Inadvertent parathyroidectomy during thyroid surgery: Incidence, risk factors, and clinical significance

Inadvertent parathyroidectomy is a well-recognized complication of thyroid surgery, which is associated with postoperative hypoparathyroidism and hypocalcemia. Reported incidence rates of inadvertent parathyroidectomy vary widely in the existing literature, and patient- and procedure-specific risk factors remain incompletely defined. This study analyzes the incidence and risk factors associated with inadvertent parathyroidectomy during thyroidectomy.

We conducted a retrospective cohort study of 830 patients who underwent thyroidectomy at a single high-volume endocrine surgery center from 2016 to 2022. The primary outcome was the occurrence of inadvertent parathyroidectomy, which was obtained from final surgical pathology reports. Multivariable analysis using logistic regression was performed to assess adjusted outcomes.

Among 830 patients, the overall incidence of inadvertent parathyroidectomy was 13.5%. After adjustment, thyroidectomy with central neck dissection (adjusted odds ratio, 4.35; 95% confidence interval, 2.29-8.24) was independently predictive of inadvertent parathyroidectomy, whereas age >65 years (adjusted odds ratio, 0.59; 95% confidence interval, 0.36-0.99), goiter (adjusted odds ratio 0.76; 95% confidence interval, 0.60-0.95), and total thyroidectomy (adjusted odds ratio, 0.41; 95% confidence interval, 0.28-0.59) were associated with lower odds of inadvertent parathyroidectomy. Gender, malignancy, specimen weight, operative time, and prior neck surgery were not associated with inadvertent parathyroidectomy.

Inadvertent parathyroidectomy is common following thyroidectomy and is associated with select patient- and procedure-related factors. Recognition of high-risk cases may support targeted intraoperative mitigation strategies to improve parathyroid identification and preservation, including autotransplantation when in situ preservation is not feasible. Future efforts should focus on investigation of emerging strategies, such as indocyanine green fluorescence imaging and near-infrared autofluorescence, to enhance intraoperative parathyroid identification and preservation.