Incidental parathyroidectomy during total thyroidectomy and functional parathyroid preservation: a retrospective cohort study

BMC Surgery

Research

Charlotte Melot¹  Nathalie Chereau²  Fabrice Menegaux²  Gabrielle Deniziaut³ 

[1] Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de L’Hôpital, 75013, Paris, France;Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de L’Hôpital, 75013, Paris, France;Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France;Department of Pathology, Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France;Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France;

关键词: Total thyroidectomy;    Parathyroid gland;    Incidental parathyroidectomy;    Parathyroid hormone;    Hypocalcemia;    Hypoparathyroidism;   

DOI  :  10.1186/s12893-023-02176-3

 received in 2023-05-29, accepted in 2023-08-30,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative transient hypocalcemia and permanent hypoparathyroidism are still debated. The aims of this study were to assess the clinical relevance of avoidable IP for transient hypocalcemia and permanent hypoparathyroidism, and to describe the risk factors for IP.MethodsThis retrospective cohort study included 1,537 patients who had a one-step total thyroidectomy in a high-volume endocrine surgery center between 2018 and 2019. Pathology reports were reviewed for incidentally removed parathyroid glands. Intrathyroidal parathyroid glands were excluded from the study. Demographic characteristics, potential risk factors, and postoperative calcium and PTH levels were compared between IP and control groups.ResultsAvoidable IP occurred in 234 (15.2%) patients. Patients with IP had a higher risk of transient hypocalcemia (17.9% vs. 11.5%, p = 0.006; odds ratio [OR] 1.68, 95% confidence interval [95% CI]1.16–2.45) and permanent hypoparathyroidism (4.7% vs. 1.6%, p = 0.002; OR 3.01, 95% CI 1.29–6.63) than patients without IP. Multivariate analysis showed that central lymph node dissection (CLND) and incidental removal of thymus tissue were independent risk factors for IP (OR 4.83, 95% CI 2.71–8.86, p < 0.001 and OR 1.72, 95% CI 1.02–2.82, p = 0.038).ConclusionsPatients with IP were more likely to develop transient hypocalcemia and permanent hypoparathyroidism, indicating the clinical significance of avoidable IP for patients and the need for raising awareness among surgeons. Patients undergoing CLND are at a higher risk for IP, and should be adequately informed and treated. Any removal of thymus tissue should be avoided during CLND.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 3