Incidental Parathyroidectomy During Total Thyroidectomy: Do Anatomic Factors Increase the Risk?

One of the most common complications of thyroidectomy is incidental parathyroidectomy, which leads to disruption of calcium metabolism. The aim of this study was to examine the incidence of incidental parathyroidectomy and its effect on calcium metabolism and anatomical risk factors that have been less emphasized in the literature. This retrospective study included 333 patients who underwent total thyroidectomy. Incidental parathyroidectomy incidence, postoperative serum calcium, and parathormone values were recorded. Demographic characteristics and clinical and anatomical risk factors were investigated. Incidental parathyroidectomy was detected in 45 (13.5%) of 333 patients who underwent thyroidectomy. The incidence of hypocalcemia (30% vs. 16%) and hypoparathyroidism (41.4% vs. 18.5%) was higher in the incidental parathyroidectomy group (p = 0.032, p = 0.005). The presence of hyperthyroidism, microcalcification in thyroid nodules, malignancy status, lymph node involvement, and presence of thyroiditis did not make a significant difference in terms of incidental parathyroidectomy. In patients who underwent central lymph node dissection, the rate of incidental parathyroidectomy was higher but not statistically significant (p = 0.306). When the anatomical features of the thyroid gland were examined, short vertical length and the presence of small nodules caused an increase in the incidence of incidental parathyroidectomy (p = 0.036, p = 0.047). Incidental parathyroidectomy causes postoperative hypoparathyroidism and hypocalcemia, so in addition to the risk factors frequently mentioned in the literature, such as the presence of malignancy, central lymph node dissection, total thyroidectomy, and reoperation, during thyroidectomy, the surgeon should also be alert to anatomical risk factors such as the presence of small nodules and a small thyroid gland.