[Parathyroid risk in thyroid surgery. Reality and prevention. 502 bilateral thyroidectomies]

Area of Science:

• Endocrinology
• Surgical Oncology

Context:

• Bilateral thyroidectomy is a common procedure with potential risks to parathyroid function.
• Understanding the incidence and persistence of hypocalcemia is crucial for patient management.

Purpose:

• To prospectively evaluate the risk of parathyroid dysfunction after bilateral thyroidectomy.
• To identify factors influencing post-operative hypocalcemia and long-term parathyroid risk.

Summary:

• A prospective study of 502 bilateral thyroidectomies showed 8.8% early post-operative hypocalcemia, persisting in 1.6% at one year.
• Late parathyroid risk was 3.3%, doubling with concurrent neck dissection. Mild hypoparathyroidism may be underdiagnosed.
• In Graves' disease, early hypocalcemia (6.9%) rarely persisted (0.4% definitive risk).

Impact:

• Painstaking dissection preserving parathyroid blood supply appears more effective than routine autotransplantation for preventing hypoparathyroidism.
• Early hyperphosphatemia may serve as a negative predictive factor for long-term outcomes.
• Findings provide valuable data for surgical decision-making and patient counseling regarding thyroidectomy outcomes.