Surgical Anatomy of the Thyroid and Parathyroid Glands

Fancy, Tanya; Gallagher, Daniel J.; Hornig, Joshua D.

doi:10.1016/j.otc.2010.01.001

Cited by 106 publications

(87 citation statements)

References 8 publications

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“…Doppler ultrasonografi ile yapılan bir çalış-mada A. thyroidea inferior ve A. thyroidea superior ayrı olarak kesildiği durumlarda, paratiroidlere giden kan akımın ancak 1/3 oranda azaldığı saptanmıştır (15). Paratiroidlerin beslenmesi terminal tipte olup, %62'sinin tek dal, %28'nin çift dal, %10'nun 3 veya fazla dal olarak bez içine girdiği belirlenmiştir (16).…”

Section: Discussionunclassified

The Impact of Bilateral Inferior Thyroid Artery Truncal Ligation and Recurrent Laryngeal Nerve Dissection on Early Postoperative Blood Calcium Levels after Total Thyroidectomy

Topal¹,

Gedik²,

Karagöz³

et al. 2014

JAREM

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ÖZETAmaç: Total tiroidektomi yapılan hastalarda, A. thyroidea inferior'un trunkal bağlanıp bağlanmamasının ve N. laryngeus inferior'un diseke edilip edilmemesinin postoperatif erken dönem kan kalsiyumuna etkisi, prospektif randomize olarak araştırıldıYöntemler: "Multinodüler guatr" tanısıyla "total tiroidektomi" endikasyonu alan ve çalışma kriterlerini taşıyan 92 hastada prospektif randomize bir çalışma planlandı. Grup 1'de (n=40) A. thyroidea inferior bilateral trunkal olarak bağlandı ve N. laryngeus inferior diseksiyonu yapıldı. Grup 2'de (n=52) ise A. thyroidea inferior tiroid dokusuna yakın bağlandı ve N. laryngeus inferior diseksiyonu yapılmadı. Tüm hastalarda ameliyattan 12 saat önce ve ameliyattan 1 ve 3 gün sonra kan kalsiyum düzeyleri ölçüldü.Bulgular: Gruplar arasında yaş, cinsiyet, ameliyat süresi ve hastanede kalış süresi açılarından istatiksel olarak anlamlı fark yoktu. İki gruptaki hastaların preoperatif, postoperatif 1. ve 3. gün kan kalsiyum değerleri arasında istatiksel olarak anlamlı fark saptanmadı (sırasıyla p=0,07; p=0,29; p=0,51). Grup 1'de postoperatif 1. gündeki kan kalsiyum değeri (p<0,018), Grup 2'de ise postoperatif 3. gündeki kan kalsiyum değeri (p<0,002) preoperatif değer-lere göre istatistiksel olarak anlamlı düzeyde azalma gösterdi. Buna paralel olarak, postoperatif dönemde Grup 1'de 4 hastada (%10), Grup 2'de ise 5 hastada (%9,5) Chvostek ve Trousseau bulguları ortaya çıktı; bulgular açısından gruplar arasında istatistiksel olarak fark saptanmadı (p=0,71). Hiçbir olguda ses kısıklığı ve/veya solunum güçlüğü gözlenmedi. Sonuç:A. thyroidea inferior'un trunkal bağlanması ve N. laryngeus inferior'un diseke edilmesi, arterin dokuya yakın bağlanması ve sinirin diseke edilmemesine göre postoperatif kan kalsiyum değerini anlamlı düzeyde etkilememiştir. Her iki yöntem de benzer ve beklenebilir oranda (%10) postoperatif erken dönem hipokalsemisi ortaya çıkmıştır. Her iki yöntemde de tiroidektomi sonrası görülebilen ses kısıklığı ve solunum güçlüğü gibi major komplikasyonlar ortaya çıkmamıştır. (JAREM 2014; 2: 69-73) Anahtar Sözcükler: Total tiroidektomi, tiroid inferior arter, laringeal inferior sinir, trunkal arter ligasyonu, sinir diseksiyonu ABSTRACT Objective: Early postoperative calcium levels were evaluated following total thyroidectomy with respect to bilateral inferior thyroid artery truncal ligation and reccurent laryngeal nerve dissection.Methods: Ninety two patients with multinodular goitre were treated with total thyroidectomy, and randomised according to the study protocol. Bilateral inferior thyroid artery truncal ligation together with dissection of recurrent laryngeal nerve was performed in group 1 (no:40). In group 2 patients (n:52), Inferior thyroid artery was ligated at the level of the thyroid gland entrance and dissection of nervus laryngeus inferior was not performed. The calcium levels were obtained 12 hours before and 24.72 hours after the operation.Results: There were no significant differences in age, gender, operating time and hospitalisation time between the t...

