Parathyroid preservation during thyroid surgery

Even though thyroid surgery is generally quite safe, permanent hypoparathyroidism is a very distressing complication. The incidence of hypoparathyroidism is directly proportional to the extent of thyroidectomy, and inversely proportional to the experience of the surgeon. It is also related to the extent of invasion of thyroid cancer and of the degree of dissection in the tracheo-esophageal groove. The incidence reported in the literature varies between 1% to 29%. Total thyroidectomy results in a higher incidence of hypoparathyroidism.

This report describes experiences with 600 thyroidectomies over a period of 11 years. The major indications for surgery included suspicion or proof of malignancy, compression symptoms, and substernal goiters. Twenty-six patients underwent surgery for Graves' disease. There were 221 men and 379 women, ranging in age from 16 to 89 years; 88% of the patients had benign disease, whereas 12% of the patients had malignant pathology. The surgical procedures included 62 total thyroidecotmies, 188 subtotal thyroidectomies, and lobectomy and isthmectomy in 350 patients.

Meticulous tracheo-esophageal groove dissection, identification of parathyroids and their preservation, including the blood supply, was routine in each case. Even in patients undergoing unilateral lobectomy, every effort was made to preserve the parathyroids. If any of the parathyroids or its blood supply was injured, it was autotransplanted in the sternomastoid muscle. Only two patients developed temporary hypoparathyroidism.

Parathyroid autotransplantation is performed whenever one or more of the parathyroids are damaged. Parathyroid preservation during thyroid surgery is crucial in the overall management of thyroid diseases.