Skip to main content
Erschienen in: European Archives of Oto-Rhino-Laryngology 8/2020

30.03.2020 | Head and Neck

Outcomes of parathyroid gland identification and autotransplantation during total thyroidectomy

verfasst von: Shivprakash Mehta, Muthuswamy Dhiwakar, Krishnan Swaminathan

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 8/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy.

Methods

Consecutive total thyroidectomy cases performed by a single surgeon using extracapsular dissection technique were considered. PGs were not intentionally sought during dissection. PG location, number identified and autoT were prospectively recorded and correlated to postoperative outcomes.

Results

In all, 265 cases were included. The mean number of PGs identified per case was 2.7. The number of PGs identified had no correlation to postoperative hypocalcemia. However, independent risk factors for hypocalcemia were female sex, bilateral central compartment neck dissection (CND) and autoT > 1 PG; and for permanent hypoparathyroidism were female sex and bilateral CND. AutoT did not protect against permanent hypoparathyroidism.

Conclusion

The number of PGs identified during the course of a standard extracapsular dissection technique had no correlation to postoperative hypocalcemia. Whenever possible, avoiding bilateral CND and careful techniques to preserve PGs in an in situ and viable state, to obviate the necessity for autoT, are recommended.
Literatur
1.
Zurück zum Zitat Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcemia. Br J Surg 101(4):307–320PubMedCrossRef Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP (2014) Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcemia. Br J Surg 101(4):307–320PubMedCrossRef
2.
Zurück zum Zitat Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A (2015) Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg 102(4):359–367PubMedCrossRef Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A (2015) Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg 102(4):359–367PubMedCrossRef
3.
Zurück zum Zitat Seo ST, Chang JW, Jin J, Lim YC, Rha KS, Koo BS (2015) Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results. Surgery 158(6):1492–1499PubMedCrossRef Seo ST, Chang JW, Jin J, Lim YC, Rha KS, Koo BS (2015) Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results. Surgery 158(6):1492–1499PubMedCrossRef
4.
Zurück zum Zitat Antakia R, Edafe O, Uttley L, Balasubramanian SP (2015) Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid 25(1):95–106PubMedCrossRef Antakia R, Edafe O, Uttley L, Balasubramanian SP (2015) Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid 25(1):95–106PubMedCrossRef
5.
Zurück zum Zitat Sheahan P, Mehanna R, Basheeth N, Murphy MS (2013) Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: a prospective study. Laryngoscope 123(9):2324–2328PubMedCrossRef Sheahan P, Mehanna R, Basheeth N, Murphy MS (2013) Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: a prospective study. Laryngoscope 123(9):2324–2328PubMedCrossRef
6.
Zurück zum Zitat Raffaelli M, De Crea C, Sessa L et al (2012) Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery 152(6):957–964PubMedCrossRef Raffaelli M, De Crea C, Sessa L et al (2012) Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery 152(6):957–964PubMedCrossRef
7.
Zurück zum Zitat Sands NB, Payne RJ, Cote V, Hier MP, Black MJ, Tamilia M (2011) Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg 145(4):561–564PubMedCrossRef Sands NB, Payne RJ, Cote V, Hier MP, Black MJ, Tamilia M (2011) Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg 145(4):561–564PubMedCrossRef
8.
Zurück zum Zitat Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP (2014) Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg 140(11):1006–1013PubMedPubMedCentralCrossRef Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP (2014) Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. JAMA Otolaryngol Head Neck Surg 140(11):1006–1013PubMedPubMedCentralCrossRef
9.
