scholarly journals Association between number of parathyroid glands identified during total thyroidectomy and functional parathyroid preservation

2021 ◽  
Author(s):  
Fiona Riordan ◽  
Matthew S. Murphy ◽  
Linda Feeley ◽  
Patrick Sheahan
Keyword(s):  
Vitamin D ◽  
Multivariate Analysis ◽  
Total Thyroidectomy ◽  
Parathyroid Glands ◽  
Graves Disease ◽  
Permanent Hypoparathyroidism ◽  
Academic Teaching ◽  
Postoperative Hypoparathyroidism ◽  
Academic Teaching Hospital ◽  
Systematic Identification

Abstract Purpose Systematic identification of all 4 parathyroid glands has been recommended during total thyroidectomy (TT); however, it is unclear whether this strategy necessarily translates into optimized functional parathyroid preservation. We wished to investigate the association between number of parathyroids identified intraoperatively during TT, and incidence of incidental parathyroidectomy, and postoperative hypoparathyroidism. Methods Retrospective review of prospectively maintained database of 511 consecutive patients undergoing TT at an academic teaching hospital. The association between number of parathyroid glands identified intraoperatively and incidence of biochemical hypocalcaemia (defined as any calcium < 2 mmol/L n first 48 h after surgery), symptomatic hypocalcaemia; permanent hypoparathyroidism (defined as any hypocalcaemia or need for calcium or vitamin D > 6 months after surgery), and incidental parathyroidectomy, was investigated. The association between number of parathyroid glands visualized and postoperative parathyroid hormone (PTH) levels was investigated in a subset of 454 patients. Results Patients in whom a greater number of parathyroids had been identified had a significantly higher incidence of biochemical and symptomatic hypocalcaemia, and significantly lower postoperative PTH levels, than patients with fewer glands identified. There were no significant differences in incidence of permanent hypoparathyroidism or incidental parathyroidectomy. On multivariate analysis, malignancy, Graves disease, and identification of 3–4 parathyroids were independent predictors of biochemical hypocalcaemia. For symptomatic hypocalcaemia, identification of 2–4 parathyroids, and identification of 3–4 parathyroids, were significant. Conclusions Systematic identification of as many parathyroid glands as possible during TT is not necessary for functional parathyroid preservation.

scholarly journals Measurement of serum intact parathyroid hormone (iPTH) at the end of total thyroidectomy: A reliable parameter for hypocalcemia?

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
A Lalos ◽  
K Linke ◽  
M von Flüe ◽  
B Kern
Keyword(s):  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Clinical Symptoms ◽  
Parathyroid Tissue ◽  
Postoperative Management ◽  
Parathyroid Glands ◽  
Intact Parathyroid Hormone ◽  
Postoperative Hypoparathyroidism ◽  
Symptomatic Hypocalcemia ◽  
The Mean

Abstract Objective Total thyroidectomy represents the gold standard surgical procedure for patients with malignant thyroid disease. Over the past decades, the total thyroidectomy gradually replaced the subtotal thyroidectomy for benign thyroid disorders as well. Postoperative hypocalcemia remains the most frequent complication. The close proximity of parathyroid glands to the thyroid capsule leads often to devascularization or adventitious removal of parathyroid tissue. Clinical symptoms like paresthesia, tingling, muscle cramps or seizures often occur. Combined measurement of intact parathyroid hormone (iPTH) and calcium after the operation are used worldwide to predict postoperative hypoparathyroidism. The purpose of this study was to find out the incidence of decreased iPTH at the end of surgery and its reliability in predicting hypocalcemia. Methods We performed a retrospective analysis of 534 patients who underwent total thyroidectomy at our institution between 2000 and 2019. Medical records were reviewed to analyze the patient characteristics, indication of the procedure, laboratory and histological results, postoperative management and complications. The iPTH was measured before and at the end of the surgery, while the calcium was measured at the first postoperative day. The iPTH assay at our hospital has a normal range between 15.0 and 80.0 pg/ml. Meanwhile hypocalcemia was defined as a calcium measurement &lt; 2.2 mmol/l. Results The mean age of the patients was 55.34 years. The female to male ratio was 4.6:1. The mean preoperative iPTH of our cohort was 48.35 pg/ml, while the postoperative iPTH was 31.74 pg/ml, indicating a mean reduction of 35.75%. A total of 174 patients (32.6%) had a iPTH &lt; 15.0 pg/ml at the end of the surgery, indicating a reduction of 75.6%. 22 of these 174 patients (12.6%) developed clinical symptoms of hypocalcemia. In contrast only 3 patients (0.08%) with normal iPTH developed symptoms. Whole parathyroid glands were identified in 95/534 (17.8%), whereas from the 174 patients with iPTH &lt; 15.0 pg/ml, 56 (32.2%) had at least one parathyroid gland in the operative specimens. Conclusion Measurement of iPTH at the end of total thyroidectomy is a good predictor to detect patient who are at risk for developing symptomatic hypocalcemia and calcium substitution can be started at the same day. A normal iPTH almost excludes symptomatic hypocalcemia.

