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Visualizing fewer parathyroid glands may be associated with lower hypoparathyroidism following total thyroidectomy

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Abstract

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.

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Acknowledgments

The authors would like to take this opportunity of thanking Dr. Tony Shek and his team of pathologists for carefully examining all the excised thyroid specimens during this study period.

Authors’ contributions

All authors were involved in the review of literature, acquisition of data, and drafting and completing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Brian Hung-Hin Lang.

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Lang, B.HH., Chan, D.T.Y. & Chow, F.CL. Visualizing fewer parathyroid glands may be associated with lower hypoparathyroidism following total thyroidectomy. Langenbecks Arch Surg 401, 231–238 (2016). https://doi.org/10.1007/s00423-016-1386-3

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  • DOI: https://doi.org/10.1007/s00423-016-1386-3

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