Routine Autotransplantation of at Least One Parathyroid Gland During Total Thyroidectomy May Reduce Permanent Hypoparathyroidism to Zero

Zedenius, Jan; Wadström, C; Delbridge, Leigh

doi:10.1046/j.1440-1622.1999.01697.x

Cited by 135 publications

(132 citation statements)

References 8 publications

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“…It was known that routine parathyroid autotransplantation increased postoperative temporary hypocalcaemia and decreased permanent hypocalcaemia (Zedenius et al, 1999;Lo, 2002). Parathyroid gland autotransplantation was not routine in our study.…”

Section: Discussionmentioning

confidence: 72%

Total thyroidectomy is safer with identification of recurrent laryngeal nerve

Canbaz

Dirlik

Çolak

et al. 2008

J. Zhejiang Univ. Sci. B

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Section: Discussionmentioning

confidence: 72%

Total thyroidectomy is safer with identification of recurrent laryngeal nerve

Canbaz

Dirlik

Çolak

et al. 2008

J. Zhejiang Univ. Sci. B

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“…The development of permanent hypocalcemia despite all the attention and care encouraged surgeons to autotransplant one or more parathyroid glands during thyroidectomy, and it was reported that the rate of permanent hypoparathyroidism is decreased to below 1% with prophylactic routine autotransplantation (15,(20)(21)(22)(23). There are two studies on the routine application of autotransplantation by Ohman (24) and Kihara (25).…”

Section: Discussionmentioning

confidence: 99%

The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy

Oran

Yetkın

Mihmanlı

et al. 2016

UCD

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Objective: Thyroidectomy is the most common cause of hypocalcemia. Preservation of parathyroid glands in situ is essential in preventing this complication. The aims of our study were to review patients who underwent parathyroid gland autotransplantation during thyroidectomy, and to compare hypocalcemia rates in patients with and without autotransplantation. Material and Methods:Parathyroid gland autotransplantation was performed in 43 (7.9%) of 543 patients who underwent thyroidectomy between 2008 and 2012.Results: Forty-four parathyroid glands were autotransplanted in 43 patients, including 36 women and 7 men. The median age was 55 (range: 30 to 68). The most common cause of autotransplantation was vascular comprise of the parathyroid gland. Early postoperative hypocalcemia developed in 37% of patients with autotransplantation, and none developed permanent hypocalcemia. Transient and permanent hypocalcemia rates were 9.6% and 0.4% in patients without autotransplantation, respectively. The risk of transient hypocalcemia was significantly high in patients with parathyroid autotransplantation (p<0.001). There was no difference between the two groups in terms of permanent hypocalcemia (p=0.156). Conclusion:Despite meticulous dissection, parathyroid glands can be devascularized or removed inadvertently during thyroidectomy. Parathyroid autotransplantation is the best method to maintain parathyroid gland function. Although the risk of transient hypocalcemia is increased following parathyroid autotransplantation, long-term results are satisfactory. INTRODUCTIONThyroid surgery is the most frequently performed operation in general surgery clinics, and constitute 1% of all medical diseases (1). The second most feared complication of thyroid surgery, following recurrent laryngeal nerve (RLN) injury, is the development of hypocalcemia. The most common cause of hypocalcemia is post-surgery hypoparathyroidism (2). Hypocalcemia may develop in the immediate postoperative period and may improve in several weeks (transient hypocalcemia), or it may persist for more than 6 months after surgery, in which case is called permanent hypocalcemia. Hypocalcemia manifests with paresthesia, mental status changes, neuromuscular irritability, and muscle spasm. Chronic hypocalcemia can lead to cataract formation, calcification in the cerebellum and basal ganglia, peripheral neuropathy, and cardiac problems. These patients require lifelong calcium and vitamin D supplements.

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“…Routine autotransplantation of parathyroid glands has been advocated in patients undergoing radical head and neck surgery including total thyroidectomy. In our unit, we routinely autotransplant at least one parathyroid gland during every total thyroidectomy; the incidence of permanent hypoparathyroidism after this maneuver has been reduced to nearly zero [21]. The adequacy of the blood supply to a dissected parathyroid gland cannot always be assessed solely by its appearance.…”

Section: Dissection Of the Lateral Aspect Of The Thyroid Lobementioning

confidence: 99%

Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique

2000

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Abstract. The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy and pathology. With appropriate techniques, total thyroid lobectomy and total thyroidectomy (which should be considered simply as a bilateral total thyroid lobectomy performed during the same operation) can be undertaken with minimal risk of damage to the recurrent laryngeal nerves, the external branches of the superior laryngeal nerves, and the parathyroid glands. Safe surgery requires a specific operative plan, progressing in a series of logical, orderly, anatomically based steps. Exposure of the thyroid gland is followed by careful dissection of the superior pole, utilizing the avascular plane between the superior pole and the cricothyroid muscle to identify and preserve the external branch of the superior laryngeal nerve. Medial retraction of the gland then allows dissection of the lateral aspect of the thyroid lobe. Protection of the recurrent laryngeal nerves and preservation of the blood supply to the parathyroid glands is best achieved by "capsular dissection," ligating the tertiary branches of the inferior thyroid artery on the gland surface. If a parathyroid gland cannot be preserved or becomes ischemic after dissection of its vascular pedicle, it should be immediately minced and autotransplanted into the ipsilateral sternocleidomastoid muscle. The current evolution of outpatient or shortstay thyroidectomy emphasizes the need to avoid complications by utilizing meticulous surgical technique. Minimally invasive thyroidectomy utilizing endoscopic techniques may also affect the practice of thyroid surgery. Even so, understanding the surgical anatomy of the thyroid gland and its possible variations is paramount to safe and effective surgery.During the latter half of the nineteenth century a revolution in surgery and surgical technique occurred. Before that time, thyroid surgery was limited to treating only life-threatening conditions. With a reported mortality rate of more than 20%, the reputation of thyroid surgery was so poor that the French Academy of Medicine banned its practice in 1850. Indeed, when Greene reported his successful thyroidectomies in America, he warned that the operations should be used "never, for the relief of deformity or discomfort merely; only, to save life" [1]. However, by the time the Nobel Prize was awarded to Kocher in 1909, the mortality rate in his hands had been reduced to 0.18% [2].The key to increasing safety of thyroid surgery was then, as now, a thorough understanding of thyroid anatomy and pathology. The general developments in surgical techniques and instrumentation, and the improvements in antisepsis and anesthetic techniques, were also crucial. When thyroidectomy became safe to perform, the specific complications of the procedure could be addressed, including prevention of injury to the recurrent laryngeal nerves and avoidance of accidental injury to, or removal of, the parathyroid glands. The surgical techniques developed at that time were, i...

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Routine Autotransplantation of at Least One Parathyroid Gland During Total Thyroidectomy May Reduce Permanent Hypoparathyroidism to Zero

Abstract: This strategy, easily adopted by any experienced surgeon, has the potential to eliminate permanent hypoparathyroidism following total thyroidectomy.

Cited by 135 publications

References 8 publications

Total thyroidectomy is safer with identification of recurrent laryngeal nerve

Total thyroidectomy is safer with identification of recurrent laryngeal nerve

The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy

Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique

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