scholarly journals Use of parathyroid hormone analog (Teriparatide) in patients with chronic hypoparathyroidism after total thyroidectomy: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 29-35
Author(s):  
Avinash Rai ◽  
P Karki ◽  
D Paudel ◽  
R Maskey
Keyword(s):  
Vitamin D ◽  
Thyroid Cancer ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Standard Treatment ◽  
Hormone Analog ◽  
Postoperative Hypoparathyroidism ◽  
Treatment Refractory ◽  
Chronic Hypoparathyroidism ◽  
Intravenous Calcium

Background: Hypoparathyroidism and hypocalcemia is a common postoperative complication, after total thyroidectomy due to thyroid cancer. Standard treatment with supplementation of calcium and vitamin D analogs, usually treat this condition. In some patients, hypoparathyroidism is refractory to standard treatment plus intermittent calcium infusions with persistent low serum calcium levels and associated clinical complications. Attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. To our knowledge, this is the first time that we encounter a patient suffering from treatment-refractory postsurgical hypoparathyroidism who was treated with teriparatide. Case presentation: Male (31 years) with postoperative hypoparathyroidism, after total thyroidectomy due to papillary thyroid cancer, several weeks after the surgery still required intermittent intravenous calcium infusions because of tetany symptoms. He had persistent hypocalcemia despite oral treatment with up to 1 ug calcitriol and 4 g calcium per day necessitating additional intravenous administration of calcium gluconate intermittently. This time, Teriparatide treatment was introduced at once daily 50 micrograms (mcg) subcutaneous injection, while doses of calcium and calcitriol were gradually decreased depending on the response of serum total and ionized calcium taken periodically, which resulted in total resolution of hypocalcemia symptoms and the achievement and maintenance of laboratory normocalcaemia in just 5 days. Conclusion: Treatment refractory chronic hypoparathyroidism may be seen in some cases after total thyroidectomy. Furthermore, the use of recombinant human parathyroid hormone analog (Teriparatide) allows for the control of recurrent hypocalcemia reducing the daily dosage of calcium and vitamin D. Finally, regular intravenous calcium administration was no more needed.

scholarly journals Effect of autotransplantation of a parathyroid gland on hypoparathyroidism after total thyroidectomy

2018 ◽  
Vol 7 (2) ◽  
pp. 286-294 ◽  
Author(s):  
Anping Su ◽  
Yanping Gong ◽  
Wenshuang Wu ◽  
Rixiang Gong ◽  
Zhihui Li ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Parathyroid Gland ◽  
Central Neck Dissection ◽  
Parathyroid Glands ◽  
Central Neck ◽  
Permanent Hypoparathyroidism ◽  
Papillary Thyroid ◽  
Transient Hypoparathyroidism

