Hostname: page-component-6d856f89d9-5pczc Total loading time: 0 Render date: 2024-07-16T07:46:43.503Z Has data issue: false hasContentIssue false
  • English
  • Français

Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism

Published online by Cambridge University Press:  06 March 2023

A W Mayer Open the ORCID record for A W Mayer [Opens in a new window] ,
A Sharp ,
S Aziz  and
S P Balasubramanian
A W Mayer*
Affiliation:
Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
A Sharp
Affiliation:
Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
S Aziz
Affiliation:
Department of Pathology, Directorate of Laboratory Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
S P Balasubramanian
Affiliation:
Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
*
Corresponding author: Mr Alasdair W Mayer; Email: alasdair.mayer@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To evaluate the incidence of inadvertent parathyroidectomy, identify risk factors, determine the location of inadvertently excised glands, review pathology reporting in inadvertent parathyroidectomy, and explore relationships between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia.

Methods

A retrospective cohort study of 899 thyroidectomies between 2015 and 2020 was performed. Histopathology slides of patients who had an inadvertent parathyroidectomy and a random sample of patients without a reported inadvertent parathyroidectomy were reviewed.

Results

Inadvertent parathyroidectomy occurred in 18.5 per cent of thyroidectomy patients. Central neck dissection was an independent risk factor (inadvertent parathyroidectomy = 49.4 per cent with central neck dissection, 12.0 per cent without central neck dissection, p < 0.001). Most excised parathyroid glands were extracapsular (53.3 per cent), followed by subcapsular (29.1 per cent) and intrathyroidal (10.9 per cent). Parathyroid tissue was found in 10.2 per cent of specimens where no inadvertent parathyroidectomy was reported. Inadvertent parathyroidectomy was associated with a higher incidence of six-month post-surgical hypoparathyroidism or hypocalcaemia (19.8 per cent who had an inadvertent parathyroidectomy, 7.7 per cent without inadvertent parathyroidectomy).

Conclusion

Inadvertent parathyroidectomy increases the risk of post-surgical hypoparathyroidism or hypocalcaemia. The proportion of extracapsular glands contributing to inadvertent parathyroidectomy highlights the need for preventative measures.

Keywords

Thyroidectomyparathyroidectomyhypocalcemiahypoparathyroidismparathyroid hormone
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 11 , November 2023 , pp. 1226 - 1232
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr A Mayer takes responsibility for the integrity of the content of the paper

