Abstract
Introduction
Inadvertent parathyroidectomy is a recognised complication of thyroid surgery. We aimed to investigate the incidence of and risk factors for inadvertent parathyroidectomy during thyroid surgery, in our patient cohort.
Methods
A retrospective review of the records of all patients undergoing thyroid surgery in our institution between January 2012 and December 2014 was performed. Medical records, laboratory investigations and histopathology reports were evaluated. Patient demographics, indication for surgery, surgery performed, final pathology, incidental parathyroidectomy and post-operative hypocalcaemia were recorded. Univariate analysis using the Fisher’s exact test was performed.
Results
Two hundred and thirty procedures were included: 147 hemi-thyroidectomies and 83 total thyroidectomies. Central neck dissection was also performed in 13 cases. The most common indication for surgery was indeterminate cytology (81 cases). Post-operatively, malignant disease was reported in 52 cases (22.6%). Inadvertent parathyroidectomy occurred in 40 cases (17.3%). There was a statistically significant increased risk of inadvertent parathyroidectomy with malignant disease (p = 0.001) and after central neck dissection (p = 0.013) but no difference was seen between hemi- and total thyroidectomies (p = 0.47), gender (p = 1.00) or with increasing age (p = 1.00). Hypocalcaemia occurred in four cases and was transient in three.
Conclusion
Inadvertent parathyroidectomy is a potential risk during thyroid surgery but post-operative hypocalcaemia as a result is rare. Malignancy and more extensive surgery appear to carry an increased risk for this complication.
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References
Loyo M, Tufano RP, Gourin CG (2013) National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope 123:2056–2063
Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP (1998) Morbidity of thyroid surgery. Am J Surg 176:71–75
Pattou F, Combemale F, Fabre S, Carnaille B, Decouix M, Wemeau JL, Racadot A, Proye C (1998) Hypocalcaemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724
Sakorafas GH, Stafyla V, Bramis C, Kotsifopoulos N, Kolettis T, Kassaras G (2005) Incidental parathyroidectomy during thyroid surgery: an underappreciated complication of thyroidectomy. World J Surg 29(12):1539–1543
Khairy GA, Al-Saif A (2011) Incidental parathyroidectomy during thyroid resection: incidence, risk factors and outcome. Ann Saudi Med 31(3):274–278
Qasaimeh GR, Al Nemre S, Al Omari AK (2011) Incidental extirpation of the parathyroid glands at thyroid surgery: risk factors and post-operative hypocalcaemia. Eur Arch Otorhinolaryngol 268(7):1047–1051
Gourgiotis S, Moustafellos P, Dimopoulos N, Papaxoinis G, Baratsis S, Hadjiyannakis E (2006) Inadvertent parathyroidectomy during thyroid surgery: the incidence of a complication of thyroidectomy. Langenbecks Arch Surg 391(6):557–560
Sasson AR, Pingpank JF, Wetherington W, Hanlon AL, Ridge JA (2001) Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia. Arch Otolaryngol Head Neck Surg 127(3):304–308
Youssef T, Gaballah G, Abd-Elaal E, El-Dosoky E (2010) Assessment of risk factors of incidental parathyroidectomy during thyroid surgery: a prospective study. Int J Surg 8(3):207–211
Sippel RS, Ozgul O, Hartig GK, Mack EA, Chen H (2007) Risks and consequences of incidental parathyroidectomy during thyroid resection. ANZ J Surg 77(1–2):33–36
Abboud B, Sleilaty G, Braidy C, Zeineddine S, Ghorra C, Abadjian G, Tabchy B (2007) Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidecotmy during thyroid surgery. Arch Otolaryngol Head Neck Surg 133(11):1105–1110
Lin DT, Patel SG, Shaha AR, Singh B, Shah JP (2002) Incidence of inadvertent parathyroid removal during thyroidectomy. Laryngoscope 112(4):608–611
Lee NJ, Blakey JD, Bhuta S, Calcaterra TC (1999) Unintentional parathyroidectomy during thyroidectomy. Laryngoscope 109(8):1238–1240
Rix TE, Sinha P (2006) Inadvertent parathyroidectomy excision during thyroid surgery. Surgeon 4(6):339–342
Manouras A, Markogiannakis H, Lagoudiankis E, Antonakis P, Genetzakis M, Papadima A, Konstantoulaki E, Papanikolaou D, Kekis P (1998) Unintentional parathyroidectomy during total thyroidectomy. Head Neck 30(4):497–502
Stack BC Jr, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, Pallota J, Snyder SK, Wong RJ, Randolph GW (2015) American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: postoperative hypoparathyroidism- definitions and management. Endocr Pract 21(6):674–685
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David M. McGoldrick declares that he has no conflict of interest. Mudassar Majeed declares that he has no conflict of interest. Akbar Amin Achakzai declares he has no conflict of interest. H. Paul Redmond declares that he has no conflict of interest.
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McGoldrick, D.M., Majeed, M., Achakzai, A.A. et al. Inadvertent parathyroidectomy during thyroid surgery. Ir J Med Sci 186, 1019–1022 (2017). https://doi.org/10.1007/s11845-017-1560-9
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DOI: https://doi.org/10.1007/s11845-017-1560-9