Hypoparathyroidism in Total Thyroidectomy due to Benign Thyroid Diseases

Area of Science:

• Otolaryngology
• Endocrine Surgery
• Nerve Anatomy

Background:

• Total thyroidectomy is a common procedure for benign thyroid diseases.
• Recurrent laryngeal nerve (RLN) injury can lead to vocal cord dysfunction.
• Hypoparathyroidism is a significant complication of thyroidectomy, impacting calcium homeostasis.

Purpose of the Study:

• To compare the outcomes of two RLN dissection techniques during total thyroidectomy.
• To evaluate the impact of these techniques on the incidence of hypoparathyroidism.

Main Methods:

• Retrospective analysis of 437 patients undergoing total thyroidectomy for benign thyroid disease.
• Group 1: RLN identified only at laryngeal entry (limited dissection).
• Group 2: Full exposure of the RLN in the tracheoesophageal groove.

Main Results:

• Higher rates of transient (12.7% vs 5.8%) and permanent (3.8% vs 1.1%) hypoparathyroidism in Group 2 (full exposure).
• Statistically significant difference in hypoparathyroidism rates between groups (P < 0.001).
• No significant difference in recurrent nerve palsy between groups.

Conclusions:

• Minimally dissecting the RLN, focusing on its laryngeal entry, is associated with lower rates of hypoparathyroidism.
• This nerve-sparing approach appears more reliable for preventing endocrine complications.
• The findings support a technique that prioritizes minimal nerve manipulation.