Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation.
Hypocalcemia
Hypoparathyroidism
Parathyroid
Parathyroid identification
Thyroidectomy
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
28
03
2021
accepted:
22
07
2021
pubmed:
19
8
2021
medline:
19
2
2022
entrez:
18
8
2021
Statut:
ppublish
Résumé
Systematic identification of all 4 parathyroid glands has been recommended during total thyroidectomy (TT); however, it is unclear whether this strategy necessarily translates into optimized functional parathyroid preservation. We wished to investigate the association between number of parathyroids identified intraoperatively during TT, and incidence of incidental parathyroidectomy, and postoperative hypoparathyroidism. Retrospective review of prospectively maintained database of 511 consecutive patients undergoing TT at an academic teaching hospital. The association between number of parathyroid glands identified intraoperatively and incidence of biochemical hypocalcaemia (defined as any calcium < 2 mmol/L n first 48 h after surgery), symptomatic hypocalcaemia; permanent hypoparathyroidism (defined as any hypocalcaemia or need for calcium or vitamin D > 6 months after surgery), and incidental parathyroidectomy, was investigated. The association between number of parathyroid glands visualized and postoperative parathyroid hormone (PTH) levels was investigated in a subset of 454 patients. Patients in whom a greater number of parathyroids had been identified had a significantly higher incidence of biochemical and symptomatic hypocalcaemia, and significantly lower postoperative PTH levels, than patients with fewer glands identified. There were no significant differences in incidence of permanent hypoparathyroidism or incidental parathyroidectomy. On multivariate analysis, malignancy, Graves disease, and identification of 3-4 parathyroids were independent predictors of biochemical hypocalcaemia. For symptomatic hypocalcaemia, identification of 2-4 parathyroids, and identification of 3-4 parathyroids, were significant. Systematic identification of as many parathyroid glands as possible during TT is not necessary for functional parathyroid preservation.
Identifiants
pubmed: 34406491
doi: 10.1007/s00423-021-02287-6
pii: 10.1007/s00423-021-02287-6
pmc: PMC8847165
doi:
Substances chimiques
Parathyroid Hormone
0
Calcium
SY7Q814VUP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
297-303Informations de copyright
© 2021. The Author(s).
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