Published in:
01-03-2016 | ORIGINAL ARTICLE
Visualizing fewer parathyroid glands may be associated with lower hypoparathyroidism following total thyroidectomy
Published in: Langenbeck's Archives of Surgery | Issue 2/2016
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Background
It remains uncertain whether the number of parathyroid glands (PGs) seen during extra-capsular dissection impacts short- and long-term hypoparathyroidism. Our study aimed to address this by analyzing patients who underwent total thyroidectomy for benign disease.
Methods
Consecutive patients undergoing total thyroidectomy were analyzed. The extra-capsular dissection technique was performed throughout the study period. The number of PGs identified, auto-transplanted and found on excised specimen was recorded prospectively. The number of PGs in situ was equaled to four minus the number of PGs auto-transplanted and PGs found on specimen. Temporary hypoparathyroidism was defined as serum adjusted calcium <2.00 mol/L 24 h after surgery and/or need for oral supplements while protracted hypoparathyroidism meant subnormal PTH (<1.2 pmol/L) at 4–6 weeks and/or need for >6-week oral supplements. Permanent hypoparathyroidism was defined as need for oral supplements for ≥1 year.
Results
Five-hundred and sixty-nine patients were eligible for analysis. After adjusting for other significant parameters, greater number of PGs identified was an independent risk factor for temporary (p < 0.001) and protracted hypoparathyroidism (p = 0.007). Mean recovery time from protracted hypoparathyroidism for identifying ≤three PGs was significantly shorter than identifying all four PGs (2.8 vs. 7.8 months, p < 0.001). Chance of having all four PGs in situ decreased with greater number of PGs identified (p < 0.001).
Conclusions
When the extra-capsular technique was adopted during total thyroidectomy, identifying fewer PGs in their orthotopic positions not only lowered risk of temporary and protracted hypoparathyroidism but also shortened recovery from protracted hypoparathyroidism.