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Unintentional parathyroidectomy during total thyroidectomy surgery: A single surgeon's experience.
1Department of Head Neck, First Affiliated Hospital of Zhengzhou University Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China.
Medicine
|March 16, 2017
Summary
Incidental parathyroidectomy during total thyroidectomy is uncommon (10.3%), with lateral neck dissection being a key risk factor. Surgeons should prioritize parathyroid gland preservation near the thymus during central lymph node dissection.
Area of Science:
- Endocrine Surgery
- Surgical Pathology
- Oncology
Background:
- Total thyroidectomy is a common procedure for thyroid pathologies.
- Central lymph node dissection (CLND) is frequently performed concurrently with total thyroidectomy.
- Incidental parathyroidectomy (IP) is a potential complication during these surgeries, impacting parathyroid hormone levels.
Purpose of the Study:
- To investigate the incidence and risk factors of incidental parathyroidectomy during total thyroidectomy with CLND.
- To analyze the location of resected parathyroid tissue and its association with surgical procedures.
- To evaluate the impact of IP on postoperative parathyroid hormone levels and symptomatic hypocalcemia.
Main Methods:
- Retrospective analysis of 341 patients undergoing total thyroidectomy and CLND between January 2013 and June 2015.
- Recording of patient demographics, surgical details, and pathology reports.
- Monitoring of parathyroid hormone levels preoperatively and at 1 day, 1 week, and 3 months postoperatively.
Main Results:
- Incidental parathyroidectomy occurred in 10.3% of cases, with one or two glands resected.
- Resected parathyroid tissue was found intrathyroidal (42.1%), in central adipose tissue, or near the thymus.
- Lateral neck dissection significantly increased the risk of IP (P < 0.001), while other factors showed no significant association.
Conclusions:
- The risk of incidental parathyroidectomy during total thyroidectomy with CLND is relatively low.
- Parathyroid tissue is frequently located outside the thyroid gland, emphasizing the need for careful dissection near the thymus.
- Lateral cervical lymph node dissection is a significant risk factor for IP and can affect parathyroid hormone expression.