Zurück zum Zitat Raffaelli M, De Crea C, Sessa L, Fadda G, Bellantone C, Lombardi CP (2015) Ipsilateral central neck dissection plus frozen section examination versus prophylactic bilateral central neck dissection in cN0 papillary thyroid carcinoma. Ann Surg Oncol 22(7):2302–2308PubMedCrossRef Raffaelli M, De Crea C, Sessa L, Fadda G, Bellantone C, Lombardi CP (2015) Ipsilateral central neck dissection plus frozen section examination versus prophylactic bilateral central neck dissection in cN0 papillary thyroid carcinoma. Ann Surg Oncol 22(7):2302–2308PubMedCrossRef
10.
Zurück zum Zitat Palazzo FF, Sywak MS, Sidhu SB, Barraclough BH, Delbridge LW (2005) Parathyroid autotransplantation during total thyroidectomy—does the number of glands transplanted affect outcome? World J Surg 29(5):629–631PubMedCrossRef Palazzo FF, Sywak MS, Sidhu SB, Barraclough BH, Delbridge LW (2005) Parathyroid autotransplantation during total thyroidectomy—does the number of glands transplanted affect outcome? World J Surg 29(5):629–631PubMedCrossRef
11.
Zurück zum Zitat Lo CY, Lam KY (2001) Routine parathyroid autotransplantation during thyroidectomy. Surgery 129(3):318–323PubMedCrossRef Lo CY, Lam KY (2001) Routine parathyroid autotransplantation during thyroidectomy. Surgery 129(3):318–323PubMedCrossRef
12.
Zurück zum Zitat Oertli D (2012) Technique of thyroidectomy. In: Oertli D, Udelsman R, Randolph G (eds) Surgery of the thyroid and parathyroid glands, 2nd edn. Elsevier, Amsterdam, pp 165–172CrossRef Oertli D (2012) Technique of thyroidectomy. In: Oertli D, Udelsman R, Randolph G (eds) Surgery of the thyroid and parathyroid glands, 2nd edn. Elsevier, Amsterdam, pp 165–172CrossRef
13.
Zurück zum Zitat Calandra D, Paloyan E, Oslapas R, Hofmann C, Ernst K, Shah KH, Lawrence AM (1983) Successful autotransplantation of parathytoid adenomas in seven patients. Am Surg 49(6):324–328PubMed Calandra D, Paloyan E, Oslapas R, Hofmann C, Ernst K, Shah KH, Lawrence AM (1983) Successful autotransplantation of parathytoid adenomas in seven patients. Am Surg 49(6):324–328PubMed
14.
Zurück zum Zitat Promberger R, Ott J, Kober F et al (2010) Intra- and postoperative parathyroid hormone—kinetics do not advocate for autotransplantation of discoloured parathyroid glands during thyroidectomy. Thyroid 20(12):1371–1375PubMedCrossRef Promberger R, Ott J, Kober F et al (2010) Intra- and postoperative parathyroid hormone—kinetics do not advocate for autotransplantation of discoloured parathyroid glands during thyroidectomy. Thyroid 20(12):1371–1375PubMedCrossRef
15.
Zurück zum Zitat Sadowski SM, Vidal Fortuny J, Triponez F (2017) A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence technique. Gland Surg 6(Suppl 1):S30–S37PubMedPubMedCentralCrossRef Sadowski SM, Vidal Fortuny J, Triponez F (2017) A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence technique. Gland Surg 6(Suppl 1):S30–S37PubMedPubMedCentralCrossRef
16.
Zurück zum Zitat Benmiloud F, Rebaudet S, Varoguaux A, Penaranda G, Bannier M, Denizot A (2018) Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery 163(1):23–30PubMedCrossRef Benmiloud F, Rebaudet S, Varoguaux A, Penaranda G, Bannier M, Denizot A (2018) Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study. Surgery 163(1):23–30PubMedCrossRef
17.
Zurück zum Zitat Prazenica P, O’Keeffe L, Holy R (2015) Dissection and identification of parathyroid glands during thyroidectomy: association with hypocalcemia. Head Neck 37(3):393–399PubMedCrossRef Prazenica P, O’Keeffe L, Holy R (2015) Dissection and identification of parathyroid glands during thyroidectomy: association with hypocalcemia. Head Neck 37(3):393–399PubMedCrossRef
18.
Zurück zum Zitat Dedivitis RA, Aires FT, Cernea CR (2017) Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg 25(2):142–146PubMedCrossRef Dedivitis RA, Aires FT, Cernea CR (2017) Hypoparathyroidism after thyroidectomy: prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg 25(2):142–146PubMedCrossRef
Metadaten
Titel
Outcomes of parathyroid gland identification and autotransplantation during total thyroidectomy
verfasst von
Shivprakash Mehta
Muthuswamy Dhiwakar
Krishnan Swaminathan
Publikationsdatum
30.03.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
European Archives of Oto-Rhino-Laryngology / Ausgabe 8/2020
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-020-05941-9

Weitere Artikel der Ausgabe 8/2020

European Archives of Oto-Rhino-Laryngology 8/2020 Zur Ausgabe

Update HNO

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.