Background The effect of parathyroid autotransplantation on hypoparathyroidism is not fully understood. The purpose of the study was to determine the effect of autotransplantation of a parathyroid gland on the incidence of hypoparathyroidism and recovery of parathyroid function at 6 months after total thyroidectomy with central neck dissection for papillary thyroid carcinoma. Methods All patients with autotransplantation of a parathyroid gland (no inadvertent parathyroidectomy) (group A), in situ preservation of all parathyroid glands (no autotransplantation and inadvertent parathyroidectomy) (group B) or inadvertent removal of a parathyroid gland (no autotransplantation) (group C) who underwent first-time total thyroidectomy with central neck dissection for papillary thyroid carcinoma between January 2013 and June 2016 were included retrospectively. Results Of the 702 patients, 383, 297 and 22 were respectively included in the groups A, B and C. The overall rates of transient and permanent hypoparathyroidism were 37.6% and 1.0%. The incidence of transient hypoparathyroidism was 43.9, 29.0 and 45.5% (A vs B, P = 0.000; A vs C, P = 1.000), and the incidence of permanent hypoparathyroidism was 1.0, 0.7 and 4.5% (P > 0.05). The recovery rates of serum parathyroid hormone levels were 71.4, 72.2 and 66.0% at 6-month follow-up (P > 0.05). Conclusion Autotransplantation of a parathyroid gland does not affect the incidence of permanent hypoparathyroidism, but increases the risk of transient hypoparathyroidism when the rest of parathyroid glands are preserved in situ. At least 2 parathyroid glands should be preserved during total thyroidectomy with central neck dissection to prevent permanent hypoparathyroidism.

scholarly journals The Preservation and Autotransplantation of the Parathyroid Glands in Total Thyroidectomy in Patients With Thyroid Cancer—A Strategy for Avoiding Permanent Hypoparathyroidism

2017 ◽  
Vol 102 (1-2) ◽  
pp. 47-51
Author(s):  
Kosho Yamanouchi ◽  
Naomi Hayashida ◽  
Sayaka Kuba ◽  
Chika Sakimura ◽  
Mitsuhisa Takatsuki ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Clinical Course ◽  
Calcium Supplementation ◽  
Serum Levels ◽  
Parathyroid Glands ◽  
Permanent Hypoparathyroidism ◽  
Postoperative Course ◽  
Calcium Supplements ◽  
Vitamin D Analog

Hypoparathyroidism is a complication that occurs after total thyroidectomy (TT) in patients with thyroid cancer. We tried to determine a strategy for avoiding permanent hypoparathyroidism. A total of 42 patients underwent TT for thyroid cancer between April 2009 and March 2014. One or more parathyroid glands (PGs) could be macroscopically preserved in all of the patients. First, we evaluated the association between the number of PGs that were macroscopically preserved and the postoperative course in 28 patients without autotransplantation. The number of preserved PGs was not associated with postoperative tetany or the serum levels of calcium or phosphorous on postoperative day 1, or the proportion of patients who needed to take calcium supplements or a vitamin D analog. However, only the patients with a single preserved PG required calcium supplementation for longer than 1 year (33.3%, P &lt; 0.05). Next, we compared the clinical course with PG autotransplantation in 16 patients in whom a single PG was preserved. Although the result was not statistically significant, only the patients without autotransplantation required calcium supplementation for longer than 1 year. To avoid permanent hypoparathyroidism after TT, it should be essential to preserve at least 2 PGs or to preserve 1 PG and perform autotransplantation.

scholarly journals Time to parathyroid function recovery in patients with protracted hypoparathyroidism after total thyroidectomy

2018 ◽  
Vol 178 (1) ◽  
pp. 103-111 ◽  
Author(s):  
Inés Villarroya-Marquina ◽  
Juan Sancho ◽  
Leyre Lorente-Poch ◽  
Lander Gallego-Otaegui ◽  
Antonio Sitges-Serra
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Calcium Concentration ◽  
Common Adverse Effect ◽  
Parathyroid Glands ◽  
Permanent Hypoparathyroidism ◽  
Serum Calcium Concentration ◽  
Parathyroid Function