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Section: Discussionunclassified

The Impact of Bilateral Inferior Thyroid Artery Truncal Ligation and Recurrent Laryngeal Nerve Dissection on Early Postoperative Blood Calcium Levels after Total Thyroidectomy

Topal¹,

Gedik²,

Karagöz³

et al. 2014

JAREM

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“…The inferior PGs irrigation is predominantly given by branches of the inferior thyroid artery, and, less frequently by branches of the STA, depending on its location (when located in the thyrothymic ligament there is no additional supply by the STA). In a few cases the irrigation comes from branches of the internal mammary artery [4][5][6].…”

Section: Workupmentioning

confidence: 99%

Hypocalcemia posthyroidectomy: prevention, diagnosis and management

Mg¹,

González-Devia²,

Fierro³

et al. 2018

J Transl Sci

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“…However, the pitfall with this strategy is that not all PGs could be found in their orthotopic or usual positions. For example, some superior PGs are located at the superior pole of the posterior thyroid gland near the cricothyroid junction and some inferior PGs may be located far away from the neck in the thymus and mediastinum (24,25). Therefore, even with the best intention, it may not be always possible to identify each and every PG at the time of total thyroidectomy.…”

Section: Routine Versus Selective Identificationmentioning

confidence: 99%

To identify or not to identify parathyroid glands during total thyroidectomy

Chang

Lang

2017

Gland Surg.

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Hypoparathyroidism is one of the most common complications after total thyroidectomy and may impose a significant burden to both the patient and clinician. The extent of thyroid resection, surgical techniques, concomitant central neck dissection, parathyroid gland (PG) autotransplantation and inadvertent parathyroidectomy have long been some of the risk factors for postoperative hypoparathyroidism. Although routine identification of PGs has traditionally been advocated by surgeons, recent evidence has suggested that perhaps identifying fewer number of in situ PGs during surgery (i.e., selective identification) may further lower the risk of hypoparathyroidism. One explanation is that visual identification may often lead to subtle damages to the nearby blood supply of the in situ PGs and that may increase the risk of hypoparathyroidism.However, it is worth highlighting the current literature supporting either approach (i.e., routine vs. selective) remains scarce and because of the significant differences in study design, inclusions, definitions and management protocol between studies, a pooled analysis on this important but controversial topic remains an impossible task. Furthermore, it is worth nothing that identification of PGs does not equal safe preservation, as some studies demonstrated that it is not the number of PGs identified, but the number of PG preserved in situ that matters. Therefore a non-invasive, objective and reliable way to localize PGs and assess their viability intra-operatively is warranted. In this aspect, modern technology such as the indocyanine green (ICG) as near-infrared fluorescent dye for real-time in situ PG perfusion monitoring may have a potential role in the future.

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Surgical Anatomy of the Thyroid and Parathyroid Glands

Cited by 106 publications

References 8 publications

The Impact of Bilateral Inferior Thyroid Artery Truncal Ligation and Recurrent Laryngeal Nerve Dissection on Early Postoperative Blood Calcium Levels after Total Thyroidectomy

The Impact of Bilateral Inferior Thyroid Artery Truncal Ligation and Recurrent Laryngeal Nerve Dissection on Early Postoperative Blood Calcium Levels after Total Thyroidectomy

Hypocalcemia posthyroidectomy: prevention, diagnosis and management

To identify or not to identify parathyroid glands during total thyroidectomy

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