Prophylaxis of postoperative hypoparathyroidism in thyroid surgery

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Technology

Background:

• Thyroid gland diseases frequently necessitate surgical intervention.
• Optimizing surgical techniques and treatment strategies is crucial for patient safety and outcomes.

Purpose of the Study:

• To introduce and evaluate a novel algorithm for preventing parathyroid gland damage during thyroid surgery.
• To minimize the incidence of hypoparathyroidism and associated complications.

Main Methods:

• The study analyzed data from 226 patients undergoing extrafascial thyroid surgery.
• Key methods included a "stress-test", 5-aminolevulinic acid (5-ALA) administration, and dual visual-instrumental fluorescence registration of parathyroid glands.
• Advanced techniques like helium-neon laser fluorescence analysis were employed when initial visualization was insufficient.

Main Results:

• Transient hypoparathyroidism occurred in only 1.8% of patients, with no permanent hypocalcemia recorded.
• Parathyroid gland autotransplantation was needed in a minimal 0.44% of cases.
• Vitamin D deficiency was identified in 35% of patients, primarily linked to secondary hyperparathyroidism, and successfully corrected.

Conclusions:

• The developed methodological approach effectively prevents persistent hypoparathyroidism after thyroid surgery.
• This strategy significantly reduces the frequency of transient hypoparathyroidism and other surgical complications.
• The algorithm enhances the safety and efficacy of surgical treatment for diverse thyroid gland pathologies.