Skip to main content
Log in

The Association of Discolored Parathyroid Glands and Hypoparathyroidism Following Total Thyroidectomy

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

It remains uncertain whether a parathyroid gland (PG) that appears darkened or severely bruised but still has an attached vascular pedicle should be left in situ or taken out and auto-transplanted following total thyroidectomy. Our study aimed to examine the impact of discolored PGs (DPGs) on short- and long-term hypoparathyroidism.

Methods

One hundred and three patients who underwent total thyroidectomy with 4 clearly identified PGs were analyzed. Location (superior/inferior) and color of each PG were recorded. Patients without DPG were grouped into I while those with 1–2 DPGs and ≥3 DPGs were grouped into II and III, respectively. Transient hypoparathyroidism meant adjusted Ca <2.00 mol/L 24 h after surgery and/or need for supplements. Protracted hypoparathyroidism meant a subnormal PTH at 4–6 weeks and/or supplements >6 weeks. Permanent hypoparathyroidism meant supplements ≥1 year.

Results

Relative to I, group III had greater adjusted Ca drop at postoperative 1-h (p = 0.012), 24-h (p < 0.001) and lower day-1 PTH (p = 0.015). Having ≥3 DPGs (OR 14.00, 95 % CI 1.575–124.474, p = 0.018) was an independent factor of transient hypoparathyroidism. However, permanent hypoparathyroidism rate was higher than in group I than II (p = 0.019). Eight patients (25.8 %) in group I had undetectable day-1 PTH, while none in group III had undetectable day-1 PTH. Graves’ disease/toxic goiter (OR 15.166, 95 % CI 2.594–88.661, p = 0.003) and excised gland weight (OR 1.028, 95 % CI 1.010–1.046, p = 0.003) were independent factors of ≥3 DPGs.

Conclusions

PG discoloration is associated with transient hypoparathyroidism while normal colored PG with seemingly adequate blood supply does not always imply functionally normal gland. These findings highlights the need for a real-time intraoperative method to assess PG viability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 101(4):307–320

    Article  CAS  PubMed  Google Scholar 

  2. Lorente-Poch L, Sancho JJ, Muñoz-Nova JL, Sánchez-Velázquez P, Sitges-Serra A (2015) Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg 4(1):82–90

    PubMed  PubMed Central  Google Scholar 

  3. Wong KP, Lang BH (2011) Graves’ ophthalmopathy as an indication increased the risk of hypoparathyroidism after bilateral thyroidectomy. World J Surg 35(10):2212–2218. doi:10.1007/s00268-011-1236-y

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mehanna HM, Jain A, Randeva H, Watkinson J, Shaha A (2010) Postoperative hypocalcemia–the difference a definition makes. Head Neck 32(3):279–283

    PubMed  Google Scholar 

  5. Cavallaro G, Iorio O, Centanni M et al (2015) Parathyroid reimplantation in forearm subcutaneous tissue during thyroidectomy: a simple and effective way to avoid hypoparathyroidism. World J Surg 39(8):1936–1942. doi:10.1007/s00268-015-3070-0

    Article  PubMed  Google Scholar 

  6. Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133(2):180–185

    Article  PubMed  Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. Kuhel WI, Carew JF (1999) Parathyroid biopsy to facilitate the preservation of functional parathyroid tissue during thyroidectomy. Head Neck 21(5):442–446

    Article  CAS  PubMed  Google Scholar 

  9. Promberger R, Ott J, Kober F, Mikola B, Karik M, Freissmuth M, Hermann M (2010) Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy. Thyroid 20(12):1371–1375

    Article  CAS  PubMed  Google Scholar 

  10. Promberger R, Ott J, Bures C, Freissmuth M, Seemann R, Hermann M (2015) Perioperative kinetics of parathyroid hormone in unilateral, primary thyroid surgery. Endocrine 48(1):293–298

    Article  CAS  PubMed  Google Scholar 

  11. Lang BH, Yih PC, Ng KK (2012) A prospective evaluation of quick intraoperative parathyroid hormone assay at the time of skin closure in predicting clinically relevant hypocalcemia after thyroidectomy. World J Surg 36(6):1300–1306. doi:10.1007/s00268-012-1561-9

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lang BH, Wong KP (2013) How useful are perioperative biochemical parameters in predicting the duration of calcium and/or vitamin D supplementation after total thyroidectomy? World J Surg 37(11):2581–2588. doi:10.1007/s00268-013-2195-2

    Article  PubMed  Google Scholar 

  13. Erbil Y, Barbaros U, Temel B et al (2009) The impact of age, vitamin D(3) level, and incidental parathyroidectomy on postoperative hypocalcemia after total or near total thyroidectomy. Am J Surg 197:439–446

    Article  CAS  PubMed  Google Scholar 

  14. Kirkby-Bott J, Markogiannakis H, Skandarajah A et al (2011) Preoperative vitamin D deficiency predicts postoperative hypocalcemia after total thyroidectomy. World J Surg 35:324–330. doi:10.1007/s00268-010-0872-y

    Article  PubMed  Google Scholar 

  15. Lang BH, Lo CY (2010) Vitamin D3 deficiency is associated with late-onset hypocalcemia after minimally invasive parathyroidectomy in a vitamin D borderline area. World J Surg 34(6):1350–1355. doi:10.1007/s00268-009-0377-8

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brian Hung-Hin Lang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lang, B.HH., Chan, D.T.Y., Chow, F.CL. et al. The Association of Discolored Parathyroid Glands and Hypoparathyroidism Following Total Thyroidectomy. World J Surg 40, 1611–1617 (2016). https://doi.org/10.1007/s00268-016-3462-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-016-3462-9

Keywords

Navigation