The risk of hypocalcemia in patients with parathyroid autotransplantation during thyroidectomy

Abstract

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.

Hypoparathyroidism: State of the Art on Cell and Tissue Therapies

“…Consequently, they could state that there were no significant differences in the parameters analyzed between groups A and B, suggesting that parathyroid autograft does not affect the rate of postoperative hypocalcemia and/or HypoPT. The same results were found in several other retrospective studies [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ].…”

An Undesirable Post-Thyroidectomy Surprise for the Surgeon: Inadvertent Parathyroidectomy

“…Intraoperative pathologic verification of inadvertent PG removal during thyroid surgeries may be necessary. Previously published reports suggest intra-muscular auto transplantation of accidentally removed PGs that are encountered peri-operatively (22,(30)(31)(32). An appropriate and timely fashioned management of postoperative hypocalcemia that may occur as a result of accidental removal of PGs is warranted to ensure better patients outcomes and protection of the surgeon against medico-legal issues.…”

The impact of different surgical procedures on hypoparathyroidism after thyroidectomy

“…[ 16 ] To avoid transient hypocalcemia after thyroidectomy calcium and vitamin D supplements along with subtotal thyroidectomy are useful in light of findings of a review study by Antakia Ramez et al [ 17 ] Some authors are of the view that as a result of parathyroid autotransplantation, the risk of transient hypocalcemia is enhanced; still it is in favor of improved patient outcomes in the long run. [ 18 ]…”