Morbidity Associated with Concomitant Thyroid Surgery in Patients with Primary Hyperparathyroidism

Area of Science:

• Endocrine Surgery
• Surgical Oncology
• Neurosurgery

Background:

• Recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism are significant complications of thyroid and parathyroid surgery.
• The management of incidentally detected thyroid nodules during parathyroid surgery remains debated.

Purpose of the Study:

• To analyze the risks of RLN palsy and hypoparathyroidism associated with concomitant thyroid surgery during primary hyperparathyroidism operations.
• To evaluate the incidence of incidentally detected thyroid carcinoma.

Main Methods:

• Retrospective analysis of 1,065 patients undergoing primary hyperparathyroidism surgery.
• Prospective documentation of surgical strategy, histology, and follow-up.
• Analysis focused on RLN palsy, hypoparathyroidism, and thyroid carcinoma occurrence and outcomes.

Main Results:

• RLN palsy occurred in 3.6% of patients (0.1% permanent). Hypoparathyroidism requiring calcium substitution occurred in 17.9% (0.3% permanent).
• Procedures other than open minimally invasive exploration significantly increased risks of temporary RLN paresis (OR 6.136) and hypoparathyroidism (OR 3.306).
• Concomitant thyroid surgery (47.1% of patients) increased risks for RLN paresis and hypoparathyroidism, especially with bilateral neck exploration and thyroidectomy.
• Thyroid malignancy was incidentally detected in 8.1% of patients.

Conclusions:

• Concomitant thyroid procedures elevate the risk of temporary RLN palsy and hypoparathyroidism.
• The high incidence of incidental thyroid carcinoma suggests hemithyroidectomy for incidentally identified thyroid nodules preoperatively.