Elsevier

Surgery

Volume 124, Issue 6, December 1998, Pages 1081-1087
Surgery

American Association of Endocrine Surgeons
Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: A comparative study

Presented at the 19th Annual Meeting of the American Association of Endocrine Surgeons, Orlando, Fla, Apr 26-28, 1998.
https://doi.org/10.1067/msy.1998.92560Get rights and content

Abstract

Background: Permanent hypoparathyroidism is a recognized complication of thyroidectomy. Apart from preservation of parathyroid glands in situ by meticulous dissection, parathyroid autotransplantation (PTHAT) has been performed increasingly to avoid permanent hypoparathyroidism. Methods: From January 1995 to October 1997, PTHAT was performed routinely for devascularized or inadvertently removed glands in 98 (36%) of 271 patients undergoing thyroidectomy. Potential risk factors and the impact of PTHAT on postoperative hypocalcemia were studied. Results: Postoperative hypocalcemia occurred in 40 patients (14.8%), whereas 5 patients (1.8%) had permanent hypocalcemia during a median follow-up of 9 months. The incidence of transient hypocalcemia (n = 35) was higher in patients who underwent PTHAT (21.4%) than in patients who did not undergo PTHAT (8.1%) (P < .01). Permanent hypocalcemia occurred only in patients who did not undergo PTHAT. None of the 21 patients who had postoperative hypocalcemia after PTHAT had permanent hypoparathyroidism compared with 26% (5/19) of patients who did not undergo PTHAT (P = .018). When the resected thyroid gland was examined for parathyroid tissue, the incidence of positive identification was higher in patients who did not undergo PTHAT (13%) than in patients who did undergo PTHAT (4%) (P = .015). Conclusions: Patients with postoperative hypocalcemia after PTHAT have virtually no risk of having permanent hypoparathyroidism. A more careful examination of the resected thyroid tissue can help to identify inadvertently removed parathyroid glands for autotransplantation. (Surgery 1998;124:1081-7.)

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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