence of 7–51%. [ 3 – 5 ] The quality of life is decreased in patients suffering from postoperative hypocalcemia, particularly in those suffering from clinical hypocalcemia. Moreover, prolonged or long-term calcium supplementation might be necessary for transient or permanent hypocalcemia.…”

“…IP has been defined as parathyroid tissue found in a postoperative specimen and occurs in 6–28% of thyroidectomy. [ 3 – 5 ] Even with careful dissection and sufficient anatomical knowledge, the identification and in situ preservation of parathyroid tissue remains challenging. There are several anatomic variants of parathyroid glands, particularly of the inferior parathyroid.…”

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

“…[ 1 ] Nowadays, thyroidectomy is a relatively safe surgical procedure, which is associated with a morbidity <5%. [ 2 ] The surgical procedure itself demands both perfect knowledge of the anatomical structures of the neck and a meticulous surgical technique.…”

Frequency of post-operative complications of thyroidectomy.

“…In specialized centres, thyroidectomy has zero mortality and fewer complications reported. 1 Most common indications for thyroidectomy are toxic nodules, multinodular goitre, graves disease and malignancy. 2 Most common complications of total thyroidectomy are recurrent laryngeal nerve palsy and transient hypocalcaemia.…”