Objective Hypocalcaemia is the most common adverse effect after total thyroidectomy. It recovers in about two-thirds of the patients within the first postoperative month. Little is known, however, about recovery of the parathyroid function (RPF) after this time period. The aim of the present study was to investigate the time to RPF in patients with protracted (>1 month) hypoparathyroidism after total thyroidectomy. Design Cohort prospective observational study. Methods Adult patients undergoing total thyroidectomy for goitre or thyroid cancer. Cases with protracted hypoparathyroidism were studied for RPF during the following months. Time to RPF and variables associated with RPF or permanent hypoparathyroidism were recorded. Results Out of 854 patients undergoing total thyroidectomy, 142 developed protracted hypoparathyroidism. Of these, 36 (4.2% of the entire cohort) developed permanent hypoparathyroidism and 106 recovered: 73 before 6 months, 21 within 6–12 months and 12 after 1 year follow-up. Variables significantly associated with RPF were the number of parathyroid glands remaining in situ (not autografted nor inadvertently resected) and a serum calcium concentration >2.25 mmol/L at one postoperative month. Late RPF (>6 months) was associated with surgery for thyroid cancer. RPF was still possible after one year in patients with four parathyroid glands preserved in situ and serum calcium concentration at one month >2.25 mmol/L. Conclusions Permanent hypoparathyroidism should not be diagnosed in patients requiring replacement therapy for more than six months, especially if the four parathyroid glands were preserved.

Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: A prospective study

2013 ◽  
Vol 123 (9) ◽  
pp. 2324-2328 ◽  
Author(s):  
Patrick Sheahan ◽  
Rania Mehanna ◽  
Naveed Basheeth ◽  
Matthew S. Murphy
Keyword(s):  
Prospective Study ◽  
Total Thyroidectomy ◽  
Parathyroid Glands ◽  
A Prospective Study ◽  
Systematic Identification

scholarly journals Short-Term Outcomes of Surgery for Graves’ Disease in Germany

2020 ◽  
Vol 9 (12) ◽  
pp. 4014
Author(s):  
Elisabeth Maurer ◽  
Christian Vorländer ◽  
Andreas Zielke ◽  
Cornelia Dotzenrath ◽  
Moritz von Frankenberg ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Cox Regression ◽  
Statistical Significance ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Perioperative Outcomes ◽  
Graves Disease ◽  
Short Term ◽  
Endocrine Orbitopathy ◽  
Cox Regression Analysis ◽  
Postoperative Hypoparathyroidism

Background: Surgical treatment of Graves’ disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. Methods: Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student’s t-test or Fisher’s exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. Results: A total of 1808 patients with GD with a median age of 44 (range 14–85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. Conclusion: Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.

scholarly journals Vitamin D Insufficiency Predicts Susceptibility of Parathyroid Hormone Reduction after Total Thyroidectomy in Thyroid Cancer Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yan Zhang ◽  
Weihui Zheng ◽  
Yuanyuan Huang ◽  
Chao Chen
Keyword(s):  
Vitamin D ◽  
Thyroid Cancer ◽  
Parathyroid Hormone ◽  
Total Thyroidectomy ◽  
Independent Predictor ◽  
Laboratory Data ◽  
Vitamin D Insufficiency ◽  
Reduction Ratio ◽  
Postoperative Hypoparathyroidism ◽  
Significant Difference

Objective. Given its role in the regulation of calcium and PTH levels, vitamin D was presumed as a potential predictor of postoperative hypoparathyroidism. However, the reports about their association were controversial. This study aims to reveal the relationship between preoperative vitamin D and postoperative parathyroid hormone (PTH). Methods. A total of 242 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy (TT) during the period from June 2016 to December 2017 at our hospital were enrolled. Patients were divided into two groups, HypoP and Non-HypoP groups, based on postoperative PTH < 15.0 or ≥15.0 pg/mL, and ΔPTH50+ and ΔPTH50− groups, based on postoperative PTH reduction ratio ≥ 50% or <50%. Clinicopathological features and laboratory data were compared between two sets of groups. Results. Preoperative PTH level was lower in the HypoP group than in the Non-HypoP group (42.83 vs. 47.52 pg/mL, p = 0.018 ). No significant difference of vitamin D insufficiency was found between the HypoP and Non-HypoP groups (80.8% vs. 74.1%, p = 0.226 ). The rate of vitamin D insufficiency was higher in the ΔPTH50+ group than in the ΔPTH50− group (82.6% vs. 68.4%, p = 0.010 ). By multivariate logistic regression analysis, vitamin D insufficiency was an independent predictor of postoperative PTH reduction ratio ≥ 50% (OR = 2.2, p = 0.017 ). Conclusion. Vitamin D insufficiency is not associated with postoperative PTH in PTC patients undergoing TT. However, vitamin D insufficiency is an independent predictor of postoperative PTH reduction ratio.

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