Preservation of the parathyroid glands in total thyroidectomy

A series of 183 patients who underwent total thyroidectomy is presented. The operative method, which emphasizes visualization and preservation of the parathyroid glands and their blood supply, as well as exposure of the recurrent laryngeal nerves, is discussed in detail. Permanent hypoparathyroidism was a complication in six patients (3.3 per cent). Permanent nerve injury occurred in one patient (0.55 per cent). Postoperatively, 78 patients had radioactive iodine uptake studies to evaluate the amount of residual thyroid tissue in the neck. Sixty-four (82 per cent) had 24 hour uptake studies of less than 2 per cent and 52 had an uptake of less than 1 per cent. Although a careful and consistent technique of total thyroidectomy substantially reduces the danger of permanent hypocalcemia, we experienced this complication sporadically. Since no operative technique completely removes the danger of permanent hypoparathyroidism, it is our opinion that total thyroidectomy should not be the standard management for carcinoma of the thyroid gland. It is best reserved for those patients in whom the extent of disease or the aggressiveness of the histologic cell type warrants the increased risk.