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In situ preservation of the parathyroid glands during operations on the Thyroid
S Ander1, K Johansson, S Smeds
1Department of Surgery Norra Alvsborgs Länssjukhus. Trollháttan, Sweden.
Objective:
To study the microcirculation of the parathyroids before and after dissection during operations on the thyroid gland to see if there were better ways of preserving them.
Design:
Prospective open study.
Setting:
University hospital, Sweden.
Subjects:
16 Patients undergoing operations on the thyroid gland. 20 Parathyroid glands located anteriorly on the thyroid lobe were selected for study.
Interventions:
Recording of microcirculation of the parathyroids with laser Doppler flowmetry. Recording of the macroscopic appearance of the parathyroid glands.
Main Outcome Measures:
Correlation between reduction in blood flow and the macroscopic appearance of glands while they were ischaemic.
Results:
Parathyroid microcirculation before dissection gave a mean Doppler signal level of 4.6 (1.4) V. 30 minutes after dissection to preserve the gland the remaining mean (SD) signal was 37 (24)% of the initial level. At the end of the operation the microcirculation tended to recover about 46 (21)% of the original value (p = 0.33). The macroscopic appearance of the gland during the ischaemic period did not correlate well with the reduction in blood flow.
Conclusion:
During dissection to preserve normal parathyroid glands there was a discrepancy between the macroscopic appearance and changes in the microcirculation. The microcirculation recovers and this can be verified by laser Doppler flowmetry.