Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery

Abstract

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.

Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism

“…17 This report found no association between gender and inadvertent parathyroidectomy, which is compatible with most other recent studies. 6,[8][9][10][11]14,16,17,[19][20][21][22]24,25 This study also found no association between age at surgery and inadvertent parathyroidectomy, in keeping with recent literature. 6,[9][10][11][12][13][14]17,19,[21][22][23] A retrospective review of 1114 thyroidectomies by Barrios et al 23 found that, on multivariable analysis, low-volume surgeons had a significantly higher incidence of inadvertent parathyroidectomy.…”

“…Several factors may contribute to the wide variation in reported inadvertent parathyroidectomy rates. Many studies (including this report) included thyroid lobectomy in the analysis of inadvertent parathyroidectomy, 7,8,10,11,[13][14][15][16]18,20,21,[23][24][25] whereas others analyse only total or near-total thyroidectomy cases. 6,7,9,12,17,19,22 Some studies excluded patients undergoing re-operative thyroid surgery 18,20,21 or central neck dissection.…”

“…6,7,9,12,17,19,22 Some studies excluded patients undergoing re-operative thyroid surgery 18,20,21 or central neck dissection. 21 The criteria used to define inadvertent parathyroidectomy are inconsistent: many studies do not report a clear definition, 8,9,11,12,15,20,22,25 some consider any amount of parathyroid tissue in the specimen, 6,10,13,14,[16][17][18]23,24 whereas others specify the need for an entire parathyroid gland to be present. 19…”

“…6 Inadvertent parathyroidectomy is a relatively frequent occurrence in thyroid surgery, with a reported incidence of 2.9 -31.0 per cent. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] The relationship between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia is controversial, with conflicting results in the recent literature. 6,9,18 Even if there is a limited overall impact, understanding the risk factors for inadvertent parathyroidectomy may allow the thyroid surgeon to exercise appropriate caution in patients who are at high risk for post-surgical hypoparathyroidism or hypocalcaemia.…”

Potential protection of indocyanine green on parathyroid gland function during near-infrared laparoscopic-assisted thyroidectomy: A case report and literature review

“…Incidental parathyroidectomy is considered a minor finding in final histopathology, but it is important for the thyroid surgeon to be able to identify the factors that increase the risk of incidental parathyroidectomy during thyroidectomy and exercise appropriate caution in these patients[ 24 ]. Despite the risk of unavoidable incidental pa-rathyroidectomy, careful dissection and meticulous intraoperative identification of PGs can reduce the incidence of incidental parathyroidectomy[ 25 ]. Although preservation of the surrounding vasculature and capsular dissection techniques are used to avoid incidental parathyroidectomy or disruption of the parathyroid vasculature, reliable tools to both identify and assess PGs during surgery, and to predict whether a patient will develop hypoparathyroidism, are limited[ 26 ].…”