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Bilateral Truncal Ligation of the Inferior Thyroid Artery during Bilateral Subtotal Thyroidectomy Causes a Decrease
Astrid Kebsch1, Utz Settmacher, Thomas Lesser
1Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich Schiller University of Jena, Gera, Germany.
Summary
Bilateral truncal ligation (BTL) of the inferior thyroid artery (ITA) during thyroid surgery reduces parathyroid hormone levels, particularly in older patients. However, it does not significantly increase the risk of clinically evident hypoparathyroidism.
Area of Science:
- Endocrinology
- Surgical Oncology
- Thyroid Surgery
Background:
- Bilateral truncal ligation (BTL) of the inferior thyroid artery (ITA) is a common surgical technique during subtotal thyroidectomy.
- Its primary aims are to minimize intra-operative blood loss and reduce post-operative bleeding.
- The impact of BTL on parathyroid function, considering patient age and thyroid remnant volume, requires further investigation.
Purpose of the Study:
- To evaluate the effect of BTL on parathyroid function after subtotal thyroidectomy.
- To assess the influence of patient age and residual thyroid volume on post-operative parathyroid hormone levels.
Main Methods:
- A randomized controlled trial involving 83 patients undergoing subtotal thyroidectomy.
- Patients were allocated to either non-BTL or BTL groups.
- Intact parathormone (PTHi) levels, hypocalcemia, and hypoparathyroidism were monitored pre- and post-operatively.
Main Results:
- The BTL group exhibited significantly lower PTHi levels on post-operative day 5 compared to the non-BTL group (29.4 vs. 34.7 ng/l).
- A pronounced decrease in PTHi was observed in patients aged 61-80 years and those with a residual thyroid volume of 0.5-1.9 ml.
- The incidence of asymptomatic hypoparathyroidism was similar between groups, with one case of clinically manifest hypoparathyroidism in the BTL group.
Conclusions:
- BTL of the ITA leads to a greater reduction in PTH levels but does not significantly increase the rate of clinically manifest hypoparathyroidism.
- Age over 61 years and a small thyroid remnant (<2 ml) are potential risk factors for post-operative hypoparathyroidism following BTL.
