Abstract
Purpose
To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy.
Methods
Consecutive total thyroidectomy cases performed by a single surgeon using extracapsular dissection technique were considered. PGs were not intentionally sought during dissection. PG location, number identified and autoT were prospectively recorded and correlated to postoperative outcomes.
Results
In all, 265 cases were included. The mean number of PGs identified per case was 2.7. The number of PGs identified had no correlation to postoperative hypocalcemia. However, independent risk factors for hypocalcemia were female sex, bilateral central compartment neck dissection (CND) and autoT > 1 PG; and for permanent hypoparathyroidism were female sex and bilateral CND. AutoT did not protect against permanent hypoparathyroidism.
Conclusion
The number of PGs identified during the course of a standard extracapsular dissection technique had no correlation to postoperative hypocalcemia. Whenever possible, avoiding bilateral CND and careful techniques to preserve PGs in an in situ and viable state, to obviate the necessity for autoT, are recommended.
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References
Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcemia. Br J Surg 101(4):307–320
Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A (2015) Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg 102(4):359–367
Seo ST, Chang JW, Jin J, Lim YC, Rha KS, Koo BS (2015) Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results. Surgery 158(6):1492–1499
Antakia R, Edafe O, Uttley L, Balasubramanian SP (2015) Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid 25(1):95–106
Sheahan P, Mehanna R, Basheeth N, Murphy MS (2013) Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: a prospective study. Laryngoscope 123(9):2324–2328
Raffaelli M, De Crea C, Sessa L et al (2012) Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery 152(6):957–964
Sands NB, Payne RJ, Cote V, Hier MP, Black MJ, Tamilia M (2011) Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg 145(4):561–564
Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP (2014) Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg 140(11):1006–1013
Raffaelli M, De Crea C, Sessa L, Fadda G, Bellantone C, Lombardi CP (2015) Ipsilateral central neck dissection plus frozen section examination versus prophylactic bilateral central neck dissection in cN0 papillary thyroid carcinoma. Ann Surg Oncol 22(7):2302–2308
Palazzo FF, Sywak MS, Sidhu SB, Barraclough BH, Delbridge LW (2005) Parathyroid autotransplantation during total thyroidectomy—does the number of glands transplanted affect outcome? World J Surg 29(5):629–631
Lo CY, Lam KY (2001) Routine parathyroid autotransplantation during thyroidectomy. Surgery 129(3):318–323
Oertli D (2012) Technique of thyroidectomy. In: Oertli D, Udelsman R, Randolph G (eds) Surgery of the thyroid and parathyroid glands, 2nd edn. Elsevier, Amsterdam, pp 165–172
Calandra D, Paloyan E, Oslapas R, Hofmann C, Ernst K, Shah KH, Lawrence AM (1983) Successful autotransplantation of parathytoid adenomas in seven patients. Am Surg 49(6):324–328
Promberger R, Ott J, Kober F et al (2010) Intra- and postoperative parathyroid hormone—kinetics do not advocate for autotransplantation of discoloured parathyroid glands during thyroidectomy. Thyroid 20(12):1371–1375
Sadowski SM, Vidal Fortuny J, Triponez F (2017) A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence technique. Gland Surg 6(Suppl 1):S30–S37
Benmiloud F, Rebaudet S, Varoguaux A, Penaranda G, Bannier M, Denizot A (2018) Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery 163(1):23–30
Prazenica P, O’Keeffe L, Holy R (2015) Dissection and identification of parathyroid glands during thyroidectomy: association with hypocalcemia. Head Neck 37(3):393–399
Dedivitis RA, Aires FT, Cernea CR (2017) Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg 25(2):142–146
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Mehta, S., Dhiwakar, M. & Swaminathan, K. Outcomes of parathyroid gland identification and autotransplantation during total thyroidectomy. Eur Arch Otorhinolaryngol 277, 2319–2324 (2020). https://doi.org/10.1007/s00405-020-05941-9
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DOI: https://doi.org/10.1007/s00405-020-05941-9