References

Nouraei, SAR, Virk, JS, Middleton, SE, Aylin, P, Mace, A, Vaz, F et al. A national analysis of trends, outcomes and volume–outcome relationships in thyroid surgery. Clin Otolaryngol 2017;42:354–65CrossRefGoogle ScholarPubMed
Bergamaschi, R, Becouarn, G, Ronceray, J, Arnaud, JP. Morbidity of thyroid surgery. Am J Surg 1998;176:71–5CrossRefGoogle ScholarPubMed
Edafe, O, Antakia, R, Laskar, N, Uttley, L, Balasubramanian, SP. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg 2014;101:307–20CrossRefGoogle ScholarPubMed
Underbjerg, L, Sikjaer, T, Mosekilde, L, Rejnmark, L. Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J Bone Miner Res 2013;28:2277–85CrossRefGoogle ScholarPubMed
Büttner, M, Musholt, TJ, Singer, S. Quality of life in patients with hypoparathyroidism receiving standard treatment: a systematic review. Endocrine 2017;58:14–20CrossRefGoogle ScholarPubMed
Chew, C, Li, R, Ng, MK, Chan, STF, Fleming, B. Incidental parathyroidectomy during total thyroidectomy is not a direct cause of post-operative hypocalcaemia. ANZ J Surg 2018;88:158–61CrossRefGoogle Scholar
Bai, B, Chen, Z, Chen, W. Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: a systematic review and meta-analysis. PLoS One 2018;13:e0207088CrossRefGoogle ScholarPubMed
Alraddadi, T, Aldhahri, S, Almayouf, M, Alharbi, J, Malas, M, Nasrullah, M et al. Risk factors of incidental parathyroidecomy in thyroid surgery. Cureus 2019;11:e6517Google ScholarPubMed
Vasileiadis, I, Charitoudis, G, Vasileiadis, D, Kykalos, S, Karatzas, T. Clinicopathological characteristics of incidental parathyroidectomy after total thyroidectomy: the effect on hypocalcemia. A retrospective cohort study. Int J Surg 2018;55:167–74CrossRefGoogle ScholarPubMed
Mencio, M, Calcatera, N, Ogola, G, Mahady, S, Shiller, M, Roe, E et al. Factors contributing to unintentional parathyroidectomy during thyroid surgery. Proc (Bayl Univ Med Cent) 2020;33:19–23Google ScholarPubMed
McGoldrick, DM, Majeed, M, Achakzai, AA, Redmond, HP. Inadvertent parathyroidectomy during thyroid surgery. Ir J Med Sci 2017;186:1019–22CrossRefGoogle ScholarPubMed
Christakis, I, Zacharopoulou, P, Galanopoulos, G, Kafetzis, ID, Dimas, S, Roukounakis, N. Inadvertent parathyroidectomy risk factors in 1,373 thyroidectomies--male gender and presence of lymphadenopathy, but not size of gland, independently increase the risk. Gland Surg 2017;6:666–74CrossRefGoogle Scholar
Ataş, H, Akkurt, G, Saylam, B, Tez, M. Central neck dissection is an independent risk factor for incidental parathyroidectomy. Acta Chir Belg 2021;121:36–41CrossRefGoogle ScholarPubMed
Hone, RWA, Tikka, T, Kaleva, AI, Hoey, A, Alexander, V, Balfour, A et al. Analysis of the incidence and factors predictive of inadvertent parathyroidectomy during thyroid surgery. J Laryngol Otol 2016;130:669–73CrossRefGoogle ScholarPubMed
Özden, S, Erdoğan, A, Simsek, B, Saylam, B, Yıldız, B, Tez, M. Clinical course of incidental parathyroidectomy: single center experience. Auris Nasus Larynx 2018;45:574–7CrossRefGoogle ScholarPubMed
Lin, YS, Hsueh, C, Wu, HY, Yu, MC, Chao, TC. Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia. Laryngoscope 2017;127:2194–200CrossRefGoogle ScholarPubMed
Zheng, J, Song, H, Cai, S, Wang, Y, Han, X, Wu, H et al. Evaluation of clinical significance and risk factors of incidental parathyroidectomy due to thyroidectomy: a single-center retrospective clinical study. Medicine (Baltimore) 2017;96:e8175CrossRefGoogle ScholarPubMed
Yazici, P, Bozkurt, E, Citgez, B, Kaya, C, Mihmanli, M, Uludag, M. Incidental parathyroidectomy as a cause of postoperative hypocalcemia after thyroid surgery: reality or illusion? Minerva Chir 2014;69:315–20Google ScholarPubMed
