American Association of Endocrine SurgeonsPostoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: A comparative study☆
Section snippets
Material and methods
From January 1995 to October 1997, 424 patients underwent thyroidectomy for treatment of various thyroid diseases by a single surgeon or surgical residents operating with supervision. Preservation by meticulous dissection of each parathyroid gland and its blood supply was attempted with the aim of leaving all parathyroid glands in situ and functioning. The preserved parathyroid glands were examined at the end of operation for potential devascularization. In case of difficulty in dissection of
Results
There were 48 male patients and 223 female patients whose ages ranged from 12 to 88 years (median 44 years). Operative procedures included total thyroidectomy (n = 86), near-total thyroidectomy (n = 41), completion total thyroidectomy (n = 36), bilateral subtotal thyroidectomy (n = 77), and ipsilateral total thyroidectomy with contralateral subtotal thyroidectomy (n = 31). Thyroid reoperations were performed in 44 patients (16%). The operations included completion total thyroidectomy by a
Discussion
Our results show that a surgical strategy combining preservation of parathyroid glands in situ with selective autotransplantation of devascularized or inadvertently removed parathyroid glands during thyroidectomy can achieve a low incidence of permanent hypoparathyroidism comparable with those in other reported series.1, 8, 9, 10 Although investigators who emphasized preservation of parathyroid glands through meticulous dissection reported a permanent hypoparathyroidism rate of less than 2%,4, 5
Acknowledgements
We thank Professor Jon A. van Heerden of Mayo Clinic, Rochester, Minn, for his invaluable advice on the manuscript.
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Reprint requests: Chung-yau Lo, FRCS(Edin), Division of Endocrine Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.