Applewhite, MK, White, MG, Xiong, M, Pasternak, JD, Abdulrasool, L, Ogawa, L et al. Incidence, risk factors, and clinical outcomes of incidental parathyroidectomy during thyroid surgery. Ann Surg Oncol 2016;23:4310–15CrossRefGoogle ScholarPubMed
Abboud, B, Sleilaty, G, Braidy, C, Zeineddine, S, Ghorra, C, Abadjian, G et al. Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidectomy during thyroid surgery. Arch Otolaryngol Head Neck Surg 2007;133:1105–10CrossRefGoogle ScholarPubMed
Karadeniz, E, Akcay, MN. Risk factors of incidental parathyroidectomy and its relationship with hypercalcemia after thyroidectomy: a retrospective study. Cureus 2019;11:e5920Google Scholar
Du, W, Fang, Q, Zhang, X, Cui, M, Zhao, M, Lou, W. Unintentional parathyroidectomy during total thyroidectomy surgery: a single surgeon's experience. Medicine (Baltimore) 2017;96:e6411CrossRefGoogle ScholarPubMed
Barrios, L, Shafqat, I, Alam, U, Ali, N, Patio, C, Filarski, CF et al. Incidental parathyroidectomy in thyroidectomy and central neck dissection. Surgery 2021;169:1145–51CrossRefGoogle ScholarPubMed
Alanzi, AR, Ghafouri, A, Khalifa, W, Hawsawi, H, Alzaidi, S. Incidence and risk factors of inadvertent parathyroidectomy during thyroid surgery: a single-center retrospective study. Saudi J Otorhinolaryngol Head Neck Surg 2020;22:78–81Google Scholar
Asya, O, Yumuşakhuylu, AC, Gündoğdu, Y, İncaz, S, Oysu, Ç. Thyroid surgery and inadvertent removal of parathyroids. Indian J Otolaryngol Head Neck Surg 2022;74(suppl 3):6022–6CrossRefGoogle ScholarPubMed
Chang, YK, Lang, BHH. To identify or not to identify parathyroid glands during total thyroidectomy. Gland Surg 2017;6:20–9CrossRefGoogle ScholarPubMed
Wang, CA. The anatomic basis of parathyroid surgery. Ann Surg 1976;183:271–5CrossRefGoogle ScholarPubMed
Phitayakorn, R, McHenry, CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2006;191:418–23CrossRefGoogle ScholarPubMed
Stephenson, TJ, Sarah, D, Johnson, J. Standards and Datasets for Reporting Cancers. Dataset for Thyroid Cancer Histopathology Reports, Unique document number G098. London: Royal College of Pathologists, 2014Google Scholar
Salem, FA, Bergenfelz, A, Nordenström, E, Almquist, M. Central lymph node dissection and permanent hypoparathyroidism after total thyroidectomy for papillary thyroid cancer: population-based study. Br J Surg 2021;108:684–90CrossRefGoogle ScholarPubMed
D'Orazi, V, Panunzi, A, di Lorenzo, E, Ortensi, AL, Cialini, M, Anichini, S et al. Use of loupes magnification and microsurgical technique in thyroid surgery: ten years experience in a single center. G Chir 2016;37:101–7Google ScholarPubMed
Pata, G, Casella, C, Mittempergher, F, Cirillo, L, Salerni, B. Loupe magnification reduces postoperative hypocalcemia after total thyroidectomy. Am Surg 2010;76:1345–50CrossRefGoogle ScholarPubMed
Kim, DH, Lee, S, Jung, J, Kim, S, Kim, SW, Hwang, SH. Near-infrared autofluorescence-based parathyroid glands identification in the thyroidectomy or parathyroidectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2022;407:491–9CrossRefGoogle ScholarPubMed
DiMarco, A, Chotalia, R, Bloxham, R, McIntyre, C, Tolley, N, Palazzo, FF. Does fluoroscopy prevent inadvertent parathyroidectomy in thyroid surgery? Ann R Coll Surg Engl 2019;101:508–13CrossRefGoogle ScholarPubMed
Benmiloud, F, Godiris-Petit, G, Gras, R, Gillot, JC, Turrin, N, Penaranda, G et al. Association of autofluorescence-based detection of the parathyroid glands during total thyroidectomy with postoperative hypocalcemia risk: results of the PARAFLUO multicenter randomized clinical trial. JAMA Surg 2020;155:106–12CrossRefGoogle ScholarPubMed
Wang, B, Zhu, CR, Liu, H, Yao, XM, Wu, J. The ability of near-infrared autofluorescence to protect parathyroid gland function during thyroid surgery: a meta-analysis. Front Endocrinol (Lausanne) 2021;12:714691CrossRefGoogle ScholarPubMed